title: Impact of advanced age on survival in patients with implantable cardioverter defibrillators.
abstract: 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.
authors.affiliation: Department of Medicine, Division of Cardiology, Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA.
authors.forename: Cara N
authors.initials: CN
authors.lastname: Pellegrini
authors.forename: Keane
authors.initials: K
authors.lastname: Lee
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Olgin
authors.forename: Mintu P
authors.initials: MP
authors.lastname: Turakhia
authors.forename: Zian H
authors.initials: ZH
authors.lastname: Tseng
authors.forename: Randall
authors.initials: R
authors.lastname: Lee
authors.forename: Nitish
authors.initials: N
authors.lastname: Badhwar
authors.forename: Byron
authors.initials: B
authors.lastname: Lee
authors.forename: Paul D
authors.initials: PD
authors.lastname: Varosy
mesh_terms: 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