Key result
Primary prevention ICD delivers appropriate therapy in only ~17% of older patients with no survival benefit.
Why the study?
The benefit of primary prevention ICD in HF patients aged ≥75 years, particularly those with significant non-cardiac comorbidities, is questionable.
Does prophylactic primary prevention ICD implantation improve survival and provide appropriate device therapy in heart failure patients aged >=75 years?
Cohort (n=140)
Yes
Does prophylactic primary prevention ICD implantation improve survival and provide appropriate device therapy in heart failure patients aged >=75 years?
In heart failure patients aged >=75 years, primary prevention ICD implantation showed limited clinical benefit as 82.8% received no appropriate therapy over ~5 years, most died without prior therapy, and appropriate therapy did not improve overall survival.
May not support routine primary prevention ICDs in patients ≥75 years; leaves open refined selection criteria in prospective trials.
Introduction The benefit of primary prevention implantable cardioverter defibrillator (ICD) in heart failure (HF) patients aged ≥75 years, particularly those with significant non-cardiac comorbidities, is questionable. We aimed to evaluate the clinical yield of primary prevention ICD in late-elderly HF patients. Method A multicenter, retrospective cohort study of all HF patients aged ≥75 years who underwent prophylactic ICD or cardiac resynchronization therapy defibrillator implantation for primary prevention at three medical centers between 2000-2020. Study endpoints included: a) First appropriate therapy event (anti-tachycardia pacing or shock) for ventricular arrhythmia; b) Mortality without prior appropriate device therapies, a surrogate for ICD non-benefit; c) Comparing Madit Risk Stratification Score (MRSS) and Charlson Comorbidity Index (CCI) with mortality endpoint. Results and discussion A total of 140 HF patients were included, mean age at implant was 79.1±3.1 years and 69.2% had ischemic HF etiology. 116 (82.8%) patients had no appropriate therapy during 60 (IQR 31-81) months follow-up, of which 99/116 (86.1%) died without any prior appropriate therapy. Twenty-four (17%) patients received appropriate device therapy during follow-up; time to first therapy was 19.5 (IQR 11.2-55.2) months. Importantly, Kaplan–Meier survival curves did not differ between the subgroup with appropriate device therapy and the subgroup without any appropriate therapy (log-rank p=0.351). Evaluation of the 81 cases with sufficient data for score calculation showed that all patients who died without appropriate therapy were classified as intermediate or high risk by the MRSS, and all were high-risk for early mortality by the CCI. Conclusion In late-elderly HF patients, the efficacy of prophylactic ICD appears limited, as only 17% experienced an appropriate device therapy, while the majority had no appropriate therapy during ~4.8 years follow-up, and the survival of those who apparently benefited from appropriate device therapy was not improved. The CCI and MRSS mortality indexes predicted most of these deaths. Thus, primary prevention ICD in late-elderly HF patients should be individualized based on patient comorbidities, considering the CCI and MRSS scores for death despite ICD.
No takes yet. Share an insight, caveat, or question.
Brin et al. (2026) conducted a cohort in Heart failure (n=140). Prophylactic ICD or cardiac resynchronization therapy defibrillator (CRT-D) implantation vs. Subgroup without appropriate device therapy (for survival comparison) was evaluated on First appropriate therapy event (anti-tachycardia pacing or shock) for ventricular arrhythmia; Mortality without prior appropriate device therapies; Overall survival by therapy status (p=0.351). Primary prevention ICD in patients ≥75 years resulted in appropriate therapy in only 17%, with no survival difference vs those without therapy (log-rank p=0.351).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: