Abstract 1895: ICD And CRT-D Therapy In The Elderly; High Rates Of Use And Little Data
Introduction: in primary and secondary prevention (PP and SP)randomized controlled trials (RCTs) of implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT-D)devices, the median age of enrolled patients (pts) was approximately 64 years(yrs). The purpose of this study is to describe: actual prescribing practice of ICD and CRT-D therapy in the elderly, given their under-representation in these studies.
Methods: The ACT Registry is a prospective database that includes over 5,000 pts with an ICD or CRT-D implanted for standard indications. They are herein reported stratified by age ≥ 70 and ≥ 80 yrs old, indication (PP vs SP), device type, and then by device type for each indication.
Results: Of 4,560 pts with age recorded, 41% (n= 1,867) of those undergoing initial implantation were ≥ 70 yrs, and 12% (n=546) were ≥ 80 yrs old. For those ≥ 70–79 yrs old (n=1,321), 82% had a PP indication. For those ≥ 80 yrs old (n=546), 79.5% had a PP indication. The distribution of’ CRT-D, dual chamber (DC) ICDs and single chamber (SC) ICDs was 33.1%, 40.7%, and 26.2% respectively for pts 70–79 yrs old. For pts ≥ 80 yrs old, a similar distribution was observed: 32.8%, 40.7% and 26.6%, respectively. For PP pts 70–79 yrs old (n=1,083), the distribution of CRT-D, DC, and SC devices was 37.5%, 37.2%, and 25.3%, respectively. For PP pts ≥ 80, yrs (n=434), the distribution of CRT-D, DC, and SC devices was 37.1%, 36.2%, and 26.7%, respectively. Among SP pts 70–79 (n=238), the distribution of CRT-D, DC and SC devices was 13%, 56.7%, and 30.3% respectively. Among SP pts ≥ 80 (n=112), the distribution of CRT-D, DC and SC devices was 16.1%, 58.0% and 25.9% respectively. For PP pts ≥ 80 yrs receiving a CRT-D, 36% had a QRS duration > 120 ms, 41% were NYHA Class III-IV, and 20.4% met both criteria.
Although relatively few elderly pts were included in RCTs on which current practice is based, over 40% of new devices are implanted in pts ≥ 70, and over 10% in pts ≥ 80 yrs.
Despite a PP ICD indication in 80% of elderly pts, only ~ 25% receive SC devices.
Of elderly pts receiving a CRT-D, < 40% have a QRS duration or NYHA Class meeting usual accepted implant criteria.
These data indicate that study of device efficacy and selection in the elderly in needed.