Predictors of early mortality in patients age 80 and older receiving implantable defibrillators.
BACKGROUND
There are no upper age restrictions for implantable defibrillators (ICDs) but their benefit may be limited in patients > or = 80 years with strong competing risks of early mortality. Risk factors for early (1-year) mortality in ICD recipients > or = 80 years of age have not been established.


METHODS
Two-center retrospective cohort study to assess predictors of one-year mortality in ICD recipients > or = 80 years of age.


RESULTS
Of 2,967 ICDs implanted in the two centers from 1990-2006, 225 (7.6%) patients were > or =80 years of age and followed-up at one of the two centers. Mean age was 83.3 +/- 3.1 years and follow-up time 3.3 +/- 2.6 years. Median survival was 3.6 years (95% confidence interval 2.3-4.9). Multivariate predictors of 1-year mortality included ejection fraction (EF) < or = 20% and the absence of beta-blocker use. Actuarial 1-year mortality of ICD recipients > or = 80 with an EF < or = 20% was 38.2% versus 13.1% in patients 80+ years with an EF > 20% and 10.6% for patients < 80 years with an EF < or = 20% (P < 0.001 for both). There was no significant difference in the risk of appropriate ICD therapy between those patients 80+ years with EF above and below 20%.


CONCLUSIONS
In general, patients > or = 80 years of age who meet current indications for ICD implantation live sufficiently long to warrant device implantation based on anticipated survival alone. However, those with an EF < or = 20% have a markedly elevated 1-year mortality with no observed increase in appropriate ICD therapy, thus reducing the benefit of device implantation in this population.
Northwestern University Feinberg School of Medicine, Department of Medicine, Chicago, Illinois, USA.
Drew
D
Ertel
Kavita
K
Phatak
Kevin
K
Makati
Marian
M
Holland
Sara
S
Baig
Michael H
MH
Kim
Mark
M
Link
Rod
R
Passman
D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000401:mortality* / Q000628:therapy; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008297:Male; D012307:Risk Factors; D015996:Survival Rate