Arrhythmias and Conduction Disturbances
Effect of Age on Survival and Causes of Death After Primary Prevention Implantable Cardioverter-Defibrillator Implantation

https://doi.org/10.1016/j.amjcard.2015.02.031Get rights and content

The benefit of implantable cardioverter-defibrillators (ICDs) remains controversial in elderly patients and may be attenuated by a greater risk of nonarrhythmic death. We examined the effect of age on outcomes after prophylactic ICD implantation. All patients with coronary artery disease or dilated cardiomyopathy implanted with an ICD for primary prevention of sudden cardiac death in 12 French medical centers were included in a retrospective observational study. The 5,534 ICD recipients were divided according to age: 18 to 59 years (n = 2,139), 60 to 74 years (n = 2,693), and ≥75 years (n = 702). Greater prevalences of coronary artery disease and atrial fibrillation at the time of implant were observed with increasing age (both p <0.0001). During a mean follow-up of 3.1 ± 2.0 years, the annual mortality rate increased with age: 3.1% per year for age 18 to 59 years, 5.7% per year for age 60 to 74 years, and 7.5% per year for age ≥75 years (p <0.001). Older age was independently associated with a greater risk of death (adjusted odds ratio 1.43, 95% confidence interval 1.14 to 1.80 for age 60 to 74 years; and adjusted odds ratio 1.65, 95% confidence interval 1.22 to 2.22 for age >75 years). Proportions of cardiac deaths (55.2%, 57.6%, and 57.0%, p = 0.84), including ICD-unresponsive sudden death (9.9%, 6.0%, and 10.6%, p = 0.08), and rates of appropriate ICD therapies were similar in the 3 age groups. Older age was independently associated with a higher rate of early complications and a lower rate of inappropriate therapies. In conclusion, older patients exhibited higher global mortality after ICD implantation for primary prevention, whereas rates of sudden deaths and of appropriate device therapies were similar across age groups.

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Methods

All patients with coronary artery disease or dilated cardiomyopathy implanted with an ICD for primary prevention of SCD at 12 centers (9 university hospitals and 3 private centers) in France from January 2002 through January 2012 were included in this retrospective, observational, single-center study (Défibrillateur Automatique Implantable en Prévention Primaire [DAI-PP]). Patients were implanted in the setting of primary prevention (no previous episode of sudden cardiac arrest or arrhythmic

Results

Of the 5,539 ICD recipients in this registry, age was known in 99.9% (n = 5,534): 38.7% were aged 18 to 59 years, 48.7% 60 to 74 years, and 12.7% ≥75 years (Table 1). The prevalences of coronary artery disease and atrial fibrillation, and the median ejection fraction, increased with higher age group (all p values <0.0001). The prevalence of noncardiovascular co-morbidities (lung disease, liver disease, cancer) also increased with older age. Older patients (≥60 years) were more likely than

Discussion

In view of the aging population, the use and associated outcomes of ICD implantation in elderly patients for the primary prevention of SCD is gaining interest. In this population-based French registry of patients who underwent new ICD implantation in routine clinical practice, nearly 50% of patients were ≥60 years and 13% were ≥75 years. Older patients (≥60 years) had a greater risk profile than younger patients and were more likely to receive a cardiac resynchronization therapy defibrillator

Acknowledgment

The authors thank the investigators of the enrolling centers for participating in the study and sharing their data; the Research Assistants and Associates Frankie Beganton, MS, Nicolas Estrugo, MS, Sandrine Hervouet, MS, Nathalie de Carsin, MS, Radu Mosei, MD, Frederic Treguer, MD, Juliette Tennenbaum, MD, Raoul Hubac-Coupet, MD, Alexandre Bendavid, MD and Marine Sroussi, MD, for collecting the data; and the Arrhythmia Group of the French Society of Cardiology for supporting this project. Mrs

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  • Cited by (0)

    Funding: This work was supported by the following independent institutions: the Toulouse Association for the Study of Rhythm Disturbances; the French Institute of Health and Medical Research; and the French Society of Cardiology.

    See page 1421 for disclosure information.

    The full list of investigators is detailed in Appendix 1.

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