title: Outcomes Among Older Patients Receiving Implantable Cardioverter-Defibrillators for Secondary Prevention: From the NCDR ICD Registry.
abstract: Clinical trials of implantable cardioverter-defibrillators (ICDs) for secondary prevention of sudden cardiac death were conducted nearly 2 decades ago and enrolled few older patients.
  
  
  
  This study assessed morbidity and mortality of older patients receiving ICDs for secondary prevention in contemporary clinical practice.
  
  
  
  We identified 12,420 Medicare beneficiaries from the National Cardiovascular Data Registry ICD Registry undergoing first-time secondary prevention ICD implantation between 2006 and 2009 in 956 U.S. hospitals. Risks of death, hospitalization, and admission to a skilled nursing facility (SNF) were assessed over 2 years in age strata (65 to 69, 70 to 74, 75 to 79, and ≥80 years of age) using Medicare claims. The adjusted association between age and outcomes was evaluated using multivariable models.
  
  
  
  The mean age was 75 years at the time of implantation; 25.3% were <70 years of age and 25.7% were ≥80 years of age. Overall, the risk of death at 2 years was 21.8%, ranging from 14.7% among those <70 years of age to 28.9% among those ≥80 years of age (adjusted risk ratio [aRR]: 2.01; 95% confidence interval [CI]: 1.85 to 2.33; p for trend <0.001). The cumulative incidence of hospitalizations was 65.4%, ranging from 60.5% in those <70 years of age to 71.5% in those ≥80 years of age (aRR: 1.27; 95% CI: 1.19 to 1.36; p for trend <0.001). The cumulative incidence of admission to a SNF ranged from 13.1% among those <70 years of age to 31.9% among those ≥80 years of age (aRR: 2.67; 95% CI: 2.37 to 3.01; p for trend <0.001); SNF admission risk was highest in the first 30 days.
  
  
  
  Almost 4 in 5 older patients receiving a secondary prevention ICD survives at least 2 years. High hospitalization and SNF admission rates, particularly among the oldest patients, identify substantial care needs after device implantation.
authors.affiliation: Department of Medicine, University of Colorado, Denver, Colorado.
authors.forename: Jarrod K
authors.initials: JK
authors.lastname: Betz
authors.affiliation: Division of Cardiology, University of Colorado, Denver, Colorado; Colorado Cardiovascular Outcomes Research Group, Denver, Colorado.
authors.forename: David F
authors.initials: DF
authors.lastname: Katz
authors.affiliation: Division of Cardiology, University of Colorado, Denver, Colorado; Colorado Cardiovascular Outcomes Research Group, Denver, Colorado; Denver Health Medical Center, Denver, Colorado.
authors.forename: Pamela N
authors.initials: PN
authors.lastname: Peterson
authors.affiliation: Division of Cardiology, University of Colorado, Denver, Colorado; Colorado Cardiovascular Outcomes Research Group, Denver, Colorado.
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Borne
authors.affiliation: Division of Cardiology, Duke University, Durham, North Carolina.
authors.forename: Sana M
authors.initials: SM
authors.lastname: Al-Khatib
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.
authors.forename: Yongfei
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Division of Cardiology, Duke University, Durham, North Carolina.
authors.forename: Carolina Malta
authors.initials: CM
authors.lastname: Hansen
authors.affiliation: Division of Cardiology, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: David D
authors.initials: DD
authors.lastname: McManus
authors.affiliation: Division of Cardiology, University of Colorado, Denver, Colorado; Colorado Cardiovascular Outcomes Research Group, Denver, Colorado.
authors.forename: Jehu S
authors.initials: JS
authors.lastname: Mathew
authors.affiliation: Division of Cardiology, University of Colorado, Denver, Colorado; Colorado Cardiovascular Outcomes Research Group, Denver, Colorado. Electronic address: fred.masoudi@ucdenver.edu.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D017147:Defibrillators, Implantable; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D012042:Registries; D055502:Secondary Prevention; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data; D016896:Treatment Outcome
keywords: arrhythmia; elderly; electrophysiology