Increasing age does not affect time to appropriate therapy in primary prevention ICD/CRT-D: a competing risks analysis.
To evaluate the impact of age on the clinical outcomes in a primary prevention implantable cardioverter defibrillator (ICD)/cardiac resynchronization therapy defibrillator (CRT-D) population.



A retrospective, multicentre analysis of patients aged 60 years and over with primary prevention ICD/CRT-D devices implanted between 1 January 2006 and 1 November 2014 was performed. Survival to follow-up with no therapy (T1), death prior to follow-up with no therapy (T2), delivery of appropriate therapy with survival to follow-up (T3), and delivery of appropriate therapy with death prior to follow-up (T4) were measured. In total, 424 patients were eligible for inclusion in the analysis, mean follow-up of 32.6 months during which time 44 patients (10.1%) received appropriate therapy. The sub-hazard ratio (SHR) for the cumulative incidence of appropriate therapy (T3) according to age at implant was 1.00 (P = 0.851; 95% CI 0.96–1.04). The SHR for cumulative incidence of death (T2) according to age at implant was 1.06 (P < 0.001; 95% CI 1.03–1.01). Age at implant, ischaemic aetiology, baseline haemoglobin, and the presence of diabetes mellitus were predictors of all-cause mortality.



Age has no impact on the time to appropriate therapy, but risk of death prior to therapy increases by 6% for every year increment. As the ICD population ages, the proportion who die without receiving appropriate therapy increases due to competing risks. Characterizing competing risks predictive of death independent of ICD indication would focus therapy on those with potential to benefit and reduce unnecessary exposure to ICD-related morbidity.
University Hospital Southampton NHS Foundation Trust, Southampton, UK.
David G
DG
Wilson
University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Hrvojka Marija
HM
Zeljko
University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Georgios
G
Leventopoulos
Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Ahmed
A
Nauman
University Hospital Southampton NHS Foundation Trust, Southampton, UK.
George E H
GE
Sylvester
University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Arthur
A
Yue
University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Paul R
PR
Roberts
Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Glyn
G
Thomas
Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Edward R
ER
Duncan
Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
Paul J
PJ
Roderick
University Hospital Southampton NHS Foundation Trust, Southampton, UK.
John M
JM
Morgan
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy; D058409:Cardiac Resynchronization Therapy Devices; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D017180:Tachycardia, Ventricular / Q000150:complications / Q000628:therapy*; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D014693:Ventricular Fibrillation / Q000150:complications / Q000628:therapy*