title: Primary prevention implantable cardioverter-defibrillator and cardiac resynchronization therapy-defibrillator in elderly patients: results of a Spanish multicentre study.
abstract: OBJECTIVE
  Currently, there continues to be a lack of evidence regarding outcomes associated with device-based therapy for ventricular arrhythmias in elderly patients, even more in primary-prevention indications. We aimed to describe the follow-up in terms of efficacy and safety of implantable cardioverter-defibrillator (ICD) therapy in a large cohort of elderly patients.
  
  
  RESULTS
  Retrospective multicentre study performed in 15 Spanish hospitals. Consecutive patients referred for ICD implantation before 2011 were included. One hundred and sixty-two of 1174 patients (13.8%) ≥75 years were considered as 'elderly'. When compared with those patients <75, this subgroup presented more co-morbid conditions, including hypertension, chronic obstructive pulmonary disease , and renal failure, and more previous hospitalizations due to heart failure (HF). During a mean follow-up of 104.4 ± 3.3 months, 162 patients (14%) died, 120 in the younger age (12.4%), and 42 (24.4%) in the elderly. Kaplan-Meier analysis showed an increased probability of death with increasing age (17, 24, 28, and 69% at 12, 24, 48, and 60 months of follow-up in the elderly group). There was neither difference regarding the rate of appropriate nor inappropriate ICD intervention.
  
  
  CONCLUSIONS
  In a real-world scenario, elderly patients comprise ∼15% of ICD implantations for primary prevention of sudden cardiac death (SCD). Although the rate of appropriate therapy is similar between groups, the benefit of ICD is attenuated for a major increase in mortality risk among those patients ≥75 years at the moment of device implantation.
authors.affiliation: Hospital Universitario Marqués de Valdecilla, Av. Hospital s/n, Santander, Spain vicast79@hotmail.com.
authors.forename: Víctor
authors.initials: V
authors.lastname: Expósito
authors.affiliation: Hospital Universitario Santiago de Compostela, Santiago, Spain.
authors.forename: Moisés
authors.initials: M
authors.lastname: Rodríguez-Mañero
authors.affiliation: Hospital Universitario Marqués de Valdecilla, Av. Hospital s/n, Santander, Spain.
authors.forename: Susana
authors.initials: S
authors.lastname: González-Enríquez
authors.affiliation: Hospitalario Virgen de la Salud, Toledo, Spain.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Arias
authors.affiliation: Hospital Clínico Universitario, Valencia, Spain.
authors.forename: Juan Miguel
authors.initials: JM
authors.lastname: Sánchez-Gómez
authors.affiliation: Hospital Universitario La Fe, Valencia, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Andrés La Huerta
authors.affiliation: Hospital Universitario San Juan, Alicante, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Bertomeu-González
authors.affiliation: Hospital Virgen del Rocío, Sevilla, Spain.
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Arce-León
authors.affiliation: Hospital Universitario Montepríncipe, Madrid, Spain.
authors.forename: María Teresa
authors.initials: MT
authors.lastname: Barrio-López
authors.affiliation: Clinica Universitaria de Navarra, Pamplona, Spain.
authors.forename: Hugo
authors.initials: H
authors.lastname: Arguedas-Jiménez
authors.affiliation: Hospital Universitario Santiago de Compostela, Santiago, Spain.
authors.forename: Javier García
authors.initials: JG
authors.lastname: Seara
authors.affiliation: Hospital Universitario Marqués de Valdecilla, Av. Hospital s/n, Santander, Spain.
authors.forename: Felipe
authors.initials: F
authors.lastname: Rodriguez-Entem
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy; D002423:Cause of Death; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000517:prevention & control; D017147:Defibrillators, Implantable; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011322:Primary Prevention; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain; D016896:Treatment Outcome
keywords: Cardiac resynchronization therapy; Elderly; Implantable cardioverter-defibrillator; Primary prevention; Survival