Efficacy of the Implantable Cardioverter-Defibrillator in the Elderly

Abstract

Among patients with similar functional class and ejection fraction, the mortality risk is increased threefold in those > or = 75 years old at the time of ICD implantation. Extrapolation of results from younger patients is likely to overestimate ICD benefit in the elderly.

Ventricular Arrhythmias in the Elderly

“…57) Another retrospective review reported that in a comparison between 74 patients greater than 75 years of age and 695 younger patients who had all undergone ICD implantation, there was no difference in the incidence of appropriate ICD defibrillations between the two groups. 58) Although this study reported that advanced age was the most powerful predictor of adverse outcomes, the incidence of sudden cardiac death was rare in the elderly ICD group.…”

Implantable Cardioverter-Defibrillators in Sudden Cardiac Death Prevention: What Guidelines Don't Tell

“…More recent meta-analysis of primary prevention trials showed that prophylactic ICD therapy in elderly patients was associated with a nonsignificant reduction in all-cause mortality compared with medical therapy [3]. Single-center ICD registries have demonstrated steep increases in both cardiac e noncardiac mortality in patients older than 75 years [80,81].…”

“…Thus patients > 80 years old are more like to die from nonarrhythmic or noncardiac causes for which an ICD is not helpful [84]. Other study [80,81] showed that given the increased probability of death from competing causes in elderly patients, patients older than a certain age cease to extract a survival benefit from an ICD. The problem therefore is reduced to identifying this specific age cutoff.…”

Subject of the year: Who are we missing, who are we overtreating, and who is best served? Refining the prescription of implantable cardioverter-defibrillator therapy

“…Interest in the allocation of ICDs to the elderly is not new [7][8][9][10][11][12][13][14][15]. As increasing age is associated with increased mortality, the benefit afforded by ICDs might be expected to be especially great in the elderly.…”

“…Some studies [7,8] reported retrospective observations that ICDs are effective treatments for life-threatening ventricular arrhythmias in both elderly and younger patients, and that age should not be a contraindication to implantation [14]. However, the elderly have worse outcomes than do younger patients [11,14,16]. Of 204 (16.6%) patients aged ≥75 years in the Multicenter Automatic Defibrillator Implantation Trial II (MADIT-II), 121 were randomized to ICD therapy [17].…”