Key result
Increasing age at implant did not affect the time to appropriate ICD/CRT-D therapy (SHR 1.00; 95% CI 0.96-1.04; P=0.851), but the risk of death prior to therapy increased by 6% per year.
Why the study?
Does increasing age affect time to appropriate therapy or death in patients aged 60 years and over with primary prevention ICD/CRT-D?
Cohort (n=424)
Yes
Does increasing age affect time to appropriate therapy or death in patients aged 60 years and over with primary prevention ICD/CRT-D?
In older patients with primary prevention ICD/CRT-D, increasing age does not affect time to appropriate therapy but significantly increases the competing risk of death without receiving therapy.
May inform shared decision-making on primary prevention ICDs in the elderly; leaves open prospective validation of age thresholds.
Aims: To evaluate the impact of age on the clinical outcomes in a primary prevention implantable cardioverter defibrillator (ICD)/cardiac resynchronization therapy defibrillator (CRT-D) population. Methods and Results: A retrospective, multicentre analysis of patients aged 60 years and over with primary prevention ICD/CRT-D devices implanted between 1 January 2006 and 1 November 2014 was performed. Survival to follow-up with no therapy (T1), death prior to follow-up with no therapy (T2), delivery of appropriate therapy with survival to follow-up (T3), and delivery of appropriate therapy with death prior to follow-up (T4) were measured. In total, 424 patients were eligible for inclusion in the analysis, mean follow-up of 32.6 months during which time 44 patients (10.1%) received appropriate therapy. The sub-hazard ratio (SHR) for the cumulative incidence of appropriate therapy (T3) according to age at implant was 1.00 (P = 0.851; 95% CI 0.96–1.04). The SHR for cumulative incidence of death (T2) according to age at implant was 1.06 (P < 0.001; 95% CI 1.03–1.01). Age at implant, ischaemic aetiology, baseline haemoglobin, and the presence of diabetes mellitus were predictors of all-cause mortality. Conclusion: Age has no impact on the time to appropriate therapy, but risk of death prior to therapy increases by 6% for every year increment. As the ICD population ages, the proportion who die without receiving appropriate therapy increases due to competing risks. Characterizing competing risks predictive of death independent of ICD indication would focus therapy on those with potential to benefit and reduce unnecessary exposure to ICD-related morbidity.
No takes yet. Share an insight, caveat, or question.
Wilson et al. (2016) conducted a cohort in Primary prevention ICD/CRT-D (n=424). Age at implant was evaluated on Cumulative incidence of appropriate therapy (SHR 1.00, 95% CI 0.96-1.04, p=0.851). Increasing age at implant did not affect the time to appropriate ICD/CRT-D therapy (SHR 1.00; 95% CI 0.96-1.04; P=0.851), but the risk of death prior to therapy increased by 6% per year.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: