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Age differences in the use of implantable cardioverter-defibrillators among older patients hospitalized with heart failure.

ABSTRACT: Practice guidelines recommend the use of ICDs in patients with heart failure (HF) and a left ventricular ejection fraction (LVEF) of ? 35% in the absence of contraindications.We performed an analysis of ICD use among patients admitted with HF with LVEF of ? 35% and discharged alive from 251 hospitals participating in the American Heart Association's Get With The Guidelines-HF Program between January 2005 and September 2011. Among 35,772 guideline-eligible patients, 17,639 received an ICD prior to hospitalization (10,886), during hospitalization (4,876), or were discharged with plans to undergo ICD placement after hospitalization (1,877). After adjustment, increasing age was associated with lower ICD use (odds ratio [OR] 0.89, 95% confidence interval [CI] 0.87-0.91 per 5-year increase in age, P? < ?0.0001). Compared with patient age < 55 years, older age groups ? 65 years were less likely to receive an ICD (P? < ?0.003). Compared with men in the same age group, women were significantly less likely to receive an ICD; this difference was more marked with increasing age (P value for interaction = 0.006). There was a temporal increase in ICD use (adjusted OR 1.23, 95% CI 1.15-1.31 of ICD use per year) that was similar in each age group (P value for interaction = 0.665).Eligible older HF patients age ? 65 years were significantly less likely to receive an ICD. With increasing age, women were less likely to receive an ICD than men. ICD use significantly increased over time in all age groups; however, age-related differences in ICD use persisted.

SUBMITTER: Hess PL

PROVIDER: S-EPMC4076932 | biostudies-literature | 2013 Jun

REPOSITORIES: biostudies-literature

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Age differences in the use of implantable cardioverter-defibrillators among older patients hospitalized with heart failure.

Hess Paul L PL Grau-Sepulveda Maria V MV Hernandez Adrian F AF Peterson Eric D ED Bhatt Deepak L DL Schwamm Lee H LH Yancy Clyde W CW Fonarow Gregg C GC Al-Khatib Sana M SM

Journal of cardiovascular electrophysiology 20130225 6

<h4>Introduction</h4>Practice guidelines recommend the use of ICDs in patients with heart failure (HF) and a left ventricular ejection fraction (LVEF) of ≤ 35% in the absence of contraindications.<h4>Methods and results</h4>We performed an analysis of ICD use among patients admitted with HF with LVEF of ≤ 35% and discharged alive from 251 hospitals participating in the American Heart Association's Get With The Guidelines-HF Program between January 2005 and September 2011. Among 35,772 guideline- ...[more]

PMID: 23437793

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Project description:ObjectivesTo examine the effectiveness of primary implantable cardioverter defibrillators (ICDs) in elderly patients receiving the device during a hospital admission for exacerbation of heart failure or other acute co-morbidities, with an emphasis on adjustment for early mortality and other factors reflecting healthy candidate bias rather than the effect of the ICD.DesignRetrospective cohort study.SettingLinked data from the Centers for Medicare and Medicaid Services and American College of Cardiology-National Cardiovascular Data Registry ICD registry, nationwide heart failure registry, and Medicare claims data 2004-09.Population23,111 patients aged ≥ 66 who were admitted to hospital for exacerbation of heart failure or other acute co-morbidities and eligible for primary ICDs.Main outcome measuresAll cause mortality and sudden cardiac death. Latency analyses with Cox regression were used to derive crude hazard ratios and hazard ratios adjusted for high dimension propensity score for outcomes after 180 days from index implantation or discharge.ResultsPatients who received an ICD during a hospital admission had lower crude mortality risk than patients who did not receive an ICD (40% v 60% at three years); however, with conditioning on 180 day survival and with adjustment for high dimension propensity score, the apparent benefit with ICD was no longer evident for sudden cardiac death (adjusted hazard ratio 0.95, 95% confidence interval 0.78 to 1.17) and had a diminished impact on total mortality (0.91, 0.82 to 1.00). There were trends towards a benefit with ICD in reducing mortality or sudden cardiac death in patients who had had a myocardial infarction more than 40 days previously, left bundle branch block, or low serum B type natriuretic peptide; however, these trends did not reach significance.ConclusionAfter adjustment for healthy candidate bias and confounding, the benefits of primary ICD therapy seen in pivotal trials were not apparent in patients aged 66 or over who received ICDs during a hospital admission for exacerbation of heart failure or other acute co-morbidities. Future research is warranted to further identify subgroups of elderly patients who are more likely to benefit from ICDs. Recognition of those patients whose dominant risk factors are from decompensated heart failure and non-cardiac co-morbidities will allow better focus on ICDs in those patients for whom the device offers the most benefit and provides meaningful prolonging of life.

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Age differences in the use of implantable cardioverter-defibrillators among older patients hospitalized with heart failure.

Publications

Age differences in the use of implantable cardioverter-defibrillators among older patients hospitalized with heart failure.

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