植入式心脏转换器-除器在老年人中的作用
Giacomo Mugnai1, Davide Genovese2, Luca Tomasi1
1Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy.
Progress in cardiovascular diseases
|December 12, 2025
概括
植入式心脏转换器-除器 (ICD) 在老年患者中存在挑战,原因是竞争的风险和并发症. 需要个性化的方法,考虑脆弱性和共享决策,以获得最佳的护理.
科学领域:
- 心脏病学 心脏病学
- 老年病的医生 老年病的医生
- 医学伦理 医学伦理
背景情况:
- 植入式心脏转换器-除器 (ICD) 对于预防心脏突发死亡 (SCD) 至关重要.
- 人口老龄化对老年患者的ICD治疗提出了挑战,特别是75岁以上的脆弱和并发症患者.
- 主要的临床试验往往不包括或不充分代表这一群体.
研究的目的:
- 批判性地检查ICD在老年患者中用于SCD的初级和二级预防的证据.
- 突出竞争风险 (非失常性死亡) 和程序性并发症对老年人风险效益比的影响.
- 倡导转向个性化护理,包括老年人评估和共享决策.
主要方法:
- 审查现有的临床试验数据和有关老年人群ICD疗效的证据.
- 对老年人非失律性死亡的竞争风险的分析.
- 检查程序并发症和长期结果,包括发电机更换和终生管理.
- 讨论伦理考虑和就ICD停用在息治疗中的共识.
主要成果:
- 由于非失常性死亡的竞争风险,ICD在老年人中的有效性减弱.
- 老年患者面临更高的程序和长期并发症的风险从ICDs.
- 替换发电机的决定需要重新评估护理目标,而不是例行程序.
- 在非常老年人中,在交换后观察到高死亡率和低适当治疗率.
- 设备停用在生命终端护理中得到了伦理的支持,以防止徒劳的冲击.
结论:
- 在老年人中植入ICD需要仔细考虑除了射出分数和时间表年龄之外.
- 一个整体的,个性化的方法,整合老年评估,并发症负担和共享决策至关重要.
- 管理策略必须适应老年患者的独特需求和风险,包括终身护理计划.
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