Impact of advanced age on survival in patients with implantable cardioverter defibrillators.

Pellegrini CN, Lee K, Olgin JE, Turakhia MP, Tseng ZH, Lee R, Badhwar N, Lee B, Varosy PD. Impact of advanced age on survival in patients with implantable cardioverter defibrillators. Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of The Working Groups On Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of The European Society of Cardiology. 2008 Nov 1; 10(11):1296-301.

Related HSR&D Project(s)

• RCD 04-115 – Outcomes Among Veterans with Implantable Defibrillators

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Abstract:

AIMS: Given the selectivity of clinical trial patients and meager representation of elderly in the major implantable cardioverter defibrillator (ICD) randomized trials ( < 25%), whether such data apply to elderly patients overall is unclear. The purpose of our study is to understand the influence of age on mortality after ICD implantation. METHODS AND RESULTS: We performed a retrospective cohort study of 502 consecutive patients receiving ICDs from 1993 to 2003 at a single university hospital. The primary predictor was patient age, categorized as < 65, 65-75, and > 75 years at ICD implantation. The primary outcome was time to death. Mean follow-up was 4 years. Median survival after ICD implantation was 5.3 years among subjects > 75 years, less than half that of the youngest group. After adjusting for potential confounders, compared with subjects < 65 years of age, patients > 75 years [hazard ratio (HR), 4.7; 95% confidence interval (CI), 2.8-7.9; P < 0.001] and those 65-75 years (HR, 2.8; 95% CI, 1.7-4.8; P < 0.001) were at greater risk of death. Increased age was associated with higher total, cardiac, and non-cardiac mortality (all P < or = 0.001). CONCLUSION: Age at ICD implantation is strongly and independently associated with mortality. Age should be considered among potential co-morbidities in anticipating survival of the elderly patient prior to ICD implantation.