Abstract 2498: Using Decision Analysis to Determine the Benefit of Primary Prevention Implantable Cardioverter-defibrillators in Elderly Patients
Introduction: It is unclear if primary prevention ICDs benefit elderly patients due to a much higher risk of all-cause death.
Methods: A Markov decision model was used to evaluate risks and benefits of ICD implantation in elderly (≥70 years of age) patients meeting criteria for a primary prevention ICD. Peer reviewed literature was used to determine event rates for both arrhythmic and non-arrhythmic death for patients, impact on co-morbidities in conjunction with patient age, and overall survival in this population. Variables included patient age (ranging from 70–90 years), procedural mortality, risk of death from various causes (arrhythmic death, other cardiac death, and non-cardiac death), and burden from other co-morbidities (EF ≤25%, chronic kidney disease, NHYA class >II).
Results: The model shows the benefit (increased survival by ≥6 months) of a primary prevention ICD depends jointly on patient age and coexisting co-morbidities. At greater than 80 years of age, the model shows that is no significant survival benefit with an ICD. Similarly for ages 75–80 and with additional co-morbidities, there is also limited benefit. Conversely, the model suggests that patients with a good functional status and no significant co-morbidities may still benefit from ICDs at older ages.
Conclusions: Our model shows that patient age has influence on the benefit of a primary prevention ICD. Age should be considered in conjunction with other patient co-morbidities, as both factors equally impact whether or not the ICD will be of benefit.