Abstract 2714: Heart Failure Device Therapy: Effect of Age and Gender on Patient Survival
Background: Indications for heart failure (HF) device therapy are well-established. Cardiac resynchronization therapy (CRT) and internal cardiovertor defibrillator (ICD) use, alone or in combination, reduce morbidity and mortality. However, the frequency of device implantation in situations with limited survival is unknown. This study assessed, in an unselected population, what proportion of patients had a < 1 year survival and whether such survival was affected by age or gender after HF device therapy.
Methods: All patients admitted from 2000 –2006 to a referral center for de novo HF device therapy were identified using ICD-9 codes: 0050 (CRT), 0051 (CRT & ICD), and 3794 (ICD). Mortality rates were estimated using Kaplan Meier product limit estimation and between group comparisons for gender and age were made using logistic regression.
Results: From 2000 to 2006, 1,735 patients received CRT, ICD, or CRT & ICD. Of these, 1,331 (77%) were men and averaged 66.7 years of age while the women averaged 64.7 years (p = 0.347). One-year survival for all patients was 91%. One-year mortality by age and gender (see Table⇓), demonstrates that the proportion deriving a less than one year survival benefit after device implantation increases with age, but is not affected by gender.
Conclusions: One-year survival after HF device implantation is high, suggestive of appropriate patient selection. However, advanced age increases the likelihood of deriving a shorter term benefit of device therapy, suggesting that careful patient selection is particularly important in older adults to avoid the futile use of expensive technologies. While no apparent gender differences were found related to survival, the overwhelming majority of devices were implanted in men, suggesting gender bias, gender-based co-morbidities affecting care, or gender-based differences in care preferences.