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Most older patients with ICDs survive 2 years, but hospitalization rates high
According to new data published in the Journal of the American College of Cardiology, about 80% of older patients who receive secondary prevention implantable cardioverter defibrillators survive at least 2 years, but risk for death increased significantly as age increased.
The researchers also found that rates of hospitalization and admission to skilled nursing facilities were high in this population.
“Although the outcomes in patients receiving an ICD for primary prevention have been characterized in detail, those for patients receiving secondary prevention ICDs are substantially more limited,” Jarrod K. Betz, MD, from the department of medicine, University of Colorado, Denver, and colleagues wrote in the study background.
The researchers analyzed 12,420 Medicare beneficiaries across 956 U.S. hospitals from the National Cardiovascular Data Registry who were undergoing first-time secondary prevention ICD implantation between 2006 and 2009.
Over 2 years, they assessed risk for death, hospitalization and admission to a skilled nursing facility using medical claims and used multivariable tools to evaluate the adjusted association between age and outcomes.
Patients were included in the study if they had a prior episode of tachycardic arrest, sustained monomorphic ventricular tachycardia or sustained polymorphic ventricular tachycardia.
At the time of implantation, the mean age of the patients was 75 years, with 25.3% younger than 70 years and 25.7% aged at least 80 years.
Risk rose with age
At 2 years, the overall risk for death was 21.8%, ranging from 14.7% among those younger than 70 years to 28.9% among those aged at least 80 years (adjusted RR = 2.01; 95% CI, 1.85-2.33), Betz and colleagues wrote.
According to the researchers, the cumulative incidence of hospitalizations was 65.4%, including 60.5% in patients younger than 70 years and 71.5% in patients aged at least 80 years (adjusted RR = 1.27; 95% CI, 1.19-1.36).
The cumulative incidence of admission to a skilled nursing facility ranged from 13.1% among those younger than 70 years to 31.9% among those aged at least 80 years (adjusted
RR = 2.67; 95% CI, 2.37-3.01); skilled nursing facility admission risk was highest in the first 30 days, the researchers wrote.
Benefit uncertain
In a related editorial, Sumeet S. Chugh, MD, from Cedars-Sinai Medical Center, and colleagues wrote that the data do not appear to help with risk stratification.
“On the basis of the available evidence, any mortality benefit of secondary prevention ICDs in patients over 80 years of age remains uncertain. In fact, we cannot rule out the possibility of adverse effects on the elderly patient, especially in terms of hospitalization and admission to skilled nursing facilities,” Chugh and colleagues wrote. “In either scenario, the significant costs to the health care system may not be justifiable.”
Until a randomized trial is performed, clinicians should consider all comorbidities and frailty in addition to age when deciding who should get an ICD, communicate all rationales and limitations of the ICD to the patient and discuss deactivating the ICD if the patient is nearing end of life, Chugh and colleagues wrote. – by Dave Quaile
Disclosure: Betz and the editorial writers report no relevant financial disclosures. Please see the full study for a list of the other researchers’ relevant financial disclosures.