Key result
ICD therapy did not significantly reduce all-cause mortality compared with medical therapy alone in patients aged >=75 years (38.1% vs. 54.0%, P = 0.073; multivariate NS).
Why the study?
Implantable cardioverter defibrillator therapy reduces mortality in selected patients, but its role in patients older than 75 years is not well established.
Does implantable cardioverter defibrillator therapy combined with pharmacological treatment reduce all-cause mortality compared to pharmacological treatment alone in patients aged 75 years or older with LVEF <=35%?
Cohort (n=126)
No
Does implantable cardioverter defibrillator therapy combined with pharmacological treatment reduce all-cause mortality compared to pharmacological treatment alone in patients aged 75 years or older with LVEF <=35%?
Answers are grounded in this paper and cite their sources.
In propensity-matched patients aged >=75 years with LVEF <=35%, ICD implantation did not significantly reduce all-cause mortality or cardiovascular events compared with medical therapy alone, whereas beta-blocker therapy was independently associated with lower mortality.
AIMS: Implantable cardioverter defibrillator (ICD) reduces mortality in selected patients. However, its role in patients older than 75 years is not well established. METHODS AND RESULTS: We performed a retrospective, non-randomized study using a historical cohort from a single centre. Between January 2008 and July 2014, we assessed patients aged ≥75 years with left ventricular ejection fraction ≤ 35%, identifying 385 patients with a Class I or IIa recommendation for ICD implantation. At the decision of the patient or attending cardiologists, 92 patients received an ICD. To avoid potential confounding factors, we used propensity-score matching. Finally, 126 patients were included (63 with ICD). The mean age was 79.1 ± 3.1 years (86.5% male). As compared with the medical therapy group, the ICD patients had a lower percentage of chronic obstructive pulmonary disease (19.0% vs. 38.1%, P < 0.05) and more frequent use of beta-blockers (BBs) (85.7 vs. 70.0%, P < 0.05). Other treatments were otherwise similar in both groups. There were no differences related to age, aetiology, or other co-morbidities. During follow-up (39.2 ± 22.4 months), total mortality was 46.0% and cardiovascular events (death or hospitalization) occurred in 66.7% of the patients. A multivariate analysis revealed that only BB therapy was shown to be an independent protective variable with respect to mortality [hazard ratio 0.4 (0.2-0.7)]. ICD therapy did not reduce overall mortality or the rate of cardiovascular events. CONCLUSIONS: According to our results, the use of ICD, as compared with medical therapy, in patients older than 75 years did not demonstrate any benefit. Well-designed randomized controlled studies in patients older than 75 years are needed to ascertain the value of ICD therapy.
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Cortés et al. (2018) conducted a cohort in Left ventricular systolic dysfunction (LVEF <=35%) in elderly patients with a Class I or IIa recommendation for ICD implantation (n=126). Implantable cardioverter defibrillator (ICD or CRT-D) combined with pharmacological therapy vs. Pharmacological medical therapy alone without ICD was evaluated on Death from any cause (total mortality) (OR 0.486 (univariate); NS on multivariate analysis, 95% CI 0.286-0.825, p=0.073). ICD therapy did not significantly reduce all-cause mortality compared with medical therapy alone in patients aged >=75 years (38.1% vs. 54.0%, P = 0.073; multivariate NS).
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