Defibrillator exchange in the elderly.

Area of Science:

• Cardiology
• Geriatric Medicine
• Medical Devices

Background:

• Implantable cardioverter-defibrillator (ICD) therapy in elderly patients presents a clinical dilemma due to potential attenuation of survival benefits by nonarrhythmic mortality.
• The efficacy and safety of ICDs in very elderly populations require further investigation.

Purpose of the Study:

• To evaluate the outcomes of septuagenarians and octogenarians following elective implantable cardioverter-defibrillator (ICD) generator exchange (GE).
• To compare the incidence of ICD shocks and survival rates between these two elderly cohorts.

Main Methods:

• Analysis of 506 patients undergoing elective ICD generator exchange, divided into septuagenarians (70-79 years) and octogenarians (≥80 years).
• Primary endpoint: all-cause mortality. Secondary endpoints: survival post-appropriate ICD shock and death without prior ICD shocks.
• Statistical analysis to determine associations between ICD therapy, mortality, and other clinical factors.

Main Results:

• Octogenarians exhibited significantly higher all-cause mortality (79%) compared to septuagenarians (42.5%) after ICD generator exchange (P < .01).
• Death without appropriate ICD shocks ('prior death') was more common than appropriate shocks in both groups.
• Advanced heart failure, peripheral arterial disease, and renal failure were identified as significant predictors of mortality in both septuagenarians and octogenarians.

Conclusions:

• Implantable cardioverter-defibrillator (ICD) generator exchange in octogenarians is associated with substantially higher mortality compared to septuagenarians.
• Nonarrhythmic causes of death are prevalent, underscoring the need for careful consideration of ICD therapy in the very elderly.
• Individualized patient assessment is paramount when making decisions regarding ICD generator exchange in elderly populations.