Impact of advanced age on survival in patients with implantable cardioverter defibrillators.
OBJECTIVE
Given the selectivity of clinical trial patients and meager representation of elderly in the major implantable cardioverter defibrillator (ICD) randomized trials (<25%), whether such data apply to elderly patients overall is unclear. The purpose of our study is to understand the influence of age on mortality after ICD implantation.


RESULTS
We performed a retrospective cohort study of 502 consecutive patients receiving ICDs from 1993 to 2003 at a single university hospital. The primary predictor was patient age, categorized as <65, 65-75, and >75 years at ICD implantation. The primary outcome was time to death. Mean follow-up was 4 years. Median survival after ICD implantation was 5.3 years among subjects >75 years, less than half that of the youngest group. After adjusting for potential confounders, compared with subjects <65 years of age, patients >75 years [hazard ratio (HR), 4.7; 95% confidence interval (CI), 2.8-7.9; P < 0.001] and those 65-75 years (HR, 2.8; 95% CI, 1.7-4.8; P < 0.001) were at greater risk of death. Increased age was associated with higher total, cardiac, and non-cardiac mortality (all P <or= 0.001).


CONCLUSIONS
Age at ICD implantation is strongly and independently associated with mortality. Age should be considered among potential co-morbidities in anticipating survival of the elderly patient prior to ICD implantation.
Pellegrini
Cara N
CN
Department of Medicine, Division of Cardiology, Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA.
Lee
Keane
K
Olgin
Jeffrey E
JE
Turakhia
Mintu P
MP
Tseng
Zian H
ZH
Lee
Randall
R
Badhwar
Nitish
N
Lee
Byron
B
Varosy
Paul D
PD
D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D004554:Electric Countershock / Q000295:instrumentation* / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate