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Erschienen in: Zeitschrift für Gerontologie und Geriatrie 6/2023

Open Access 08.12.2022 | Original Contributions

Impact of age on the prognosis of patients with ventricular tachyarrhythmias and aborted cardiac arrest

verfasst von: Dr. Kathrin Weidner, MD, Tobias Schupp, MD, Jonas Rusnak, MD, Ibrahim El-Battrawy, MD, Uzair Ansari, MD, Jorge Hoppner, MD, Julian Mueller, MD, Maximilian Kittel, MD, Gabriel Taton, MD, Linda Reiser, MD, Armin Bollow, MD, Thomas Reichelt, MD, Dominik Ellguth, MD, Niko Engelke, MD, Dirk Große Meininghaus, MD, Muharrem Akin, MD, Thomas Bertsch, MD, Ibrahim Akin, MD, Prof. Dr. Michael Behnes, MD

Erschienen in: Zeitschrift für Gerontologie und Geriatrie | Ausgabe 6/2023

Abstract

Background

This study evaluated the prognostic impact of age on patients presenting with ventricular tachyarrhythmias (VTA) and aborted cardiac arrest.

Material and methods

The present registry-based, monocentric cohort study included all consecutive patients presenting at the University Medical Center Mannheim (UMM) between 2002 and 2016 with ventricular tachycardia (VT), ventricular fibrillation (VF) and aborted cardiac arrest. Middle-aged (40–60 years old) were compared to older patients (> 60 years old). Furthermore, age was analyzed as a continuous variable. The primary endpoint was all-cause mortality at 2.5 years. The secondary endpoints were cardiac death at 24 h, all-cause mortality at index hospitalization, all-cause mortality after index hospitalization and the composite endpoint at 2.5 years of cardiac death at 24 h, recurrent VTA, and appropriate implantable cardioverter defibrillator (ICD) treatment.

Results

A total of 2259 consecutive patients were included (28% middle-aged, 72% older). Older patients were more often associated with all-cause mortality at 2.5 years (27% vs. 50%; hazard ratio, HR = 2.137; 95% confidence interval, CI 1.809–2.523, p = 0.001) and the secondary endpoints. Even patient age as a continuous variable was independently associated with mortality at 2.5 years in all types of VTA. Adverse prognosis in older patients was demonstrated by multivariate Cox regression analyses and propensity score matching. Chronic kidney disease (CKD), systolic left ventricular dysfunction (LVEF) < 35%, cardiopulmonary resuscitation (CPR) and cardiogenic shock worsened the prognosis for both age groups, whereas acute myocardial infarction (STEMI/NSTEMI) and the presence of an ICD improved prognosis.

Conclusion

The results of this study suggest that increasing age is associated with increased mortality in VTA patients. Compared to the middle-aged, older patients were associated with higher all-cause mortality at 2.5 years and the secondary endpoints.
Hinweise

Supplementary Information

The online version of this article (https://​doi.​org/​10.​1007/​s00391-022-02131-6) contains supplementary material, which is available to authorized users.
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Abkürzungen
CAD
Coronary artery disease
CKD
Chronic kidney disease
CPR
Cardiopulmonary resuscitation
ICD
Implantable cardioverter defibrillator
LVEF
Left ventricular ejection fraction
NSTEMI
Non-ST-segment elevation myocardial infarction
NSVT
Non-sustained ventricular tachycardia
STEMI
ST-segment elevation myocardial infarction
SVT
Sustained ventricular tachycardia
VF
Ventricular fibrillation
VT
Ventricular tachycardia
VTA
Ventricular tachyarrhythmia

Introduction

Age is the main risk factor for vascular disease and therefore for cardiovascular and cerebrovascular events [1]. The incidence of VTA and cardiac death increases with age [2, 3]. VTA in geriatric patients is caused mostly by the increased prevalence of structural heart diseases as a consequence of arterial hypertension, coronary artery disease (CAD), and heart failure [4]. Data regarding the long-term mortality of geriatric patients with ventricular tachyarrhythmias is rare [4, 5]. Therefore, the present study investigated the clinical characteristics of older (> 60 years old) and middle-aged (40–60 years old) patients and evaluates the prognostic impact of age compared to other clinical parameters on the short-term and long-term outcomes of patients presenting with VTA and aborted cardiac arrest on hospital admission.

