Mahmoud Suleiman1, Ilan Goldenberg2, Moti Haim3, Jorge E Schliamser4, Monther Boulos1, Michael Ilan5, Moshe Swissa6, Natalie Gavrielov-Yusim7, Therese Fuchs8, Guy Amit9, Michael Glikson7. 1. Rambam Medical Center, Haifa. 2. Israeli Association for Cardiovascular Trials, Sheba Medical Center, Tel Hashomer. Electronic address: ilan.goldenberg@sheba.health.gov.il. 3. Meir Medical Center, Kfar Saba. 4. Carmel Medical Center, Haifa. 5. Shaare Zedek Medical Center, Jerusalem. 6. Kaplan Medical Center, Rehovot. 7. Israeli Association for Cardiovascular Trials, Sheba Medical Center, Tel Hashomer. 8. Assaf Harofeh Medical Center, Tzrifin. 9. Soroka Medical Center, Beer Sheva, Israel.
Abstract
BACKGROUND: Elderly patients are underrepresented in clinical trials of device therapy. OBJECTIVE: To provide real-world data regarding outcomes associated with device-based therapy in a large cohort of elderly patients enrolled in the Israeli ICD Registry. METHODS: Between July 2010 and June 2012, a total of 2807 consecutive patients undergoing implanted cardioverter-defibrillator/cardiac resynchronization therapy-defibrillator (ICD/CRT-D) implantation were prospectively enrolled in the Israeli ICD Registry. For the present analysis, patients were categorized into 3 age groups: ≤60 years (n = 1378 [49%]), 61-75 years (n = 863 [31%]), and >75 years (n = 566 [20%]). RESULTS: Elderly patients (>75 years of age) had more comorbid conditions and were more likely to undergo CRT-D implantation (all P < .01). However, the rate of device-related complications associated with surgical reinterventions at 1 year was <3% regardless of age (P = .70 for the comparison among the 3 age groups). Multivariate analysis showed that the risk of heart failure or death and of appropriate ICD therapy for ventricular arrhythmias was significantly increased with increasing age among patients who received an ICD. In contrast, the age-related increase in the risk of all end points was attenuated among patients who received CRT-D devices (all P values for age-by-device-type interactions are <.05). CONCLUSIONS: In a real-world scenario, elderly patients (>75 years of age) comprise approximately 20% of the ICD/CRT-D recipients and experience a device reintervention rate similar to that of their younger counterparts. Our data suggest that the association between advanced age and adverse clinical outcomes is attenuated in elderly patients implanted with CRT-D devices.
BACKGROUND: Elderly patients are underrepresented in clinical trials of device therapy. OBJECTIVE: To provide real-world data regarding outcomes associated with device-based therapy in a large cohort of elderly patients enrolled in the Israeli ICD Registry. METHODS: Between July 2010 and June 2012, a total of 2807 consecutive patients undergoing implanted cardioverter-defibrillator/cardiac resynchronization therapy-defibrillator (ICD/CRT-D) implantation were prospectively enrolled in the Israeli ICD Registry. For the present analysis, patients were categorized into 3 age groups: ≤60 years (n = 1378 [49%]), 61-75 years (n = 863 [31%]), and >75 years (n = 566 [20%]). RESULTS: Elderly patients (>75 years of age) had more comorbid conditions and were more likely to undergo CRT-D implantation (all P < .01). However, the rate of device-related complications associated with surgical reinterventions at 1 year was <3% regardless of age (P = .70 for the comparison among the 3 age groups). Multivariate analysis showed that the risk of heart failure or death and of appropriate ICD therapy for ventricular arrhythmias was significantly increased with increasing age among patients who received an ICD. In contrast, the age-related increase in the risk of all end points was attenuated among patients who received CRT-D devices (all P values for age-by-device-type interactions are <.05). CONCLUSIONS: In a real-world scenario, elderly patients (>75 years of age) comprise approximately 20% of the ICD/CRT-D recipients and experience a device reintervention rate similar to that of their younger counterparts. Our data suggest that the association between advanced age and adverse clinical outcomes is attenuated in elderly patients implanted with CRT-D devices.
Authors: Elena de la Cruz; Marcelino Cortés; Jerónimo Farré; Julia Palfy; Paloma Ávila; Ignacio Hernández; Angélica Romero; Juan Benezet; Juan Antonio Franco; Miguel Angel Navas; Jose Joel Hernandez; Sem Briongos; José M Rubio Journal: J Interv Card Electrophysiol Date: 2015-02-17 Impact factor: 1.900
Authors: Bartosz Olechowski; Rebecca Sands; Donah Zachariah; Neil P Andrews; Richard Balasubramaniam; Mark Sopher; John Paisey; Paul R Kalra Journal: J Geriatr Cardiol Date: 2015-09 Impact factor: 3.327
Authors: Leonard Bergau; Tobias Tichelbäcker; Barbora Kessel; Lars Lüthje; Thomas H Fischer; Tim Friede; Markus Zabel Journal: PLoS One Date: 2017-10-17 Impact factor: 3.240
Authors: Samaneh Salimian; Marc W Deyell; Jason G Andrade; Santabhanu Chakrabarti; Matthew T Bennett; Andrew D Krahn; Nathaniel M Hawkins Journal: Heart Rhythm O2 Date: 2021-12-17