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Implantable cardioverter-defibrillators in elderly patients: outcome and predictors of mortality

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

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.

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Authors and Affiliations

  1. Department of Cardiology, S. Chiara Hospital, Trento, Italy

    Massimiliano Marini, Marta Martin, Mattia Strazzanti, Silvia Quintarelli, Fabrizio Guarracini, Alessio Coser & Roberto Bonmassari

  2. Boston Scientific, Milan, Italy

    Sergio Valsecchi

Authors
  1. Massimiliano Marini
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  2. Marta Martin
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  3. Mattia Strazzanti
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  4. Silvia Quintarelli
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  5. Fabrizio Guarracini
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  6. Alessio Coser
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  7. Sergio Valsecchi
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  8. Roberto Bonmassari
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Contributions

Massimiliano Marini: conception and design of the research, drafting of the manuscript.

Marta Martin, Mattia Strazzanti, Silvia Quintarelli, Fabrizio Guarracini, Alessio Coser: acquisition of data, critical revision of the manuscript.

Sergio Valsecchi: statistical analysis.

Roberto Bonmassari: supervision.

All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Massimiliano Marini.

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Conflict of interest

S. Valsecchi is an employee of Boston Scientific, Inc. No other conflicts of interest exist.

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Marini, M., Martin, M., Strazzanti, M. et al. Implantable cardioverter-defibrillators in elderly patients: outcome and predictors of mortality. J Interv Card Electrophysiol 64, 573–580 (2022). https://doi.org/10.1007/s10840-021-01017-8

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  • DOI: https://doi.org/10.1007/s10840-021-01017-8

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