Outcomes Among Older Patients Receiving Implantable Cardioverter-Defibrillators for Secondary Prevention

Abstract

Almost 1 in 5 older patients receiving a secondary prevention ICD survives at least 2 years. High hospitalization and SNF admission rates, particularly among the oldest patients, identify substantial care needs after device implantation.

Updated Geriatric Cardiology Guidelines of the Brazilian Society of Cardiology - 2019

“…A noteworthy example of this scenario is the need for hospitalization and admission to skilled nursing facilities in 4 of every 5 elderly patients who received an implantable cardioverter-defibrillator for secondary prevention of sudden cardiac death, even though they survived at least 2 years. 30…”

Increased mortality in octogenarians treated for lifestyle limiting claudication

“…Octogenarians had a LOS of 3.0 ± 3.4 days (versus younger cohort = 2.8 ± 3.2 days) and were at a three‐time higher risk of being discharged to SNF rather than home (12.5% versus 4.8% in younger cohort), which has been repeatedly validated for other cardiovascular and trauma hospitalizations . The interpretation of LOS should be taken with caution because although, the values are statistically significant, the clinical implication of discharging a patient after 2.8 days versus 3.0 days is not practical.…”

How Do Patients Receiving a Secondary Prevention ICD in Clinical Practice Compare with Patients Enrolled in the Antiarrhythmic Versus Implantable Defibrillator (AVID) Trial?

“…While outcomes of the 2 groups could not be formally compared in the present study due to small sample sizes, numerically, the rates of death in the ICD registry were comparable to those observed in ICD recipients in the AVID trial. Also, a recent analysis of the NCDR ICD Registry showed that almost 4 in 5 older patients receiving a secondary prevention ICD survive at least for 2 years [14]. A trial of secondary prevention ICDs versus no ICDs in a contemporary cohort will likely never be feasible due to the widespread acceptance of the importance of the ICD in such high-risk populations.…”