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More studies needed to assess risks, benefits of cardiac devices in older patients

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More than one-fifth of patients who receive cardiac devices are aged 80 years or older and may be at increased risk for complications or death following cardiac defibrillator or pacemaker implantation, study results suggested.

“Implantable cardiac devices have been increasingly used in primary prevention of sudden cardiac death among patients with systolic HF, largely on the basis of favorable results from large multicenter clinical trials,” wrote researchers from the Saint Louis University School of Medicine and the Washington University School of Medicine, both in St. Louis.

However, they noted that the average patient age in major clinical trials typically ranges from 58 to 67 years, with some trials specifying an upper age limit of 80 years — limiting the amount of available data for device use in older adults.

To better understand the importance of advanced age in cardiac device procedures, the researchers analyzed data from PREMIER’s Perspective Comparative Database, an administrative claims system that included information from 26,887 adults who were hospitalized with HF diagnosis and had a defibrillator implanted or who underwent cardiac resynchronization therapy in 2004 or 2005. Median patient age was 70 years; 17.5% were aged 80 years or older, 21.1% were aged older than 85 years and 6.6% were aged 89 years or older.

Findings indicated that in-hospital death rates increased from 0.7% among patients aged younger than 80 years to 1.2% among those aged 80 to 85 years and 2.2% among those aged older than 85 years (P<.001). Patients aged 80 years or older were more likely to receive cardiac resynchronization therapy alone compared with younger patients. Concomitant cardiac procedures and a high comorbidity score were less likely among older patients; however, younger patients experienced complications less frequently (P=.03).

“Given trends in the demographics of HF and the costs of device therapy, additional studies are required to clarify the appropriateness of device implantation in older patients with HF, as well as the merits of less invasive options,” the researchers wrote.

Swindle JP. Arch Intern Med. 2010;170:631-637.

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