Abstract 15178: Population-Based Evaluation of Appropriate Therapies and Death Among Elderly Implantable Cardioverter Defibrillator (ICD) Recipients: The Ontario ICD Database
BACKGROUND ICDs reduce all cause mortality in patients at risk of sudden cardiac death. However, the benefit derived in elderly patients is controversial and may be attenuated by non-arrhythmic death.
OBJECTIVES To examine the impact of age on mortality and device-delivered therapies after ICD implantation for primary or secondary prevention indications.
METHODS We examined 5399 ICD recipients in Ontario, Canada (Feb 2007-Sep 2010), using a province-wide prospective registry. Outcomes were stratified by age (18-65, 66-75, and >75 years) and primary or secondary prevention indication. Hospitalizations and deaths were determined by linkages with the Canadian Institute for Health Information and vital status databases. ICD-delivered therapies and complications were determined at routine clinic visits.
RESULTS There were 1923, 1321, and 695 primary and 655, 452, and 353 secondary prevention ICD patients aged 18-65, 66-75, and >75 years, respectively. Total mortality increased with older age but rates of appropriate shock were similar across age groups for both primary and secondary prevention cohorts (Table). Older patients were more likely to experience cardiovascular hospitalizations within 30 d prior to death (Table). After covariate adjustment, age >75 yrs was an independent predictor of mortality among primary (HR 1.44, 95% CI; 1.02-2.03) and secondary (HR 1.92, 95% CI; 1.28-2.89) prevention cohorts. There were no differences in major 45-day complications across age groups with rates ranging from 3.5-4.2% for primary and 3.8-6.4% for secondary prevention (both p=NS). Death after appropriate shock increased with age, and was higher for primary than secondary prevention patients (Table).
CONCLUSIONS Elderly ICD recipients exhibited similar rates of appropriate shock but higher risk of death than younger patients. While factors predisposing to death should be considered, older age alone should not systematically exclude patients from ICD candidacy.
- © 2012 by American Heart Association, Inc.