title: Clinical characteristics and outcomes of elderly patients treated with an implantable cardioverter-defibrillator or cardiac resynchronization therapy in a real-world setting: data from the Israeli ICD Registry.
abstract: BACKGROUND
  Elderly patients are underrepresented in clinical trials of device therapy.
  
  
  OBJECTIVE
  To provide real-world data regarding outcomes associated with device-based therapy in a large cohort of elderly patients enrolled in the Israeli ICD Registry.
  
  
  METHODS
  Between July 2010 and June 2012, a total of 2807 consecutive patients undergoing implanted cardioverter-defibrillator/cardiac resynchronization therapy-defibrillator (ICD/CRT-D) implantation were prospectively enrolled in the Israeli ICD Registry. For the present analysis, patients were categorized into 3 age groups: ≤60 years (n = 1378 [49%]), 61-75 years (n = 863 [31%]), and >75 years (n = 566 [20%]).
  
  
  RESULTS
  Elderly patients (>75 years of age) had more comorbid conditions and were more likely to undergo CRT-D implantation (all P < .01). However, the rate of device-related complications associated with surgical reinterventions at 1 year was <3% regardless of age (P = .70 for the comparison among the 3 age groups). Multivariate analysis showed that the risk of heart failure or death and of appropriate ICD therapy for ventricular arrhythmias was significantly increased with increasing age among patients who received an ICD. In contrast, the age-related increase in the risk of all end points was attenuated among patients who received CRT-D devices (all P values for age-by-device-type interactions are <.05).
  
  
  CONCLUSIONS
  In a real-world scenario, elderly patients (>75 years of age) comprise approximately 20% of the ICD/CRT-D recipients and experience a device reintervention rate similar to that of their younger counterparts. Our data suggest that the association between advanced age and adverse clinical outcomes is attenuated in elderly patients implanted with CRT-D devices.
authors: Rambam Medical Center, Haifa.
authors: Mahmoud
authors: M
authors: Suleiman
authors: Israeli Association for Cardiovascular Trials, Sheba Medical Center, Tel Hashomer. Electronic address: ilan.goldenberg@sheba.health.gov.il.
authors: Ilan
authors: I
authors: Goldenberg
authors: Meir Medical Center, Kfar Saba.
authors: Moti
authors: M
authors: Haim
authors: Carmel Medical Center, Haifa.
authors: Jorge E
authors: JE
authors: Schliamser
authors: Rambam Medical Center, Haifa.
authors: Monther
authors: M
authors: Boulos
authors: Shaare Zedek Medical Center, Jerusalem.
authors: Michael
authors: M
authors: Ilan
authors: Kaplan Medical Center, Rehovot.
authors: Moshe
authors: M
authors: Swissa
authors: Israeli Association for Cardiovascular Trials, Sheba Medical Center, Tel Hashomer.
authors: Natalie
authors: N
authors: Gavrielov-Yusim
authors: Assaf Harofeh Medical Center, Tzrifin.
authors: Therese
authors: T
authors: Fuchs
authors: Soroka Medical Center, Beer Sheva, Israel.
authors: Guy
authors: G
authors: Amit
authors: Israeli Association for Cardiovascular Trials, Sheba Medical Center, Tel Hashomer.
authors: Michael
authors: M
authors: Glikson
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy; D015897:Comorbidity; D017147:Defibrillators, Implantable; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Defibrillators; Elderly; Outcomes; Resynchronization