Purpose

The implantable cardioverter-defibrillator (ICD) is the therapy of choice for the prevention of sudden cardiac death. The number of elderly patients receiving ICDs is increasing. This study aimed to assess the outcome of patients according to their age at the time of implantation, and to identify variables potentially associated with patient survival.

Methods

Between June 2009 and December 2019, we retrospectively enrolled all consecutive patients in whom ICD implantation had been performed for primary or secondary prevention at our center.

Results

During the study period, 670 patients underwent ICD implantation. We stratified the population into four age-classes: Class 1 (23%) (pts aged less than 60 years), Class 2 (28%) (pts aged between 60 and 70 years), Class 3 (39%) (pts aged between 70 and 80 years) and Class 4 (9%) (pts aged 80 years or older). Over a median follow-up of 42 months, the rate of deaths in Class 4 was higher than in Classes 1 and 2 (log-rank test, P < 0.01), but was comparable to that in Class 3 (P = 0.407). With increasing age, we observed more complications at the time of implantation and during follow-up. On multivariate analysis, higher NYHA class, creatinine level and CHA₂DS₂-VASc score were identified as independent predictors of death, while age was not associated with worse prognosis. Higher body mass index, higher NYHA class and CHA₂DS₂-VASc score were also confirmed as independent predictors of hospitalizations or death due to any cause.

Conclusion

This study showed good survival in ICD patients in all age-groups, including those aged ≥80 years. The CHA₂DS₂-VASc score seems to be a stronger predictor of death than age.

中文翻译：

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老年患者的植入式心脏复律除颤器：结果和死亡率的预测因素

目的

植入式心脏复律除颤器 (ICD) 是预防心源性猝死的首选疗法。接受 ICD 的老年患者数量正在增加。本研究旨在根据植入时患者的年龄评估患者的预后，并确定可能与患者生存相关的变量。

方法

在 2009 年 6 月至 2019 年 12 月期间，我们回顾性地招募了在我们中心进行 ICD 植入以进行一级或二级预防的所有连续患者。

结果

在研究期间，670 名患者接受了 ICD 植入。我们将人口分为四个年龄组：1 级（23%）（年龄小于 60 岁的患者）、2 级（28%）（60 至 70 岁的患者）、3 级（39%）（年龄在70 至 80 岁之间）和 4 级（9%）（80 岁或以上的患者）。在中位 42 个月的随访中，4 级的死亡率高于 1 级和 2 级（对数秩检验，P  < 0.01），但与 3 级相当（P  = 0.407）。随着年龄的增长，我们在植入时和随访期间观察到更多并发症。在多变量分析中，更高的 NYHA 等级、肌酐水平和 CHA ₂ DS ₂-VASc 评分被确定为死亡的独立预测因子，而年龄与较差的预后无关。较高的体重指数、较高的 NYHA 等级和 CHA ₂ DS ₂ -VASc 评分也被确认为因任何原因住院或死亡的独立预测因素。

结论

该研究显示，所有年龄组的 ICD 患者（包括 80 岁以上的患者）均具有良好的生存率。CHA ₂ DS ₂ -VASc 评分似乎比年龄更能预测死亡。