Key result
Elderly patients (≥75 years) receiving an ICD had similar rates of appropriate therapy but higher 5-year overall mortality compared to younger patients.
Why the study?
Does age ≥ 75 years affect survival, appropriate therapy, and complication rates in patients receiving implantable cardioverter defibrillators compared to younger patients?
Cohort (n=500)
Does age ≥ 75 years affect survival, appropriate therapy, and complication rates in patients receiving implantable cardioverter defibrillators compared to younger patients?
ICD therapy is equally effective at preventing sudden cardiac death with similar complication rates in patients ≥ 75 years compared to younger patients, though overall long-term mortality is higher due to heart failure.
Answers are grounded in this paper and cite their sources.
May warrant individualized ICD decisions in elderly patients; leaves open net survival benefit versus medical therapy alone.
AIMS OF THE STUDY: To examine the patterns of use, complication rates, and survival in elderly recipients of implantable cardioverter defibrillators (ICD). METHODS AND RESULTS: We followed 500 consecutive patients included in the Marburg Defibrillator database for 48+/-39 months. There were 40 patients (8%) >/= 75 and 460 (92%) < 75 years of age at the time of implant. The 5-year Kaplan-Meier estimate for appropriate treatment of VT or VF by ICD was 49% among patients < 75- versus 57% among patients >/= 75-years-old (P = 0.17). The 5-year sudden death rate was similarly low in both groups of patients (2% versus 3%). The 5-year overall mortality rate was significantly higher in patients >/= 75 than in patients < 75 years of age (55% versus 21%, P = 0.001), due to a higher mortality from heart failure (HF). All procedure-related, lead-related, and pulse generator-related complications were similar in both patient groups (23% versus 25%). CONCLUSIONS: ICD therapy was equally effective in patients >/= 75 and patients < 75 years of age in the prevention of sudden cardiac death. While the complication rates were similar in both age groups, the long-term mortality was considerably higher in elderly patients, due to a higher mortality from HF. The current ICD therapy guidelines appear applicable to elderly patients who are otherwise medically stable and without advanced HF.
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Grimm et al. (2007) conducted a cohort in Implantable cardioverter defibrillator (ICD) recipients (n=500). Age ≥ 75 years vs. Age < 75 years was evaluated on 5-year overall mortality (p=0.001). Elderly patients (≥75 years) receiving an ICD had similar rates of appropriate therapy but higher 5-year overall mortality compared to younger patients.
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