Predictors of early mortality in patients age 80 and older receiving implantable defibrillators

Drew Ertel, Kavita Phatak, Kevin Makati, Marian Holland, Sara Baig, Michael H. Kim, Mark Link, Rod Passman

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background: There are no upper age restrictions for implantable defibrillators (ICDs) but their benefit may be limited in patients ≥ 80 years with strong competing risks of early mortality. Risk factors for early (1-year) mortality in ICD recipients ≥ 80 years of age have not been established. Methods: Two-center retrospective cohort study to assess predictors of one-year mortality in ICD recipients ≥ 80 years of age. Results: Of 2,967 ICDs implanted in the two centers from 1990-2006, 225 (7.6%) patients were ≥80 years of age and followed-up at one of the two centers. Mean age was 83.3 ± 3.1 years and follow-up time 3.3 ± 2.6 years. Median survival was 3.6 years (95% confidence interval 2.3-4.9). Multivariate predictors of 1-year mortality included ejection fraction (EF) ≤ 20% and the absence of beta-blocker use. Actuarial 1-year mortality of ICD recipients ≥ 80 with an EF ≤ 20% was 38.2% versus 13.1% in patients 80+ years with an EF > 20% and 10.6% for patients < 80 years with an EF ≤ 20% (P < 0.001 for both). There was no significant difference in the risk of appropriate ICD therapy between those patients 80+ years with EF above and below 20%. Conclusion: In general, patients ≥ 80 years of age who meet current indications for ICD implantation live sufficiently long to warrant device implantation based on anticipated survival alone. However, those with an EF ≤ 20% have a markedly elevated 1-year mortality with no observed increase in appropriate ICD therapy, thus reducing the benefit of device implantation in this population.

Original languageEnglish (US)
Pages (from-to)981-987
Number of pages7
JournalPACE - Pacing and Clinical Electrophysiology
Volume33
Issue number8
DOIs
StatePublished - Aug 1 2010

Fingerprint

Implantable Defibrillators
Mortality
Equipment and Supplies
Survival
Cohort Studies
Retrospective Studies
Confidence Intervals
Therapeutics
Population

Keywords

  • geriatrics
  • ICDs
  • octogenarian
  • sudden cardiac death

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Predictors of early mortality in patients age 80 and older receiving implantable defibrillators. / Ertel, Drew; Phatak, Kavita; Makati, Kevin; Holland, Marian; Baig, Sara; Kim, Michael H.; Link, Mark; Passman, Rod.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 33, No. 8, 01.08.2010, p. 981-987.

Research output: Contribution to journalArticle

Ertel, Drew ; Phatak, Kavita ; Makati, Kevin ; Holland, Marian ; Baig, Sara ; Kim, Michael H. ; Link, Mark ; Passman, Rod. / Predictors of early mortality in patients age 80 and older receiving implantable defibrillators. In: PACE - Pacing and Clinical Electrophysiology. 2010 ; Vol. 33, No. 8. pp. 981-987.
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abstract = "Background: There are no upper age restrictions for implantable defibrillators (ICDs) but their benefit may be limited in patients ≥ 80 years with strong competing risks of early mortality. Risk factors for early (1-year) mortality in ICD recipients ≥ 80 years of age have not been established. Methods: Two-center retrospective cohort study to assess predictors of one-year mortality in ICD recipients ≥ 80 years of age. Results: Of 2,967 ICDs implanted in the two centers from 1990-2006, 225 (7.6{\%}) patients were ≥80 years of age and followed-up at one of the two centers. Mean age was 83.3 ± 3.1 years and follow-up time 3.3 ± 2.6 years. Median survival was 3.6 years (95{\%} confidence interval 2.3-4.9). Multivariate predictors of 1-year mortality included ejection fraction (EF) ≤ 20{\%} and the absence of beta-blocker use. Actuarial 1-year mortality of ICD recipients ≥ 80 with an EF ≤ 20{\%} was 38.2{\%} versus 13.1{\%} in patients 80+ years with an EF > 20{\%} and 10.6{\%} for patients < 80 years with an EF ≤ 20{\%} (P < 0.001 for both). There was no significant difference in the risk of appropriate ICD therapy between those patients 80+ years with EF above and below 20{\%}. Conclusion: In general, patients ≥ 80 years of age who meet current indications for ICD implantation live sufficiently long to warrant device implantation based on anticipated survival alone. However, those with an EF ≤ 20{\%} have a markedly elevated 1-year mortality with no observed increase in appropriate ICD therapy, thus reducing the benefit of device implantation in this population.",
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N2 - Background: There are no upper age restrictions for implantable defibrillators (ICDs) but their benefit may be limited in patients ≥ 80 years with strong competing risks of early mortality. Risk factors for early (1-year) mortality in ICD recipients ≥ 80 years of age have not been established. Methods: Two-center retrospective cohort study to assess predictors of one-year mortality in ICD recipients ≥ 80 years of age. Results: Of 2,967 ICDs implanted in the two centers from 1990-2006, 225 (7.6%) patients were ≥80 years of age and followed-up at one of the two centers. Mean age was 83.3 ± 3.1 years and follow-up time 3.3 ± 2.6 years. Median survival was 3.6 years (95% confidence interval 2.3-4.9). Multivariate predictors of 1-year mortality included ejection fraction (EF) ≤ 20% and the absence of beta-blocker use. Actuarial 1-year mortality of ICD recipients ≥ 80 with an EF ≤ 20% was 38.2% versus 13.1% in patients 80+ years with an EF > 20% and 10.6% for patients < 80 years with an EF ≤ 20% (P < 0.001 for both). There was no significant difference in the risk of appropriate ICD therapy between those patients 80+ years with EF above and below 20%. Conclusion: In general, patients ≥ 80 years of age who meet current indications for ICD implantation live sufficiently long to warrant device implantation based on anticipated survival alone. However, those with an EF ≤ 20% have a markedly elevated 1-year mortality with no observed increase in appropriate ICD therapy, thus reducing the benefit of device implantation in this population.

AB - Background: There are no upper age restrictions for implantable defibrillators (ICDs) but their benefit may be limited in patients ≥ 80 years with strong competing risks of early mortality. Risk factors for early (1-year) mortality in ICD recipients ≥ 80 years of age have not been established. Methods: Two-center retrospective cohort study to assess predictors of one-year mortality in ICD recipients ≥ 80 years of age. Results: Of 2,967 ICDs implanted in the two centers from 1990-2006, 225 (7.6%) patients were ≥80 years of age and followed-up at one of the two centers. Mean age was 83.3 ± 3.1 years and follow-up time 3.3 ± 2.6 years. Median survival was 3.6 years (95% confidence interval 2.3-4.9). Multivariate predictors of 1-year mortality included ejection fraction (EF) ≤ 20% and the absence of beta-blocker use. Actuarial 1-year mortality of ICD recipients ≥ 80 with an EF ≤ 20% was 38.2% versus 13.1% in patients 80+ years with an EF > 20% and 10.6% for patients < 80 years with an EF ≤ 20% (P < 0.001 for both). There was no significant difference in the risk of appropriate ICD therapy between those patients 80+ years with EF above and below 20%. Conclusion: In general, patients ≥ 80 years of age who meet current indications for ICD implantation live sufficiently long to warrant device implantation based on anticipated survival alone. However, those with an EF ≤ 20% have a markedly elevated 1-year mortality with no observed increase in appropriate ICD therapy, thus reducing the benefit of device implantation in this population.

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