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Octogenarians are among the fastest growing age groups in the United States. Nonetheless, the efficacy of implantable cardioverter defibrillator (ICD) therapy for primary prevention of sudden cardiac death (SCD) is less clear in octogenarians due to elevated risk of non-cardiac death in these patients. We hypothesized that benefit from ICD therapy is less in octogenarians compared to younger patients.
We included 556 consecutive patients who underwent new ICD implantation or generator replacement for primary prevention of SCD at the Minneapolis VA Medical Center from 2006 to 2010. Patients were divided into elderly (age > 80 years) vs. younger age groups. Follow up was uniform and ICD shocks were adjudicated as “appropriate” or “inappropriate”.
Of 556 patients with primary prevention ICD, 87 (16%) were >80 years-old [median age 82 (range 80-96) vs. 64 (range 38-79) in younger patients; p<0.0001] at the time of the procedure. Older patients were more likely to have atrial fibrillation (p=0.002), stroke (p=0.016), chronic kidney disease (p<0.0001) and widened QRS (p=0.001), but less likely to have diabetes (p<0.0001) or smoking (p<0.0001) compared to younger patients. Otherwise, baseline characteristics including ejection fraction (median 30% in both groups) were similar. After 3.3±2.4 years of follow-up, the incidence of appropriate (16% vs. 18%, respectively, p=0.79) and inappropriate (3% vs. 8%, respectively, p=0.14) ICD shocks was similar in the elderly vs. younger patients. All-cause mortality was higher in the elderly (41% vs. 21%; p<0.0001). However, time from first appropriate ICD shock to death (or ICD shock to last follow-up, if the patient was alive), used as a surrogate of survival benefit from ICD, was similar in octogenarians vs. younger patients (1.6±1.1 vs. 2.0±1.3 years; respectively, p=0.29).
Efficacy of ICD therapy for primary prevention of SCD is similar in octogenarians vs. younger patients.
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: 1277-32
- 2013 American College of Cardiology Foundation