title: Comparison of benefit and mortality of implantable cardioverter-defibrillator therapy in patients aged ≥75 years versus those <75 years.
abstract: Implantable cardioverter-defibrillator (ICD) therapy decreases arrhythmic and all-cause mortality in patients at high risk of sudden death. However, its clinical benefit in elderly patients is uncertain. The aim of this study was to assess the long-term efficacy of ICD treatment in elderly patients and to identify markers of successful ICD therapy and risk factors of mortality. We performed multivariate analysis of a prospective long-term database from 2 tertiary care centers including 936 consecutive patients with an ICD. Predictors of ICD therapy and risk factors for mortality were assessed in patients ≥75 years old at ICD implantation compared to younger patients. Mean follow-up time was 43 ± 40 months. Rates of ICD therapy were similar in the 2 age groups. No significant predictors of ICD therapy could be identified in older patients. Median estimated survival was 132 months in patients <75 years and 81 months in those ≥75 years old (p = 0.006). Decreased ejection fraction (hazard ratio 1.62 per 10% decrease, p = 0.03) and impaired renal function (hazard ratio 1.57 per 10 ml/kg/m(2) decrease in estimated glomerular filtration rate, p = 0.02) were independent risk factors of mortality in patients ≥75 years old. However, mortality of older patients was similar to that of the age-matched general population irrespective of delivery of ICD therapy. In conclusion, ICD therapy is effective for treatment of life-threatening arrhythmias in all age groups. However, prevention of sudden cardiac death may have limited impact on overall mortality in older patients. Despite a similar rate of appropriate ICD therapies, risk of death is increased 1.6-fold in ICD recipients ≥75 years old compared to younger patients. Patients with decreased ejection fraction and impaired renal function are at highest risk.
authors.affiliation: Cardiovascular Center, Department of Cardiology, University Hospital Zurich, Switzerland.
authors.forename: Simon
authors.initials: S
authors.lastname: Brüllmann
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Dichtl
authors.forename: Ursula
authors.initials: U
authors.lastname: Paoli
authors.forename: Laurent
authors.initials: L
authors.lastname: Haegeli
authors.forename: Christian
authors.initials: C
authors.lastname: Schmied
authors.forename: Jan
authors.initials: J
authors.lastname: Steffel
authors.forename: Corinna
authors.initials: C
authors.lastname: Brunckhorst
authors.forename: Florian
authors.initials: F
authors.lastname: Hintringer
authors.forename: Burkhard
authors.initials: B
authors.lastname: Seifert
authors.forename: Firat
authors.initials: F
authors.lastname: Duru
authors.forename: Thomas
authors.initials: T
authors.lastname: Wolber
mesh_terms: D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D002423:Cause of Death / Q000639:trends; D017147:Defibrillators, Implantable; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013557:Switzerland / Q000453:epidemiology; D017180:Tachycardia, Ventricular / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D013997:Time Factors