Methods

Study patients, design, and data collection

The present study is derived from an analysis of the Registry of Malignant Arrhythmias and Sudden Cardiac Death—Influence of Diagnostics and Interventions (RACE-IT) and presents a single-center registry of consecutive patients presenting to the UMM between 2002 and 2016 with VTA and SCD (clinicaltrials.gov identifier: NCT02982473; date of registration 5 December 2016) as previously published [6, 7] (suppl. Fig. 1, flowchart). The registry was established according to the principles of the Declaration of Helsinki and was approved by the Ethics Committee II of the Faculty of Medicine Mannheim, University of Heidelberg, Germany. VTA was defined according to current guidelines as previously published [2, 7].

Definition of study groups and inclusion and exclusion criteria

Risk in the present analysis was stratified according to age, with both age as a binary and age as a continuous variable. For analysis with age as a binary variable, middle-aged (40–60 years old) patients were compared to older patients (> 60 years old) [8]. Furthermore, patients > 75 years were compared to patients < 75 years. Patients younger than 40 years old were excluded.

Study endpoints

The primary endpoint was all-cause mortality at long-term follow-up of 2.5 years. The secondary endpoints were cardiac death at 24 h, all-cause mortality at index hospitalization, all-cause mortality after index hospitalization and the composite endpoint at 2.5 years of cardiac death at 24 h, recurrent VTA and appropriate ICD treatment.
As previously published, the statistical methods included multivariate Cox regression models, Kaplan-Meier analyses, and propensity score matching [7].

