Key result
Octogenarians receiving an ICD for secondary prevention had a significantly higher all-cause mortality rate (47.1%) compared to patients under 80 years (23.3%), though rates of appropriate ICD therapy did not differ.
Why the study?
ICD therapy is well established for secondary prevention, but data on its efficacy and safety in elderly patients are lacking.
Does age affect mortality, appropriate therapy, and adverse events in patients receiving ICD therapy for secondary prevention?
Observational (n=519)
No
Does age affect mortality, appropriate therapy, and adverse events in patients receiving ICD therapy for secondary prevention?
Absolute Event Rate: 47.1% vs 23.3%
p-value: p=<0.001
ICD therapy for secondary prevention appears to be an effective and safe treatment modality in octogenarians, with appropriate therapy and adverse event rates similar to younger patients.
Supports considering secondary prevention ICDs in octogenarians despite higher mortality; leaves open need for prospective trials to confirm net benefit.
BACKGROUND: Implantable cardioverter-defibrillator (ICD) therapy is well established for secondary prevention, but studies on the efficacy and safety in elderly patients are still lacking. This retrospective study compared the outcome after ICD implantation between octogenarians and other age groups. METHODS: Data were obtained from a local ICD registry. Patients who received ICD implantation for secondary prevention at our department were included. All-cause mortality, appropriate ICD therapy and acute adverse events requiring surgical intervention were compared between different age groups. RESULTS: 519 patients were enrolled, 34 of whom were aged ≥ 80 years. During the median follow-up of 35 months after ICD implantation 129 patients (annual mortality rate 5.0%) had died, including 16 patients aged ≥ 80 years (annual mortality rate 9.4%). The mortality rate of patients aged ≥ 80 years was significantly higher than that of patients aged ≤ 69 years (p < 0.001), but similar to that of patients aged 70-79 years. Age at the time of ICD implantation was an independent predictor of all-cause mortality (p < 0.001). 29.7% of patients had appropriate ICD therapy with no difference between age groups. Acute adverse events leading to surgical intervention were low (n = 13) and not age-related. CONCLUSION: Age is an independent predictor of mortality after ICD implantation for secondary prevention. Mortality rates did not differ significantly between octogenarians and other elderly aged 70-79 years. Appropriate ICD therapy and acute adverse events leading to surgical intervention were not age-related. Implantable cardioverter-defibrillator therapy for secondary prevention seems to be an effective and safe treatment modality in octogenarians.
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Hauck et al. (2021) conducted an observational in Secondary prevention of ventricular arrhythmias (n=519). Age ≥ 80 years vs. Age < 80 years was evaluated on All-cause mortality (p=<0.001). Octogenarians receiving an ICD for secondary prevention had a significantly higher all-cause mortality rate (47.1%) compared to patients under 80 years (23.3%), though rates of appropriate ICD therapy did not differ.
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