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Vijayarajan V, Hsu A, Cheng YY, Shu MWS, Hyun K, Sy R, Chow V, Brieger D, Kritharides L, Ng ACC. Outcomes Following Implantable Cardioverter-Defibrillator Insertion in Patients 80 Years of Age or Older: A Statewide Population Cohort Study. Can J Cardiol 2024; 40:389-398. [PMID: 37898173 DOI: 10.1016/j.cjca.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/10/2023] [Accepted: 10/23/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Patients ≥ 80 years of age are underrepresented in major implantable cardioverter-defibrillator (ICD) trials, and real-world data are lacking. In this study, we sought to assess ICD utilisation, outcomes, and their predictors, in an unselected statewide population including patients ≥ 80 years old. METHODS We extracted details of ICDs implanted from 2009 to 2018 in New South Wales (NSW), Australia from the Centre for Health Record Linkage administrative data sets. Analysis was stratified into age groups of < 60 years, 60-79 years, and ≥ 80 years. RESULTS A total of 9304 patients (mean age 66.1 ± 13.1 years; 12.1% ≥ 80 years) had de novo ICD placement at an average rate of 1163 ± 122 patients per annum, with more implants in men in all age groups. After adjusting for NSW population size by sex, age group, and calendar year, mean implantation rates were 5.5 ± 0.6, 63.2 ± 8.6, and 52.7 ± 10.8 per 100,000 persons per annum in patients aged < 60 years, 60-79 years, and ≥ 80 years, respectively. In-hospital mortality was 0.4% and did not differ among age groups. However, 1-year mortality was 2.1%, 5.9%, and 10.7%, in those < 60 years, 60-79 years, and ≥ 80 years of age, respectively (P < 0.001), with hazard ratios for those aged ≥ 80 years of 4.3 (95% confidence interval [CI] 3.1-6.0) and those aged 60-79 years of 2.6 (95% CI 1.9-3.5) relative to those aged < 60 years (both P < 0.001) after adjusting for ICD indications, sex, implantation year, referral source, and comorbidities. In those aged ≥ 80 years, age > 83 years, congestive cardiac failure, chronic renal failure, neurodegenerative disease, and a higher Charlson comorbidity index score were each independent predictors of 1-year mortality. CONCLUSIONS ICD use in patients aged ≥ 80 years and 60-79 years was 10-fold that in patients aged < 60 years, and perioperative outcomes were good in all ages, but there was substantially increased 1-year mortality in those aged ≥ 80 years. Careful selection based on age and comorbidity may further reduce 1-year mortality in patients ≥ 80 years old receiving ICDs.
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Affiliation(s)
- Vijayatubini Vijayarajan
- Department of Cardiology, Concord Hospital, University of Sydney, Concord, New South Wales, Australia.
| | - Arielle Hsu
- Department of Cardiology, Concord Hospital, University of Sydney, Concord, New South Wales, Australia
| | - Yeu-Yao Cheng
- Department of Cardiology, Concord Hospital, University of Sydney, Concord, New South Wales, Australia
| | - Matthew Wei Shun Shu
- Department of Cardiology, Concord Hospital, University of Sydney, Concord, New South Wales, Australia
| | - Karice Hyun
- Department of Cardiology, Concord Hospital, University of Sydney, Concord, New South Wales, Australia
| | - Raymond Sy
- Department of Cardiology, Concord Hospital, University of Sydney, Concord, New South Wales, Australia
| | - Vincent Chow
- Department of Cardiology, Concord Hospital, University of Sydney, Concord, New South Wales, Australia
| | - David Brieger
- Department of Cardiology, Concord Hospital, University of Sydney, Concord, New South Wales, Australia
| | - Leonard Kritharides
- Department of Cardiology, Concord Hospital, University of Sydney, Concord, New South Wales, Australia
| | - Austin Chin Chwan Ng
- Department of Cardiology, Concord Hospital, University of Sydney, Concord, New South Wales, Australia
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Yilmaz D, Egorova AD, Schalij MJ, van Erven L. Implantable cardioverter-defibrillators and the older patient: the Dutch clinical practice. Eur J Cardiovasc Nurs 2022; 21:169-173. [DOI: 10.1093/eurjcn/zvab100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 05/25/2021] [Indexed: 11/12/2022]
Abstract
Abstract
Background and objective
Balance between benefit and burden of implantable cardioverter-defibrillator (ICD) therapy is more debatable in older patients, compared to younger patients. Of around 6000 yearly implanted ICDs in the Netherlands, 1:4 is received by patients ≥75 years. We aimed to evaluate the current clinical practice in the Netherlands for ICD implants and generator replacements, with a special focus on the older ICD patients.
Research design and methods
Cardiologists from all Dutch ICD implanting centres (n = 28) were interviewed. Questions aimed to evaluate outpatient care, pre-operative patient assessment, end-of-life-care counselling, evaluation of social and cognitive wellbeing, clinical evaluation of all patients prior to ICD replacement, and the consideration of the option to downgrade or not replace a device.
Results
Implanting cardiologists from all 28 implanting centres were approached for an interview. Response rate was 86%. Management appeared diverse. An age ≥80 years was consistently reported as incentive for more extensive patient evaluation. Patients were invited for counselling prior to device replacements in only the minority (46%) of hospitals. Downgrade or non-replacement was performed in rare cases. End-of-life care discussions were not standard procedure in 67% of the hospitals. Evaluation of social and cognitive wellbeing of patients was based solely on the general clinical impression of the physician in 83%, or not at all assessed in 8% of the centres.
Discussion and implication
A structured framework for care and evaluation of cognitive and/or physical limitations is currently absent in most hospitals. At time of ICD (re-)evaluation, several factors may be considered before deciding on (continuation of) ICD therapy: patient preferences and comorbidity, the need for pacemaker therapy, primary vs. secondary prevention, procedural risks, and patient preferences.
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Affiliation(s)
- Dilek Yilmaz
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Anastasia D Egorova
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Lieselot van Erven
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
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