Results

Study population before propensity score matching

The present study included a total of 2259 consecutive patients presenting with VTA and aborted cardiac arrest. Of these, 28% were middle-aged (40–60 years old) and 72% were older (> 60 years old) (suppl. Fig. 1, flowchart). As outlined in Table 1, older patients showed higher rates of VT and middle-aged patients showed higher rates of VF. Middle-aged patients had higher rates of CPR due mainly to out-of-hospital CPR. Older patients suffered more often from arterial hypertension, diabetes mellitus and hyperlipidemia, whereas middle-aged patients showed higher rates of a family history of cardiac diseases and smoking. Prior CAD and prior myocardial infarction were more common in older patients; however, middle-aged patients had higher rates of acute myocardial infarction, coronary angiography and electrophysiological examination at index. Nonischemic cardiomyopathy was more frequent among the middle-aged and atrial fibrillation was more frequent among the older patients, besides CKD and chronic obstructive pulmonary disease (COPD). Older patients showed higher rates of prior heart failure, acute heart failure at index and highly restricted LVEF < 35%. Furthermore, older patients had higher rates of device treatment and they were more likely to take beta blockers, ACE inhibitors, angiotensin receptor blockers, statins, amiodarone and digitalis. Study population after propensity score matching is shown in suppl. Table 4.
Table 1
Baseline characteristics before propensity matching
Characteristic
40–60 years old
(n = 628; 28%)
> 60 years old
(n = 1631; 72%)
p value
Age, median years (range)
52 (40–60)
73 (61–97)
0.001
Male gender, n (%)
456
(73)
1184
(73)
0.993
Ventricular tachyarrhythmias at index, n (%)
VT
311
(50)
960
(59)
0.001
Sustained
138
(44)
437
(46)
0.724
Non-sustained
173
(28)
523
(32)
0.037
Induced
110
(37)
282
(30)
0.034
Fast
292
(98)
916
(99)
0.547
Slow
6
(2)
14
(2)
Monomorphic
290
(97)
898
(97)
0.522
Polymorphic
8
(3)
32
(3)
VF
317
(50)
671
(41)
0.001
Cardiopulmonary resuscitation, n (%)
314
(50)
772
(47)
0.001
In-hospital
94
(15)
365
(22)
Out-of-hospital
220
(35)
407
(25)
Cardiovascular risk factors, n (%)
Arterial hypertension
286
(46)
1062
(65)
0.001
Diabetes mellitus
102
(16)
526
(32)
0.001
Hyperlipidemia
157
(25)
492
(30)
0.015
Smoking
262
(42)
352
(22)
0.001
Cardiac family history
94
(15)
102
(6)
0.001
Comorbidities, n (%)
Prior myocardial infarction
97
(15)
446
(27)
0.001
Prior coronary artery disease
154
(25)
790
(48)
0.001
Prior heart failure
105
(17)
443
(27)
0.001
Prior PTCA
91
(15)
398
(24)
0.001
Prior CABG
35
(6)
263
(16)
0.001
Atrial fibrillation
95
(15)
612
(38)
0.001
Paroxysmal
77
(12)
421
(26)
0.001
Persisting
12
(2)
48
(3)
Permanent
6
(1)
143
(9)
Nonischemic cardiomyopathy
47
(8)
78
(5)
0.012
Chronic kidney disease
231
(38)
928
(59)
0.001
COPD
27
(4)
180
(11)
0.001
Asthma
5
(1)
16
(1)
0.682
Comorbidities at index, n (%)
Cardiogenic shock
46
(7)
236
(15)
0.001
Acute heart failure
90
(14)
298
(18)
0.026
Acute myocardial infarction at index, n (%)
217
(35)
459
(28)
0.003
STEMI
93
(15)
140
(9)
0.001
NSTEMI
124
(20)
319
(20)
0.920
Coronary angiography at index, n (%)
409
(65)
960
(59)
0.006
No evidence of CAD
122
(30)
213
(22)
0.001
1‑vessel disease
117
(29)
195
(20)
2‑vessel disease
97
(24)
237
(25)
3‑vessel disease
73
(18)
315
(33)
Presence of chronic total occlusion
55
(13)
235
(25)
0.001
Presence of CABG
28
(7)
155
(16)
0.001
PCI
217
(53)
415
(43)
0.001
Left ventricular ejection fraction, n (%)
Not documented
171
(27)
433
(27)
1.000
>55%
170
(27)
297
(18)
0.001
45–54%
65
(10)
161
(10)
35–44%
85
(14)
248
(15)
<35%
137
(22)
492
(30)
Cardiac treatment at index, n (%)
Electrophysiological examination
177
(28)
340
(21)
0.001
VT ablation treatment
36
(6)
70
(4)
0.147
Device treatment overall, n (%)
226
(46)
555
(52)
0.016
Medication at discharge, n (%)
Beta blocker
390
(79)
891
(84)
0.016
ACE inhibitor
304
(61)
713
(67)
0.027
ARB
39
(8)
145
(14)
0.001
Statin
301
(61)
704
(66)
0.035
Amiodarone
54
(11)
200
(19)
0.001
Digitalis
43
(9)
163
(15)
0.001
Aldosterone antagonist
54
(11)
121
(11)
0.781
Follow-up times
Hospitalization total, days- median (IQR)
10
(4–17)
11
(5–22)
0.001
ICU time, days- median (IQR)
2
(0–7)
3
(0–8)
0.134
Follow-up, days- mean; median (range)
1832; 1709
1116; 491
0.001
(0–5089)
(0–5106)
Bold type indicates statistical significance p < 0.05
ACE angiotensin-converting enzyme, ARB angiotensin receptor blocker, CABG coronary artery bypass grafting, CAD coronary artery disease, COPD chronic obstructive pulmonary disease, ICU intensive care unit, IQR interquartile range, NSTEMI non-ST-segment myocardial infarction, PCI percutaneous coronary intervention, PTCA percutaneous transluminal coronary angioplasty, STEMI ST-segment myocardial infarction, VF ventricular fibrillation, VT ventricular tachycardia

Primary and secondary endpoints before propensity score matching

As shown in Table 2, left panel, older patients > 60 years old in the unmatched cohort showed higher rates of all-cause mortality at 2.5 years (27% vs. 50%, p = 0.001, hazard ratio, HR = 2.137, 95% confidence interval, CI 1.809–2.523, p = 0.001), cardiac death at 24 h and all-cause mortality at index hospitalization and after index hospitalization. Furthermore, older patients showed higher rates of the composite endpoint at 2.5 years (24% vs. 34%, p = 0.001, HR = 1.471; 95% CI 1.230–1.759, p = 0.001). Even after propensity score matching, older patients showed increased mortality at 2.5 years, as shown in Table 2, right panel.
Table 2
Primary and secondary endpoints for all patients before and after propensity score matching
 
Before matching
After matching
Characteristic
40–60 years old
(n = 628; 28%)
> 60 years old
(n = 1631; 72%)
p value
40–60 years old
(n = 442; 50%)
> 60 years old
(n = 442; 50%)
p value
Primary endpoint, n (%)
All-cause mortality at 2.5 years
168
(27)
812
(50)
0.001
83
(19)
156
(35)
0.001
Secondary endpoints, n (%)
Cardiac death at 24 h
80
(13)
335
(21)
0.001
25
(6)
40
(9)
0.053
All-cause mortality at index hospitalization
131
(21)
564
(35)
0.001
57
(13)
86
(20)
0.001
All-cause mortality after index hospitalization
96
(15)
536
(33)
0.001
81
(18)
154
(35)
0.001
Composite endpoint at 2.5 years
(Cardiac death at 24 h, recurrent ventricular tachyarrhythmias, appropriate ICD treatment)
153
(24)
557
(34)
0.001
80
(18)
109
(25)
0.020
ICD implantable cardioverter-defibrillator

