Almost 80 percent of patients over age 65 who received an implantable cardioverter-defibrillator (ICD) after surviving sudden cardiac arrest or a near-fatal arrhythmia survived two years, according to a study published Jan. 16 in the Journal of the American College of Cardiology.
Frederick A. Masoudi, MD, MSPH, FACC, and colleagues used data from ACC’s ICD Registry to examine 12,420 Medicare beneficiaries undergoing an ICD implantation after surviving sudden cardiac arrest or a near-fatal ventricular arrhythmia, between 2006 and 2009 in almost 1,000 U.S. hospitals.
The researchers found 65.4 percent of patients were hospitalized during the two years after receiving an ICD, ranging from 60.5 percent in those less than age 70, to 71.5 percent in those 80 and older. In addition, 13.1 percent among those less than 70 years old and 21.9 percent of those 80 and older were admitted to a skilled nursing facility. The authors note that the risk of admission to a skilled nursing facility was greatest in the first 30 days after the procedure. The risks of hospitalization and admission to skilled nursing facility were all greater with increasing patient age. The high hospitalization and skilled nursing facility admission rates, particularly among the oldest patients, indicate there are substantial care needs after an ICD is implanted, the authors conclude.
In an accompanying editorial, Sumeet S. Chugh, MD, FACC, writes that the findings from the study would suggest that although patients over age 75 implanted with ICDs after a sudden cardiac arrest or near-fatal ventricular arrhythmia “may have reasonable overall survival, they also have significantly high rates of admission to hospitals and skilled nursing facilities, with no clear evidence of mortality benefit from the device.”
He adds that until more research is done about the devices in elderly patients, doctors should consider non-heart-related co-occurring medical conditions and frailty along with age in their decision-making process about ICDs. They should provide the patient with a clear understanding of the rationale and limitations of the ICD, encourage advance directives and bring up the possibility of deactivating the ICD if the patient is nearing end of life.SOURCE: American College of Cardiology