Implantable cardioverter-defibrillator prescription in the elderly

Epstein, Andrew E.; Kay, G. Neal; Plumb, Vance J.; McElderry, H. Thomas; Doppalapudi, Harish; Yamada, Takumi; Shafiroff, Jeff; Syed, Zeeshan; Shkurovich, S.

doi:10.1016/j.hrthm.2009.04.010

Cited by 119 publications

(103 citation statements)

References 26 publications

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“…A recent study showed that age and GFR are the only indipendent predictors of survival in patients ≥ 80 years old, whereas ICD do not appear to influence the overall survival [82]. Of note, in none of the ICD recipients followed in this study there were any true instances of documented ventricular fibrillation, which adds to the evidence that ICDs are unlike to influence survival in this patient population and is consistent with previous reports [83]. A consistent finding, however, is that older patients have an increased risk of death and an altered profile as to their cause of death.…”

Section: Agesupporting

confidence: 91%

“…In primary prevention ICD trials, which constitute the basis for current clinical practice, more than 50% of enrolled patients were younger than 60 years [49,53,58,59,85]. In real-world practice, nearly 70% of ICDs are implanted in patients older than 60 years, and more than 40% are implanted in patients older than 70 years [83]. A primary prevention indication accounts for two thirds of cases in which such devices are used.…”

Section: Agementioning

confidence: 99%

“…The real-world extrapolation of data has resulted in 1 out of 6 Medicare ICD implants in patients older than 80 years, with a mean age of 70. The ACT registry (Advancements in ICD Therapy) showed that more than 40% of patients undergoing primary prevention ICD implantation were older than 70 years, with 12% older than 80 [83]. In light of this evidence and given of the cost and the potential risks associated with ICD implantation, the benefit of ICD therapy in the elderly are not well established.…”

Section: Agementioning

confidence: 99%

See 2 more Smart Citations

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

Giaccardi¹,

Colella²,

Santoro³

et al. 2013

Cardiac Defibrillation

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Section: Agesupporting

confidence: 91%

Section: Agementioning

confidence: 99%

Section: Agementioning

confidence: 99%

See 1 more Smart Citation

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

Giaccardi¹,

Colella²,

Santoro³

et al. 2013

Cardiac Defibrillation

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“…11 One study of that dataset showed that more than 40 % of new ICDs are implanted in patients over 70 years of age. 12 This underscores the importance of conducting studies aimed at examining the outcomes of primary prevention ICDs in patients ≥70-75 years of age.…”

Section: Introductionmentioning

confidence: 99%

Future Research Prioritization: Implantable Cardioverter-Defibrillator Therapy in Older Patients

et al. 2015

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BACKGROUND: Although the implantable cardioverterdefibrillator (ICD) is highly effective therapy for preventing sudden cardiac death, there is considerable uncertainty about its benefits and harms in older patients, especially in the presence of factors, other than old age, that increase the risk of death. OBJECTIVE: To develop a prioritized research agenda for the Patient-Centered Outcomes Research Institute as informed by a diverse group of stakeholders on the use and outcomes of the ICD in older patients. DESIGN: The existing literature was reviewed to identify evidence gaps, which were then refined by engaged stakeholders. Using a forced-ranking prioritization method, the stakeholders ranked evidence gaps by importance. For the highest-ranked evidence gaps, relevant recent studies were identified using PubMed, and relevant ongoing trials were identified using ClinicalTrials.gov. PARTICIPANTS: Eighteen stakeholders, including clinical experts and researchers in the prevention of sudden cardiac death and ICD therapy, representatives from federal and non-governmental funding agencies, representatives from relevant professional societies, health care decision-makers and policymakers, and representatives from related consumer and patient advocacy groups KEY RESULTS: The top 12 evidence gaps prioritized by stakeholders were related to the safety and effectiveness of ICDs in older patient subgroups not well represented in clinical trials, predictors of SCD, the impact of the ICD on quality of life, the use of shared decision-making, disparities in ICD use, risk stratification strategies, patient preferences, and distribution of modes of death in older patients. CONCLUSIONS: In this paper, we identify evidence gaps of high priority for current and future investigations of ICD therapy. Addressing these gaps will likely resolve many of the uncertainties surrounding the use and outcomes of the ICD in older patients seen in clinical practice.KEY WORDS: stakeholder engagement; cardiovascular disease; decision making.

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“…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].…”

mentioning

confidence: 99%

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

Implantable cardioverter-defibrillator prescription in the elderly

Cited by 119 publications

References 26 publications

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

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

Future Research Prioritization: Implantable Cardioverter-Defibrillator Therapy in Older Patients

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

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