Key result
In octogenarians undergoing de novo ICD or CRT-D implantation, mortality was 34% over a median 29-month follow-up, with appropriate device therapy occurring in 38%.
Why the study?
What are the clinical outcomes and survival rates of de novo ICD or CRT-D implantation in octogenarians?
Cohort (n=50)
No
What are the clinical outcomes and survival rates of de novo ICD or CRT-D implantation in octogenarians?
De novo ICD or CRT-D implantation in octogenarians is associated with high one-year survival and acceptable rates of appropriate device therapy, supporting their use in selected very elderly patients.
Substantial mortality despite frequent appropriate therapy in octogenarian ICD/CRT-D recipients; leaves open net benefit versus medical therapy and requires randomized confirmation.
AIMS: Limited data exist on outcomes in very elderly ICD recipients. We describe outcomes in new ICD and Cardiac Resynchronisation Therapy with Defibrillator (CRT-D) implants in octogenarians at our institution. METHODS: Patients aged 80 years and above who underwent de novo ICD or CRT-D implantation from January 2006 to July 2012 were identified. Clinical data were collected from the procedural record, medical and ICD notes. Baseline characteristics were compared using independent sample t test for continuous variables and Fisher's exact test for categorical variables. Kaplan-Meier curves were constructed. RESULTS: Ten per cent of all new ICD/CRT-D implants were aged 80 years and over. Median age was 83.0 years. Median follow-up was 29 months. Death occurred in 17 (34%). Median time to death was 23 months. Three deaths (6%) occurred within 12 months of ICD implantation. Appropriate therapy (ATP or shock) occurred in 19 (38%). Inappropriate therapy occurred in 6 (12%). Rates of appropriate shocks and inappropriate therapy (shocks and ATP) and significant valvular incompetence were higher amongst deceased patients (P=0.03 OR 5.9 95% CI 1.3-27) and (P=0.02 OR 12 95% CI 1.3-112). Univariate analysis identified diuretic use (P=0.008 95% C.I. 0.05 to 0.63) and appropriate shock (P= 0.025 95% C.I. 1.25 to 26.3) as predictors of mortality. CONCLUSION: Octogenarians make up a small but increasing number of ICD recipients. This study highlights high survival rates at one year with acceptable rates of appropriate and inappropriate device therapy. Ongoing debate regarding the appropriateness of ICD in very elderly patients is warranted.
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Wilson et al. (2015) conducted a cohort in Indications for ICD or CRT-D (n=50). ICD or CRT-D implantation was evaluated on Death. In octogenarians undergoing de novo ICD or CRT-D implantation, mortality was 34% over a median 29-month follow-up, with appropriate device therapy occurring in 38%.
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