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Efficacy of the implantable cardioverter-defibrillator in the elderly
P T Panotopoulos1, K Axtell, A J Anderson
1Electrophysiology Laboratory, Milwaukee Heart Institute of Sinai Samaritan Medical Center, Wisconsin, USA.
Insights
Elderly patients (75+) receiving an implantable cardioverter-defibrillator (ICD) have a threefold increased mortality risk, mainly from nonsudden cardiac death. Advanced age significantly impacts ICD outcomes, necessitating tailored treatment considerations.
Area of Science:
- Cardiology
- Geriatric Medicine
- Medical Devices
Background:
- Implantable cardioverter-defibrillators (ICDs) reduce sudden cardiac death but survival benefits are limited by nonsudden cardiac death.
- The impact of advanced age on ICD patient outcomes remains understudied despite age being a key factor in cardiovascular mortality.
Purpose of the Study:
- To evaluate the effect of advanced age on the outcomes of patients who received an implantable cardioverter-defibrillator (ICD).
Main Methods:
- Multivariate analysis of 769 patients with an ICD.
- Comparison of 74 patients aged 75 years or older (Group 1) with 695 younger patients (Group 2).
Main Results:
- Four-year survival was 57% in elderly patients versus 78% in younger patients (p=0.0001).
- Higher nonsudden cardiac death rates were observed in the elderly group.
- Age 75+, NYHA class III, LVEF <30%, and appropriate shocks independently predicted mortality.
Conclusions:
- Patients 75+ at ICD implantation face a threefold higher mortality risk, even with similar functional class and ejection fraction.
- Results from younger ICD patients may overestimate benefits in the elderly, highlighting the need for age-specific considerations.
Objectives:
We sought to assess the effect of advanced age on the outcome of patients with an implantable cardioverter-defibrillator (ICD).
Background:
ICDs are effective in preventing sudden cardiac death in susceptible patients, but their beneficial effect on survival is attenuated by the high rate of nonsudden cardiac death in those treated. Although advanced age is an important variable in determining cardiovascular mortality, its impact on the outcome of patients with an ICD has been inadequately studied.
Methods:
We performed multivariate analysis of a data base consisting of 769 consecutive patients with an ICD. Seventy-four patients > or = 75 years old at ICD implantation (Group 1) were compared with the remaining 695 patients (Group 2).
Results:
The two groups were similar in clinical presentation, left ventricular function and gender distribution. The mean follow-up time was 29 and 42 months, respectively, for patients in Group 1 and Group 2. Actuarial survival at 4 years was 57% in Group 1 versus 78% in Group 2 (p = 0.0001). This difference was primarily due to a higher rate of nonsudden cardiac death in Group 1. On multivariate analysis, age > or = 75 years, New York Heart Association functional class III, left ventricular ejection fraction < 30% and appropriate shocks during follow-up were independently associated with increased mortality (odds ratio 3.56, 1.8, 1.6 and 1.39, respectively).
Conclusions:
Among patients with similar functional class and ejection fraction, the mortality risk is increased threefold in those > or = 75 years old at the time of ICD implantation. Extrapolation of results from younger patients is likely to overestimate ICD benefit in the elderly.