Most Older Patients Survive 2 Years After Getting ICD for Secondary Prevention

By Will Boggs MD

NEW YORK (Reuters Health) - Nearly 80% of older patients who receive implantable cardioverter-defibrillators (ICDs) for secondary prevention of sudden cardiac death survive at least two years, but they have substantial care needs, according to a new study.

"These findings suggest that physicians are on average appropriately selective of the patients who receive secondary-prevention ICDs but that these patients have important care needs in the months and years following these procedures," said senior author Dr. Frederick A. Masoudi from the University of Colorado, Denver.

"The results also provide a perspective on what older patients who consider this therapy and their physicians might expect following the implantation of a secondary-prevention ICD," he told Reuters Health by email.

Outcomes of older patients receiving an ICD for secondary prevention in clinical practice have not been well characterized.

Dr. Masoudi and colleagues used data from the National Cardiovascular Data Registry to assess rates of death, rehospitalization, and skilled nursing facility admission among more than 12,000 Medicare beneficiaries 65 and older who underwent ICD implantation for secondary prevention.

Mortality at 30 days after implantation was 1.5% in the youngest group (65 to 69 years of age) and 3.0% among those at least 80 years of age, the team reports in the January 24 issue of Journal of the American College of Cardiology.

At two years, the overall death rate was 21.8%, with rates increasing progressively from 14.7% in the youngest group to 28.9% in the oldest.

Individuals in the oldest age group (at least 80 years) were twice as likely to die in the first two years, compared with the youngest group, after adjustment for other variables.

Nearly two-thirds of patients required hospitalization during the two years after implantation (60.5% of the youngest vs. 71.5% of the oldest).

The cumulative incidence of admission to a skilled nursing facility at two years was 13.1% in the 65- to 69-year-old age group, compared to 31.9% of those who were 80+ years of age.

"The study demonstrates the value of national registry programs that can provide representative perspectives on the outcomes of patients receiving therapies in contemporary clinical settings," Dr. Masoudi said.

"Additional research is needed to more precisely define which particular coexisting conditions have the greatest impact on a variety of outcomes including death, hospitalization, and loss of physical function in patients receiving a secondary prevention ICD," the researchers note.

Dr. Sumeet S. Chugh from Cedars-Sinai Medical Center in Los Angeles, who coauthored a linked editorial, told Reuters Health by email, "The overall survival of older patients implanted with secondary prevention defibrillators appears acceptable, but we don't have the benefit of comparison with an age-matched non-ICD population. The admission rate to hospitals and skilled nursing facilities during the two-year follow-up period was quite high, >70% and >30% respectively for age over 80 years."

"To make a real impact on use of ICDs in the elderly, we need a clinical trial focused on the elderly population," Dr. Chugh said.

"In the meantime," he notes in the editorial, "clinicians should: 1) consider noncardiac comorbidities and frailty along with age in their decision-making process; 2) provide the patient with a clear understanding of the rationale and limitations of the ICD; and 3) encourage advance directives and bring up the possibility of deactivating the ICD if the patient is nearing end of life."

SOURCE: bit.ly/2jAXIJn and bit.ly/2k3N7Ds

J Am Coll Cardiol 2017.

(c) Copyright Thomson Reuters 2017. Click For Restrictions - https://about.reuters.com/fulllegal.asp