Multivariate Cox regression models before propensity score matching with age as binary variable

Age was significantly associated with the primary endpoint all-cause mortality at 2.5 years. Other predictors of this endpoint were CKD, LVEF < 35%, cardiogenic shock, CPR and male gender. The presence of an ICD and AMI were beneficial. (Table 3, upper panel). Age > 60 years was also significantly associated with the composite endpoint at 2.5 years. Other predictors of this endpoint were cardiogenic shock, ICD, LVEF < 35%, CPR and CKD; however, STEMI was not significantly associated with this endpoint (Table 3, lower panel). Furthermore, patient age as a continuous variable was independently associated with mortality at 2.5 years in all types of VTA (suppl. Tables 1–3).
Table 3
Multivariate Cox regression analyses for all patients before propensity score matching
Endpoint
HR
95% CI
p value
All-cause mortality at 2.5 years
Male gender
1.283
1.059–1.554
0.011
Chronic kidney disease
2.453
2.022–2.976
0.001
Diabetes
1.090
0.914–1.300
0.336
STEMI
0.504
0.362–0.703
0.001
NSTEMI
0.787
0.634–0.975
0.029
Cardiogenic shock
1.796
1.479–2.182
0.001
CPR
1.745
1.566–1.944
0.001
ICD
0.239
0.193–0.296
0.001
LVEF < 35%
2.039
1.713–2.427
0.001
CAD
0.879
0.722–1.070
0.200
Age > 60 years
2.068
1.627–2.630
0.001
Composite endpoint at 2.5 years
Male gender
1.002
0.802–1.250
0.989
Chronic kidney disease
1.355
1.105–1.661
0.004
Diabetes
0.905
0.733–1.118
0.356
STEMI
0.456
0.282–0.738
0.001
NSTEMI
0.879
0.671–1.151
0.348
Cardiogenic shock
1.502
1.167–1.933
0.002
CPR
1.371
1.202–1.564
0.001
ICD
1.451
1.173–1.794
0.001
LVEF < 35%
1.437
1.175–1.758
0.001
CAD
0.844
0.676–1.055
0.136
Age > 60 years
1.621
1.261–2.084
0.001
Bold type indicates statistical significance p < 0.05
CAD coronary artery disease, CI confidence interval, HR hazard ratio, CPR cardiopulmonary resuscitation, ICD implantable cardioverter-defibrillator, LVEF left ventricular ejection fraction, NSTEMI non-ST-segment myocardial infarction, STEMI ST-segment myocardial infarction

Kaplan-Meier analyses after propensity score matching

As shown in Fig. 1, older patients > 60 years had a worse long-term prognosis for all-cause mortality (18% vs. 35%, p = 0.001, HR = 2.023; 95% CI 1.550–2.641, p = 0.001) and the composite endpoint at 2.5 years (18% vs. 25%, p = 0.006, HR = 1.401; 95% CI 1.050–1.870, p = 0.020). Furthermore, patients ≥ 75 years were associated with increased mortality at 2.5 years and an increased risk of the composite endpoint (suppl. Fig. 2).

Multivariate Cox regression analysis

The multivariate Cox regression model values in Table 4 show consistent significant associations of CKD, LVEF < 35% and CPR with all-cause mortality at 2.5 years and the composite endpoint at 2.5 years for both middle-aged (40–60 years old) and older patients > 60 years old. In contrast, STEMI and ICD at index were beneficial. There was an association among middle-aged patients after cardiogenic shock and ICD treatment with all-cause mortality at 2.5 years, despite a lack of association with the composite endpoint.
Table 4
Multivariate Cox regression models for middle-aged (40–60 years old) and older patients > 60 years old
  
All-cause mortality at 2.5 years
 
Composite endpoint at 2.5 years
(Cardiac death at 24 h, recurrent ventricular tachyarrhythmias, appropriate ICD treatment)
Variables
40–60 years
> 60 years
40–60 years
> 60 years
 
