Primary prevention implantable cardioverter-defibrillator and cardiac resynchronization therapy-defibrillator in elderly patients: results of a Spanish multicentre study

• DOI: 10.1093/europace/euv337
• Publication Date: 2015-11-13T20:24:59Z
• Authors: Víctor Expósito; Moisés Rodríguez-...; Susana González-E...; Miguel A. Arias; Juan Miguel Sánch...; Ana Andrés La Huerta; Vicente Bertomeu-...; Álvaro Arce-León; María Teresa Barr...; Hugo Arguedas-Jim...; Javier García Seara; Felipe Rodriguez-...
• Keywords: Male; Survival; Kaplan-Meier Estimate; Implantable cardioverter-defibrillator; Cardiac Resynchronization Therapy; 03 medical and health sciences; Elderly; 0302 clinical medicine; Risk Factors; Cause of Death; Humans; Mortality; Aged; Retrospective Studies; Cardiac resynchronization therapy; Primary prevention; Middle Aged; Defibrillators, Implantable; 3. Good health; Hospitalization; Primary Prevention; Death, Sudden, Cardiac; Treatment Outcome; Spain; Female

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.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.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.