Background

Elderly patients are often underrepresented in implantable cardioverter defibrillator (ICD) trials, and ICD implantation in patients ≥75 years consequently remains controversial. We aimed to evaluate mortality, appropriate ICD therapy rates and survival gain in an elderly population after risk stratification according to the Charlson Comorbidity Index (CCI).

Methods

This monocentric retrospective study included elderly ICD patients ≥75 years. They were subdivided according to their CCI score into 3 categories (0–1, 2–3 or ≥4 points). Elderly patients were matched 1:2 with younger control ICD patients on gender, type of prevention (primary or secondary) and type of device (associated cardiac resynchronization therapy or not).

Results

Between January 2009 and July 2017, 121 elderly patients (mean age 78 ± 3; 83% male) matched with 242 controls (mean age 66 ± 5) were included. At 5 year follow-up after ICD implantation, overall survival was 78%, 57%, and 29% (P = 0.002) in the elderly with a CCI score of 0-1, 2-3 and ≥4 respectively, and 72% in controls. There was no significant difference regarding ICD appropriate therapy between the 3 subgroups despite a trend towards lower rates of therapy in CCI ≥ 4 points patients (34.2%, 39.7% and 22.8% respectively; P = 0.45). Median potential survival gain after an appropriate therapy was >5, 4.7 and 1.4 years, with a CCI score of 0-1, 2-3 and ≥4 respectively (P = 0.01).

Conclusion

Elderly patients with CCI score ≥ 4 had the lowest survival after ICD implantation and little survival gain in case of appropriate defibrillator therapy. More than age alone, the burden of comorbidities assessed by the CCI could be helpful to better select elderly patients for ICD implantation.

中文翻译：

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查尔森合并症指数对老年人进行心脏复律除颤器植入的预后价值。

背景

老年患者在植入式心脏复律除颤器（ICD）试验中的代表性不足，因此，≥75岁患者的ICD植入仍然存在争议。我们旨在根据查尔森合并症指数（CCI）评估风险分层后的老年人群的死亡率，适当的ICD治疗率和存活率。

方法

这项单中心回顾性研究纳入了≥75岁的ICD老年患者。根据他们的CCI得分将他们分为3类（0-1、2-3或≥4分）。在性别，预防类型（主要或次要）和器械类型（是否有相关的心脏再同步治疗）方面，将老年患者与年轻的ICD对照患者以1：2的比例配对。

结果

在2009年1月至2017年7月之间，纳入了121名老年患者（平均年龄为78±3；男性为83％）和242名对照（平均年龄为66±5）。植入ICD后的5年随访中， CCI分别为0-1、2-3和≥4的老年人的总生存率为78％，57％和29％（P = 0.002），而72％在控件中。尽管CCI≥4点患者的治疗率有降低的趋势（34.2％，39.7％和22.8％；P  = 0.45），但3个亚组之间的ICD适当治疗没有显着差异。适当治疗后中位潜在生存期增加> 5、4.7和1.4年，CCI评分分别为0-1、2-3和≥4（P  = 0.01）。

结论

CCI评分≥4的老年患者在ICD植入后存活率最低，而在适当的除颤器治疗下存活率几乎没有增加。CCI评估的合并症负担不仅仅超过年龄，可能有助于更好地选择老年患者进行ICD植入。