Primary prevention ICD recipients aged ≥80 years had similar rates of receiving ≥1 appropriate therapy compared to matched younger controls (19.4% vs. 21.6%; P=0.65).
Observational (n=300)
Yes
Does primary prevention ICD implantation have similar rates of appropriate therapy and complications in patients ≥80 years compared to younger controls?
Primary prevention ICDs in patients ≥80 years show similar rates of appropriate therapies and device-related complications compared to younger patients, though careful multidisciplinary evaluation is needed due to competing mortality risks.
Absolute Event Rate: 19.4% vs 21.6%
p-value: p=0.65
AIMS: Current guidelines do not propose any age cut-off for the primary prevention implantable cardioverter-defibrillator (ICD). However, the risk/benefit balance in the very elderly population has not been well studied. METHODS AND RESULTS: In a multicentre French study assessing patients implanted with an ICD for primary prevention, outcomes among patients aged ≥80 years were compared with <80 years old controls matched for sex and underlying heart disease (ischaemic and dilated cardiomyopathy). A total of 300 ICD recipients were enrolled in this specific analysis, including 150 patients ≥80 years (mean age 81.9 ± 2.0 years; 86.7% males) and 150 controls (mean age 61.8 ± 10.8 years). Among older patients, 92 (75.6%) had no more than one associated comorbidity. Most subjects in the elderly group got an ICD as part of a cardiac resynchronization therapy procedure (74% vs. 46%, P < 0.0001). After a mean follow-up of 3.0 ± 2 years, 53 patients (35%) in the elderly group died, including 38.2% from non cardiovascular causes of death. Similar proportion of patients received ≥1 appropriate therapy (19.4% vs. 21.6%; P = 0.65) in the elderly group and controls, respectively. There was a trend towards more early perioperative events (P = 0.10) in the elderly, with no significant increase in late complications (P = 0.73). CONCLUSION: Primary prevention ICD recipients ≥80 years in the real world had relatively low associated comorbidity. Rates of appropriate therapies and device-related complications were similar, compared with younger subjects. Nevertheless, the inherent limitations in interpreting observational data on this particular competing risk situation call for randomized controlled trials to provide definitive answers. Meanwhile, a careful multidisciplinary evaluation is needed to guide patient selection for ICD implantation in the elderly population.
Zakine et al. (Fri,) conducted a observational in Primary prevention implantable cardioverter-defibrillator (ICD) (n=300). Age ≥80 years vs. Age <80 years was evaluated on ≥1 appropriate therapy (p=0.65). Primary prevention ICD recipients aged ≥80 years had similar rates of receiving ≥1 appropriate therapy compared to matched younger controls (19.4% vs. 21.6%; P=0.65).