Abstract 2430: Should All Octogenarians Who Meet Criteria Receive an Implantable Cardioverter Defibrillator?
Background: There are no upper age restrictions for ICD implantation, though guidelines state that placement should be reserved for those with expected survival of > 1 year. In octogenarians, competing comorbidities may limit the mortality benefit of ICDs.
Methods: A retrospective cohort study was used to identify octogenarians who received ICD implantation and follow-up at Northwestern Memorial Hospital or Tufts New England Medical Center between 1990 and 2006. The primary endpoint was death within 1 year of implant.
Results: The study identified 241 octogenarians. Mean age 83.3 ± 3.1 years, 79% male, 87% coronary disease and 35% implanted for primary prophylaxis. Mean EF 31 ± 13%, creatinine 1.49 ± 0.71 mg/dl, and mean survival was 3.9 ± 0.3 years. Death within 1 year of implant occurred in 32 (13.2%) patients. Univariate predictors of 1-year mortality included EF ≤ 20% and creatinine ≥ 1.5 mg/dl (p < 0.01 and 0.04, respectively). Cox proportional analysis demonstrated that EF ≤ 20% was the only independent predictor of death within 1 year of ICD implant [Hazard Ratio = 3.2 (95% CI 1.5– 6.5; p<0.002)] and was associated with a 48% 1-year mortality. Of these patients, 6 (19%) received appropriate ICD therapy prior to death; the mean time from therapy to death was 3 months.
Conclusion: Octogenarians with EF ≤ 20% have a very high 1-year mortality despite ICD implantation. A minority of these patients will receive appropriate ICD therapy during this time. These results would be expected to have significant impact on the cost-effectiveness of ICDs and should be considered when evaluating device implantation in this population.