HR
95% CI
p value
HR
95% CI
p value
HR
95% CI
p value
HR
95% CI
p value
Male gender
1.430
0.864–2.365
0.164
1.263
1.025–1.556
0.028
0.981
0.593–1.621
0.939
1.013
0.790–1.298
0.921
Diabetes
1.211
0.694–2.113
0.501
1.135
0.941–1.369
0.185
0.494
0.241–1.013
0.054
0.950
0.758–1.190
0.656
Chronic kidney disease
3.226
1.939–5.365
0.001
2.261
1.833–2.789
0.001
1.751
1.106–2.774
0.017
1.292
1.028–1.622
0.027
Atrial fibrillation
1.398
0.805–2.427
0.234
1.101
0.919–1.319
0.295
1.598
0.958–2.664
0.072
0.831
0.668–1.033
0.096
Cardiogenic shock
1.929
1.148–3.240
0.001
1.755
1.421–2.168
0.001
1.398
0.705–2.773
0.337
1.525
1.158–2.010
0.003
CPR
2.031
1.439–2.866
0.001
1.663
1.455–1.901
0.001
1.607
1.117–2.311
0.011
1.470
1.245–1.735
0.001
Coronary artery disease
0.781
0.456–1.338
0.368
0.940
0.757–1.167
0.577
0.609
0.363–1.021
0.060
0.919
0.712–1.185
0.517
NSTEMI
0.427
0.205–0.890
0.023
0.875
0.696–1.100
0.253
0.659
0.296–1.468
0.307
0.988
0.739–1.323
0.938
STEMI
0.395
0.175–0.883
0.024
0.523
0.360–0.762
0.001
0.747
0.286–1.953
0.552
0.421
0.237–0.746
0.003
ICD
0.118
0.061–0.227
0.001
0.260
0.207–0.327
0.001
1.424
0.857–2.364
0.172
1.494
1.180–1.893
0.001
LVEF < 35%
2.303
1.429–3.712
0.001
1.902
1.575–2.297
0.001
1.654
1.028–2.661
0.038
1.378
1.103–1.723
0.005
Ventricular fibrillation
0.828
0.459–1.494
0.531
1.091
0.871–1.342
0.478
0.455
0.254–0.816
0.008
0.868
0.666–1.130
0.293
Bold type indicates statistical significance p < 0.05
CPR cardiopulmonary resuscitation, ICD implantable cardioverter-defibrillator, LVEF left ventricular ejection fraction, NSTEMI non-ST-segment elevation myocardial infarction, STEMI ST-segment elevation myocardial

Discussion

The results of the present study suggest that increasing age is associated with increased mortality in VTA patients. Compared to the middle-aged (40–60 years old), older patients > 60 years old were associated with higher all-cause mortality at 2.5 years, all-cause mortality at index hospitalization and after index hospitalization, cardiac death at 24 h, and the composite endpoint at 2.5 years. The overall all-cause mortality rate in Germany in 2015 was far lower than that seen is this study; however, the mortality rate for the elderly was 12 times higher than that of the middle-aged (0.97% ÷ 0.08% = 12) (© Statistisches Bundesamt [Destatis], 2021).
Compared to the general population the overall 2015 all-cause mortality rate within our university medical centre across all fields of specializations was higher than in the general population but for patients > 60 years old only 2.8 times higher than that of middle-aged patients (4.8% ÷ 1.7% = 2.8).
This increase in mortality rate is related to the disease severity and the number of affected patients in the hospital population; however, the lower ratio of age-dependent mortality rates in the hospital population is caused by the preselection of diseased people and the exclusion of healthy individuals, who are more numerous in the general population. Respectively within a cardiologic department. Here, the mortality rate for elderly patients is only 1.6 times higher than that of middle-aged patients (10.3% ÷ 6.3% = 1.6). In this context, all-cause mortality rates in the present preselected cohort of patients with VTA are even higher, whereas the ratio between age groups is further reduced (before propensity score matching: 50% ÷ 27% = 1.85; after propensity score matching: 34% ÷ 18% = 1.9).
In daily clinical routine patients age is regarded as one of the highest prognosis-limiting factors and geriatric patients are predicted to have the worst prognosis. The present data suggests that patient age influences mortality in VTA patients but has less influence on mortality then in the general and the overall hospital population. Therefore, risk stratification in VTA patients should not be applied only by chronological age and needs to be seen in context with other comorbidities that influence the biological age of a patient.
The biological vascular age is determined by chronic diseases, such as CDK and heart failure that are in a bidirectional relationship with functional and structural changes in vessels, such as arterial wall stiffness, arterial hypertension, intima thickening and endothelial dysfunction [1].
The present study revealed that CKD and heart failure with LVEF < 35% on admission are consistently associated with an adverse prognosis for mortality, cardiac death, and recurrent VTA for both middle-aged and older patients. This suggests that besides the chronological age the biological age influences mortality in VTA patients.
In the present study a beneficial effect of an ICD on the prevention of all-cause mortality at 2.5 years, cardiac death at 24 h, recurrent ventricular tachyarrhythmias, and ICD treatment in patients > 60 years old was shown. In general, the ICD implantation effectively decreased long-term mortality in patients with LVEF < 35% irrespective of the underlying type of heart failure. International guidelines recommend implanting an ICD at any age when assuming a life expectancy of at least 1 year [2, 9]; however, clinical trials on ICDs frequently exclude geriatric patients [4, 10, 11], which raises doubts about the benefit, efficacy and safety of ICD implantation in geriatric patients [2]. Therefore, further studies on geriatric patients examining the safety and effectiveness of the ICD would be desirable.
There is no distinctive guideline-recommended treatment for geriatric patients presenting with ventricular tachyarrhythmias, such as specific antiarrhythmic drug treatment and VT catheter ablation, because older patients frequently suffer from various heterogeneous comorbidities [10]. Furthermore, older patients commonly suffer adverse side effects from antiarrhythmic drugs because of decreased physiological function, polypharmacy, and frailty syndrome [10, 12]. Therefore, geriatric patients in particular should receive individualized treatment designed by multidisciplinary teams, as they are in greater danger of ventricular tachyarrhythmias and sudden cardiac arrest.

