title: Age differences in the use of implantable cardioverter-defibrillators among older patients hospitalized with heart failure.
abstract: BACKGROUND
  Practice guidelines recommend the use of ICDs in patients with heart failure (HF) and a left ventricular ejection fraction (LVEF) of ≤ 35% in the absence of contraindications.
  
  
  RESULTS
  We performed an analysis of ICD use among patients admitted with HF with LVEF of ≤ 35% and discharged alive from 251 hospitals participating in the American Heart Association's Get With The Guidelines-HF Program between January 2005 and September 2011. Among 35,772 guideline-eligible patients, 17,639 received an ICD prior to hospitalization (10,886), during hospitalization (4,876), or were discharged with plans to undergo ICD placement after hospitalization (1,877). After adjustment, increasing age was associated with lower ICD use (odds ratio [OR] 0.89, 95% confidence interval [CI] 0.87-0.91 per 5-year increase in age, P  <  0.0001). Compared with patient age < 55 years, older age groups ≥ 65 years were less likely to receive an ICD (P  <  0.003). Compared with men in the same age group, women were significantly less likely to receive an ICD; this difference was more marked with increasing age (P value for interaction = 0.006). There was a temporal increase in ICD use (adjusted OR 1.23, 95% CI 1.15-1.31 of ICD use per year) that was similar in each age group (P value for interaction = 0.665).
  
  
  CONCLUSIONS
  Eligible older HF patients age ≥ 65 years were significantly less likely to receive an ICD. With increasing age, women were less likely to receive an ICD than men. ICD use significantly increased over time in all age groups; however, age-related differences in ICD use persisted.
authors: Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC 27715, USA. p.hess@duke.edu
authors: Paul L
authors: PL
authors: Hess
authors: Maria V
authors: MV
authors: Grau-Sepulveda
authors: Adrian F
authors: AF
authors: Hernandez
authors: Eric D
authors: ED
authors: Peterson
authors: Deepak L
authors: DL
authors: Bhatt
authors: Lee H
authors: LH
authors: Schwamm
authors: Clyde W
authors: CW
authors: Yancy
authors: Gregg C
authors: GC
authors: Fonarow
authors: Sana M
authors: SM
authors: Al-Khatib
mesh_terms: D000367:Age Factors; D000368:Aged; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged