Safety and Effectiveness of Primary Prevention Cardioverter defibrillators in Octogenarians

Strimel, D O William; Koplik, Sheri; Chen, H. Robert; Song, Juhee; Huang, Shoei K. Stephen

doi:10.1111/j.1540-8159.2011.03082.x

Cited by 18 publications

(12 citation statements)

References 18 publications

(34 reference statements)

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“…Similarly, several articles have been published showing a positive role of ICD in the elderly. However, this and other studies are observational registries, or studies that compare senior ICD recipients with their younger counterparts rather than with patients of the same age group receiving optimized medical therapy …”

Section: Discussionmentioning

confidence: 99%

“…According to a recently published registry from the USA, 40% of new ICDs and cardiac resynchronization therapy defibrillators (CRT‐D) are implanted in patients older than 70 years and >10% in octogenarians . However, the benefit and safety of the ICD in the elderly are still a matter of debate owing to controversial results of observational studies and the lack of randomized trials in patients of this age group . This study analyses the role of ICD in a population of elderly patients with left ventricular dysfunction, seeking to provide a potential indication for the implantation of this type of device.…”

Section: Introductionmentioning

confidence: 99%

“…7 However, the benefit and safety of the ICD in the elderly are still a matter of debate owing to controversial results of observational studies and the lack of randomized trials in patients of this age group. [8][9][10][11][12][13][14][15][16][17] This study analyses the role of ICD in a population of elderly patients with left ventricular dysfunction, seeking to provide a potential indication for the implantation of this type of device.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Comparison of pharmacological treatment alone vs. treatment combined with implantable cardioverter defibrillator therapy in patients older than 75 years

Cortés

Palfy²,

López

et al. 2018

ESC Heart Failure

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AimsImplantable cardioverter defibrillator (ICD) reduces mortality in selected patients. However, its role in patients older than 75 years is not well established.Methods and resultsWe performed a retrospective, non‐randomized study using a historical cohort from a single centre. Between January 2008 and July 2014, we assessed patients aged ≥75 years with left ventricular ejection fraction ≤ 35%, identifying 385 patients with a Class I or IIa recommendation for ICD implantation. At the decision of the patient or attending cardiologists, 92 patients received an ICD. To avoid potential confounding factors, we used propensity‐score matching. Finally, 126 patients were included (63 with ICD). The mean age was 79.1 ± 3.1 years (86.5% male). 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 more frequent use of beta‐blockers (BBs) (85.7 vs. 70.0%, P < 0.05). Other treatments were otherwise similar in both groups. There were no differences related to age, aetiology, or other co‐morbidities. During follow‐up (39.2 ± 22.4 months), total mortality was 46.0% and cardiovascular events (death or hospitalization) occurred in 66.7% of the patients. A multivariate analysis revealed that only BB therapy was shown to be an independent protective variable with respect to mortality [hazard ratio 0.4 (0.2–0.7)]. ICD therapy did not reduce overall mortality or the rate of cardiovascular events.ConclusionsAccording to our results, the use of ICD, as compared with medical therapy, in patients older than 75 years did not demonstrate any benefit. Well‐designed randomized controlled studies in patients older than 75 years are needed to ascertain the value of ICD therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of pharmacological treatment alone vs. treatment combined with implantable cardioverter defibrillator therapy in patients older than 75 years

Cortés

Palfy²,

López

et al. 2018

ESC Heart Failure

View full text Add to dashboard Cite

show abstract

“…There was, however, an increase in all-cause mortality in the [75 group. Another study found that patients over 80 also benefitted from CRT with ICD implantation as well [73]. With any procedure, there are complications, with ICD implantation as well as ICD and CRT implantation.…”

Section: Clinical Managementmentioning

confidence: 94%

“…The use of ICDs for patients who have had a cardiac arrest or sustained ventricular tachycardia is also indicated [72]. A recent study examining patients over 80 years old found that even they too benefitted from ICD implantation for primary prevention [73]. For patients with symptomatic HF and a QRS width of 120 ms or more, CRT can be considered too [72].…”

Section: Clinical Managementmentioning

confidence: 99%

Systolic heart failure in the elderly: optimizing medical management

Man

Jugdutt

2011

Heart Fail Rev

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The aging population with hypertension and coronary artery disease is rapidly increasing worldwide and develops heart failure (HF). A wide range of pharmacotherapeutic drugs are recommended in the HF management guidelines. For the most part, these recommendations are based on the results of studies in the younger population, and most drugs were not adequately tested in the elderly. However, many changes that occur during the aging process affect the response to several of the recommended therapeutic drugs. Physicians will be increasingly involved in managing the expanding elderly population with HF. It is therefore imperative that they recognize ways to use current pharmacotherapeutic agents and the increasing need for novel agents for optimizing the management of the elderly patient with HF.

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Impact of diabetes on clinical outcome of patients with heart failure undergoing ICD and CRT procedures: results from the German Device Registry

et al. 2020

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Aims Diabetes mellitus (DM) has a negative impact on prognosis in patients with heart failure (HF). The role impact of DM in HF patients with implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy (CRT) devices might differ and remains unclear. The aim of our study was to investigate the impact of DM on periprocedural complications and clinical outcome in HF patients undergoing ICD or CRT implantation. Methods and results Within the German Device Registry, data from 50 German centres were collected between January 2007 and February 2014. A retrospective analysis of n = 5329 patients undergoing ICD implantation was conducted. Patients' characteristics, procedural data, periprocedural complications, and post-procedural clinical outcome, including a composite clinical endpoint of all-cause mortality, stroke, and myocardial infarction (MACCE), were analysed. Subgroup analysis were performed for ICD and CRT implantations. Median follow-up was 15.7 (12.9; 20.0) and 16.2 (12.8; 21.2) months in DM and non-DM patients. Of 5329 patients enrolled, n = 1448 (27.2%) had a diagnosis of DM. Within the cohort, 94% of DM and 90% of non-DM patients had a diagnosis of HF. Patients with DM were older, had higher body mass index, and higher rate of cardiovascular comorbidities compared with non-DM patients. Unadjusted and adjusted analyses revealed similar all-over intrahospital periprocedural complication rates in both groups (4.1% vs 3.9%). Unadjusted Kaplan-Meier survival analysis showed higher all-cause mortality after 1 year (9.0% vs 6.3%; log-rank P = 0.001) with higher MACCE rates (10.0% vs 7.3%; P < 0.001) in the DM group versus non-DM patients. After multivariable adjustment for relevant covariates, the association of DM to MACCE disappeared [HR 1.11 (0.89-1.38)]. Because chronic kidney disease (CKD) was clearly associated with increased 1 year MACCE after multivariate adjustment [odds ratio (OR) 2.11 (1.68-2.64)], a subgroup analysis was performed showing a strong trend towards more perioperative complications in DM patients with CKD [OR 2.16 (0.9-5.21)], while no effect of DM was observed in patients without CKD [OR 0.73 (0.42-1.28)]. Conclusions The overall risk of periprocedural complications and short-term (1 year) clinical outcome in patients with DM and HF undergoing ICD or CRT defibrillator (CRT-D) implantation was not increased. In contrast, CKD was associated with an increased risk of 1 year MACCE in HF patients undergoing ICD/CRT-D implantation.

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Safety and Effectiveness of Primary Prevention Cardioverter defibrillators in Octogenarians

Cited by 18 publications

References 18 publications

Comparison of pharmacological treatment alone vs. treatment combined with implantable cardioverter defibrillator therapy in patients older than 75 years

Comparison of pharmacological treatment alone vs. treatment combined with implantable cardioverter defibrillator therapy in patients older than 75 years

Systolic heart failure in the elderly: optimizing medical management

Impact of diabetes on clinical outcome of patients with heart failure undergoing ICD and CRT procedures: results from the German Device Registry

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