title: Determinants of all-cause mortality in different age groups in patients with severe systolic left ventricular dysfunction receiving an implantable cardioverter defibrillator (from the Italian ClinicalService Multicenter Observational Project).
abstract: Heart failure (HF) is a common condition in elderly patients. Despite great improvements in medical therapy, HF mortality remains high. Implantable cardioverter defibrillator (ICD) significantly lengthens the survival rate of subjects with severe HF, but little evidence exists on its effect in elderly persons. Aim of this study was to compare the age-related determinants of prognosis in a large population of patients with ICD. We divided all patients who underwent an ICD implantation in 117 Italian centers of the "ClinicalService Project" into 3 age groups (<65, 65 to 74, ≥ 75 years), and collected clinical and instrumental variables at baseline and during follow-up (median length: 27 months). Between 2004 and 2011, 6,311 patients were enrolled (5,174 men; left ventricular ejection fraction 29% ± 9%); 1,510 subjects were ≥ 75 years (23.9%; mean age 78 ± 3 years). The prevalence of co-morbidities increased with age. HF was most frequently due to coronary artery disease in the elderly, who also showed the worst New York Heart Association class. At multivariate analysis, older age, coronary artery disease, chronic obstructive pulmonary disease, chronic renal failure, diabetes, complex ventricular arrhythmias, and left ventricular ejection fraction were significant predictors of all-cause mortality. After adjustment, the hazard ratio(age group) for mortality was 22.6% less than at univariate analysis. When groups were analyzed separately, age alone predicted mortality in the oldest. In conclusion, a large proportion of our population was aged ≥ 75 years. Mortality was related to age and several co-morbidities, except for the oldest patients in whom age alone resulted predictive.
authors.affiliation: ICU, Geriatric Cardiology and Medicine Unit, University of Florence and AOU Careggi, Florence, Italy. Electronic address: fumadue@tin.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Fumagalli
authors.affiliation: Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Gasparini
authors.affiliation: Foundation IRCCS Polyclinic San Matteo, University of Pavia, Pavia, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Landolina
authors.affiliation: Department of Cardiology, Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Lunati
authors.affiliation: Department of Cardiology, Sant'Orsola-Malpighi Polyclinic, University of Bologna, Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
authors.affiliation: Department of Cardiology, University Hospital "Santa Maria della Misericordia", Udine, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Proclemer
authors.affiliation: Department of Cardiology, San Filippo Neri Hospital, Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Santini
authors.affiliation: Medtronic Clinical Research Institute, Rome, Italy.
authors.forename: Lorenza
authors.initials: L
authors.lastname: Mangoni
authors.affiliation: ICU, Geriatric Cardiology and Medicine Unit, University of Florence and AOU Careggi, Florence, Italy.
authors.forename: Margherita
authors.initials: M
authors.lastname: Padeletti
authors.affiliation: ICU, Geriatric Cardiology and Medicine Unit, University of Florence and AOU Careggi, Florence, Italy.
authors.forename: Niccolò
authors.initials: N
authors.lastname: Marchionni
authors.affiliation: Postgraduate School of Cardiology, University of Florence, Florence, Italy; Cliniche Humanitas Gavazzeni, Bergamo, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Padeletti
mesh_terms: D000367:Age Factors; D000368:Aged; D002423:Cause of Death / Q000639:trends; D017147:Defibrillators, Implantable; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D015996:Survival Rate / Q000639:trends; D013599:Systole; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D016277:Ventricular Function, Left / Q000502:physiology*