Author + information
- Marcelino Cortes,
- Paloma Avila,
- Elena de la Cruz,
- Jose Joel Hernandez,
- Ignacio Hernandez,
- Miguel Angel Navas,
- Juan Benezet-Mazuecos,
- Jose Manuel Rubio,
- Rosa Rabago,
- Manuel Rey,
- Maria Esther Martinez,
- Miguel Orejas and
- Jeronimo Farre
The implantable cardioverter defibrillator (ICD) therapy reduces mortality in selected patients with systolic left ventricular dysfunction with or without heart failure (HF). The role of ICD in patients aged >75 years is not well established.
Between January, 2008 and March, 2011 we analyzed every patient aged ≥ 75 years and an ejection fraction (EF) ≤ 35%. We included patients with a class I or IIa indication for an ICD implantation at the time of inclusion or during follow up. We collected the baseline characteristics of the patients and the cardiovascular events that occurred during follow up. We performed a multivariate analysis of survival to identify prognostic factors related to total mortality and cardiovascular events (cardiac death or cardiac hospitalization because of ventricular tachycardia or HF).
We included 237 consecutive patients aged 81.4±4.7 years. During follow up, an ICD was implanted in 60 patients (CRT-ICD in 28). The ICD group as compared with the medical therapy group had a higher percentage of males (90 vs 67.8 %), a lower EF (25,1 vs 27,9%) and a higher proportion of cases in NYHA class III or IV (31,5 vs 12 %). Patients in the ICD group were younger (78,7 vs 82,3 years old), had a lower incidence of chronic obstructive pulmonary disease (11.7 vs 28.2%) and a higher proportion of use of beta-blockers (BB) (89.8 vs 73.3%) (P<0.05 for all comparisons). During a follow up of 25.4±12.5 months, total mortality was 33.8 % and a cardiovascular events occurred in 55,3% of the patients. The presence of cardiovascular events was related to the following independent variables: history of HF, age, EF, BB, and ACE inhibitors or ARB's. After a multivariate analysis, only BB demonstrated to be an independent protective variable with respect to the prognosis (OR 0.50 (0,31-0,83).
The benefit of an ICD implantation in very old patients still is unclear. In our study with a population obtained from the real clinical practice, the use of an ICD did not demonstrate any benefit as compared with medical therapy in spite of a younger age of the ICD group. Well-designed randomized controlled studies in patients ≥75 years to ascertain the value of ICD therapy are badly needed.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Arrhythmias: Devices IV – Ethical and Economic Issues Related to Arrhythmia Devices
Abstract Category: 8. Arrhythmias: Devices
Presentation Number: 1277-36
- 2013 American College of Cardiology Foundation