Author + information
- Marcelino Cortes,
- Juan Antonio Franco Pelaez,
- Marta Lopez Castillo,
- Alvaro Garcia Ropero,
- Maria Luisa Martin Mariscal,
- Angelica Maria Romero Daza,
- Julia Anna Palfy,
- Sem Briongos-Figuero,
- Mikel Taibo Urquia,
- Juan Benezet-Mazuecos,
- Jose Rubio Campal and
- Jeronimo Farre
Background: Implantable cardioverter-defibrillator (ICD) therapy has been shown to reduce mortality in high risk patients. However, the benefit of the ICD in the elderly is still a matter of debate due to controversial results of observational studies and the lack of randomized trials in patients of this age group. Our purpose is to assess the role of ICD therapy in patients aged ≥75 years.
Methods: From January 2008 to July 2014 we have recruited prospectively 802 patients aged ≥75 years that had a left ventricular ejection fraction (LVEF) ≤35%. From this group we identified 385 patients with a class I or IIa recommendation for ICD implantation at inclusion or during follow-up. Based on the patients or attending cardiologists’ decisions, 92 patients received an ICD. In order to avoid potential confounding factors, we performed a propensity-score matched analysis. Patients-matching was performed in a 1:1 ratio with the nearest neighbor method.
Results: 126 patients were included in our study (63 with ICD). The mean age of the study population was 79.1±3.1 years and 86.5% were males. As compared with the medical therapy group, the ICD patients had a lower percentage of chronic obstructive pulmonary disease (19.0% vs 38.1%, p<0.05), and showed higher use of beta-blockers (BB) (87.1 vs 71.0%, p<0.05). Other treatments were otherwise similar in both groups. There were not significant differences in relation with age, etiology or other comorbidities between ICD group and non-ICD group. During the follow-up of 39.2±22.4 months, total mortality was 46.0% and cardiovascular events (death or hospitalization because of ventricular tachycardia or heart failure) occurred in 66.7% of the patients. After a multivariate Cox proportional hazard analysis, only BB therapy was shown to be an independent protective variable with respect to total mortality [HR 0.4 (0.2-0.7)]. ICD therapy did not reduce overall mortality or cardiovascular event rate.
Conclusions: According to our results, the use of ICD did not demonstrate any benefit as compared with medical therapy. Well-designed randomized controlled studies in patients ≥75 years are needed to ascertain the value of ICD therapy.
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: 1109-092
- 2017 American College of Cardiology Foundation