Study limitations

Study limitations were previously published [7]. The ICD programming changed during the last years, mainly due to the knowledge of the MADIT-RIT study (Multicenter Automatic Defibrillator Implantation Trial–Reduce Inappropriate Therapy) in 2012 and might have influenced the endpoints in the present study [13]. Due to the study’s retrospective nature, no geriatric assessments were carried out and documented, which could be included in the evaluation of a patient’s prognosis.

Conclusion

The results of the present study suggest that increasing age is associated with increased mortality in VTA patients. Compared to the middle-aged (40–60 years old), older patients > 60 years old were associated with higher all-cause mortality at 2.5 years, all-cause mortality at index hospitalization and after index hospitalization, cardiac death at 24 h, and the composite endpoint at 2.5 years. In both middle-aged and older patients CKD and LVEF < 35% were associated with impaired prognosis at 2.5 years, which implies a high impact of both chronological and biological age on mortality of VTA patients. The presence of an ICD predicted better prognosis in both middle-aged and older patients.

Declarations

Conflict of interest

K. Weidner, T. Schupp, J. Rusnak, I. El-Battrawy, U. Ansari, J. Hoppner, J. Mueller, M. Kittel, G. Taton, L. Reiser, A. Bollow, T. Reichelt, D. Ellguth, N. Engelke, D. Große Meininghaus, M. Akin, T. Bertsch, I. Akin and M. Behnes declare that they have no competing interests.
For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://​creativecommons.​org/​licenses/​by/​4.​0/​.

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Metadaten
Titel
Impact of age on the prognosis of patients with ventricular tachyarrhythmias and aborted cardiac arrest
verfasst von
Dr. Kathrin Weidner, MD
Tobias Schupp, MD
Jonas Rusnak, MD
Ibrahim El-Battrawy, MD
Uzair Ansari, MD
Jorge Hoppner, MD
Julian Mueller, MD
Maximilian Kittel, MD
Gabriel Taton, MD
Linda Reiser, MD
Armin Bollow, MD
Thomas Reichelt, MD
Dominik Ellguth, MD
Niko Engelke, MD
Dirk Große Meininghaus, MD
Muharrem Akin, MD
Thomas Bertsch, MD
Ibrahim Akin, MD
Prof. Dr. Michael Behnes, MD
Publikationsdatum
08.12.2022
Verlag
Springer Medizin
Erschienen in
Zeitschrift für Gerontologie und Geriatrie / Ausgabe 6/2023
Print ISSN: 0948-6704
Elektronische ISSN: 1435-1269
DOI
https://doi.org/10.1007/s00391-022-02131-6

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