1. Increasing age does not affect time to appropriate therapy in primary prevention ICD/CRT-D: a competing risks analysis
- Author
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Paul R. Roberts, Edward Duncan, Arthur M. Yue, John M. Morgan, Glyn Thomas, Georgios Leventopoulos, Ahmed Nauman, David G. Wilson, Hrvojka Marija Zeljko, Paul Roderick, and George E.H. Sylvester
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,Cardiac resynchronization therapy ,030204 cardiovascular system & hematology ,Risk Assessment ,Time-to-Treatment ,Cardiac Resynchronization Therapy ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,Cumulative incidence ,Cardiac Resynchronization Therapy Devices ,030212 general & internal medicine ,education ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Aged, 80 and over ,education.field_of_study ,business.industry ,Proportional hazards model ,Age Factors ,Retrospective cohort study ,Middle Aged ,Implantable cardioverter-defibrillator ,Defibrillators, Implantable ,Surgery ,Primary Prevention ,Death, Sudden, Cardiac ,Ventricular Fibrillation ,Tachycardia, Ventricular ,Female ,Cardiology and Cardiovascular Medicine ,business ,Risk assessment - Abstract
Aims To evaluate the impact of age on the clinical outcomes in a primary prevention implantable cardioverter defibrillator (ICD)/cardiac resynchronization therapy defibrillator (CRT-D) population. Methods and results A retrospective, multicentre analysis of patients aged 60 years and over with primary prevention ICD/CRT-D devices implanted between 1 January 2006 and 1 November 2014 was performed. Survival to follow-up with no therapy (T1), death prior to follow-up with no therapy (T2), delivery of appropriate therapy with survival to follow-up (T3), and delivery of appropriate therapy with death prior to follow-up (T4) were measured. In total, 424 patients were eligible for inclusion in the analysis, mean follow-up of 32.6 months during which time 44 patients (10.1%) received appropriate therapy. The sub-hazard ratio (SHR) for the cumulative incidence of appropriate therapy (T3) according to age at implant was 1.00 ( P = 0.851; 95% CI 0.96–1.04). The SHR for cumulative incidence of death (T2) according to age at implant was 1.06 ( P < 0.001; 95% CI 1.03–1.01). Age at implant, ischaemic aetiology, baseline haemoglobin, and the presence of diabetes mellitus were predictors of all-cause mortality. Conclusion Age has no impact on the time to appropriate therapy, but risk of death prior to therapy increases by 6% for every year increment. As the ICD population ages, the proportion who die without receiving appropriate therapy increases due to competing risks. Characterizing competing risks predictive of death independent of ICD indication would focus therapy on those with potential to benefit and reduce unnecessary exposure to ICD-related morbidity.
- Published
- 2016