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Background: The efficacy and safety of prophylactic Implantable Cardioverter Defibrillator (ICD) implantation in elderly subjects with reduced Ejection Fraction (EF) is not well understood.
Methods: Authors conducted meta-analysis to evaluate efficacy and safety of ICD vs conventional therapy in elderly subjects (age >65 years) with reduced EF. PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were searched for randomized controlled trials of ICD vs. conventional therapy which reported stratified data for elderly. Pooled estimates were calculated using Der-Simonian and Laird random-effects models.
Results: Six randomized trials comprising of 2, 807 elderly patients met inclusion criteria. This study includes results from recently published DANISH trial. There was no statistical significant difference in all-cause mortality among ICD vs. conventional therapy group in elderly subjects [Hazard Ratio (HR): 0.94; 95% confidence intervals (CI): 0.75-1.17]. However, younger patients experienced lower all-cause mortality in ICD group (HR: 0.69; 0.56-0.85) [fig. 1]. Data were consistent across all trials for younger population (I2=0%) but less so for elderly (I2=54.9%). Additional clinical end points could not be compared due lack of age stratified data.
Conclusions: Younger patients have lower all-cause mortality from prophylactic ICD implantation for reduced EF compared to elderly. The elderly have higher noncardiovascular mortality before they achieve benefit from ICDs.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Arrhythmias and Clinical EP: Devices 1
Abstract Category: 5. Arrhythmias and Clinical EP: Devices
Presentation Number: 1109-089
- 2017 American College of Cardiology Foundation