Implantable cardioverter-defibrillators for secondary prevention: is it worth it in the elderly?
Aging is associated with structural alterations in the heart that predispose the elderly to life-threatening ventricular arrhythmias. The majority of sudden cardiac deaths occur in people aged 65 and older. As the proportion of elderly in our population continues to grow, a greater number of elderly patients with malignant ventricular arrhythmias will require appropriate medical management. Clinical outcome trials have demonstrated that implantable cardioverter-defibrillators (ICDs) improve overall survival compared with pharmacologic therapy when used for the secondary prevention of cardiac arrest. Despite proven efficacy, physicians may be reluctant to implant a defibrillator in an older patient. This review summarizes the data pertaining to the use of defibrillators for secondary prevention in the elderly. ICD use for secondary prevention reduces all-cause mortality and appears to be economically advantageous in an older patient population. Currently, there is no convincing data to suggest that ICD therapy should be withheld from a patient based on age alone.
Traub
Darren
D
The Western Pennsylvania Hospital, Pittsburgh, PA; and Temple University School of Medicine, Philadelphia, PA, USA.
Ganz
Leonard
L
D000367:Age Factors; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D006801:Humans; D018579:Patient Selection; D016032:Randomized Controlled Trials as Topic; D014481:United States / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000628:therapy
D000889:Anti-Arrhythmia Agents