Implantable cardioverter-defibrillator prescription in the elderly
Received 9 March 2009; accepted 8 April 2009. published online 13 April 2009.
Background
Because sudden cardiac death increases with age, implantable cardioverter-defibrillators (ICDs) might greatly benefit the elderly. However, elderly patients are underrepresented in clinical trials, and comorbid conditions may attenuate benefit.
Objective
The purpose of this study was to examine ICD prescription in the elderly.
Methods
The ages, indications, and implanted ICD type of patients enrolled in the Advancements in ICD Therapy (ACT) Registry were compared to those from the National Cardiovascular Data Registry (NCDR).
Results
The ACT Registry included 4,566 patients who underwent first ICD or cardiac resynchronization therapy ICD (CRT-D) implantation. Among these patients, 2.6% were 18–39 years old, 8.6% were 40–49 years, 20.1% were 50–59 years, 27.6% were 60–69 years, 29.0% were 70–79 years, and 12.0% were ≥80 years. In the six age groups, 82.5%, 79.4%, 77.3%, 80.1%, 77.7%, and 74.6% received devices for primary prevention, and single-chamber ICDs were implanted in 41.4%, 42.8%, 38.7%, 33.8%, 25.2%, and 28.1%, respectively (P <.0001). Two-year mortality rates increased incrementally from 5.80% to 17.80% in the six groups (P <.05). Noncardiac death was more common in older than in younger patients. Among patients ≥80 years old receiving a CRT-D, 78% had QRS duration and New York Heart Association class that met accepted implantation criteria. Age distribution, indication, and type of device were similar in the ACT Registry and in 74,476 patients in the NCDR.
Conclusion
More than 40% of new ICDs and CRT-Ds are implanted in patients >70 years old and more than 10% in patients ≥80 years old. A significant proportion of those receiving a CRT-D did not fulfill accepted criteria for implantation. Noncardiac death occurred more frequently in older patients, but cardiac death rates were similar.
Address reprint requests and correspondence: Dr. Andrew E. Epstein, Division of Cardiovascular Disease, University of Alabama at Birmingham, THT 321, 1530 3rd Avenue South, Birmingham, Alabama 35294
This study was sponsored by St. Jude Medical, Sylmar, California. Drs. Epstein, Doppalapudi, Kay, Plumb, and Yamada have research grants from Biotronik, Boston Scientific, Medtronic, and St. Jude Medical. The University of Alabama Cardiac Electrophysiology fellowship program is supported by grants from Boston Scientific, Medtronic, and St. Jude Medical. Drs. Epstein and Kay have received honoraria from Biotronik, Boston Scientific, Medtronic, and St. Jude Medical. Dr. McElderry has received honoraria from Boston Scientific, Medtronic, and St. Jude Medical. Drs. Jeff Shafiroff and Sergio Shkurovich and Mr. Syed are employees of St. Jude Medical.
ABSTRACT