Age Differences in Primary Prevention Implantable Cardioverter-Defibrillator Use in U.S. Individuals

• Autores: Vivian Tsai, Mary K. Goldstein, Henry H. Hsia, Yongfei Wang, Curtis Curtis, Paul A. Heidenreich
• Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 59, Nº. 9, 2011, págs. 1589-1595
• Idioma: inglés
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• Resumen

  • OBJECTIVES: To estimate the potentially inappropriate use of implantable cardioverter-defibrillator ICDs in older U.S. adults.

    DESIGN: Retrospective study.

    SETTING: The National Cardiovascular Data ICD Registry.

    PARTICIPANTS: Forty-four thousand eight hundred five individuals in the National Cardiovascular Data's ICD Registry� who had received ICDs for primary prevention from January 2006 to December 2008. Individuals with a prior myocardial infarction and ejection fraction less than 30% were included.

    MEASUREMENTS: Mortality risk was categorized using the Multicenter Automatic Defibrillator Implantation (MADIT) II risk-stratification system. Low-risk and very-high-risk individuals were considered potentially inappropriate recipients.

    RESULTS: Of 44,805 individuals, 67% (n=29,893) were aged 65 and older, of whom 51% were aged 75 and older. A significant proportion of ICD recipients had a low risk of death (16%, n=6,969) or very high risk of nonarrhythmic death (8%, n=3,693). Potentially inappropriate ICD use was 10% in those aged 75 and older, much less than in younger groups (40%, <65; 21%, 65�74, P<.001). Although age was associated with a high risk of nonarrhythmic death, its influence was markedly attenuated after adjusting for comorbidities and timing of ICD implantation (odds ratio=1.02, 95% confidence interval=1.02�1.03, P<.001).

    CONCLUSION: Potentially inappropriate ICD use appears significantly less�and at modest rates�in older Americans than in younger age groups. Overall, almost one-quarter of individuals may have received ICDs inappropriately based on their risk of death. Physicians appear to be conservatively referring older adults and wisely deferring those with high comorbid burden.