This article is more than 5 years old. Information may no longer be current.
ICDs underutilized in elderly patients after MI
Click Here to Manage Email Alerts
Fewer than one in 10 older adults who were eligible for an implantable cardioverter defibrillator received one, despite a significantly reduced risk for mortality at 2 years in those who received an implantable cardioverter defibrillator, according to results of a large registry study.
Researchers analyzed data on 10,318 patients with MI and ejection fraction of 35% or less who were treated at 441 U.S. hospitals from 2007 to 2010. The patients’ median age was 78 years and none had received an ICD before enrollment. For the study, the researchers compared patients who received an ICD within 1 year after MI vs. those who did not receive an ICD. Follow-up was conducted through December 2010 (median, 718 days).
Overall, 8.1% of patients received an ICD within 1 year after MI.
Patients who did not receive an ICD were more likely to be older, female and have end-stage renal disease. Compared with no ICD, patients who received an ICD were significantly more likely to have previously undergone CABG (adjusted HR = 1.49; 95% CI, 1.26-1.78), have a higher rate of in-hospital carcinogenic shock (adjusted HR = 1.57; 95% CI, 1.25-1.97), have increased peak troponin levels (adjusted HR = 1.02; 95% CI, 1.01-1.03 per 10-fold increase) and have a higher rate of cardiology follow-up within 2 weeks of discharge (adjusted HR = 1.64; 95% CI, 1.37-1.95).
Sean D. Pokorney, MD, MBA, from the cardiology division at Duke University Medical Center, and colleagues noted that ICD implantation was significantly associated with reduced risk for 2-year mortality. In an unadjusted analysis, the researchers observed 15.3 events per 100 patient-years among patients who received an ICD vs. 26.4 events per 100 patient-years among patients who did not receive an ICD. This association persisted after adjustment for patient characteristics and time-dependent readmissions for HF or MI after discharge (adjusted HR = 0.64; 95% CI, 0.53-0.78).
In addition, the link between ICDs and mortality was observed regardless of age or sex. Sensitivity analyses excluding patients with end-stage renal disease, a history of cancer and a history of stroke yielded similar results (adjusted HR = 0.62; 95% CI, 0.48-0.79), as did an analysis that included only patients who survived for 40 days after MI (adjusted HR = 0.65; 95% CI, 0.53-0.79).
In a related editorial, Robert G. Hauser, MD, cardiologist at Minneapolis Heart Institute, noted that these findings provide important information about the use of ICDs and clinical outcomes after MI.
“It is concerning that so few potentially ICD-eligible elderly patients are undergoing implantation, especially considering that ICDs significantly improve survival,” he wrote. “A possible scenario is that many of these patients did not receive an appropriate ICD simply because they fell into a crevasse of the fragmented health care system in which overly burdened primary care physicians are expected to connect all the clinical and diagnostic information without the essential tools and necessary facts.” – by Adam Taliercio
Disclosure: Pokorney reports receiving grant/research support from AstraZeneca, Boston Scientific and Gilead, and serving on an advisory board for Janssen Pharmaceuticals. Hauser reports no relevant financial disclosures.
Click Here to Manage Email Alerts