Skip to main content

Survival benefit of the primary prevention implantable cardioverter-defibrillator among older patients: does age matter? An analysis of pooled data from 5 clinical trials.

Publication ,  Journal Article
Hess, PL; Al-Khatib, SM; Han, JY; Edwards, R; Bardy, GH; Bigger, JT; Buxton, A; Cappato, R; Dorian, P; Hallstrom, A; Kadish, AH; Kudenchuk, PJ ...
Published in: Circ Cardiovasc Qual Outcomes
March 2015

BACKGROUND: The impact of patient age on the risks of death or rehospitalization after primary prevention implantable cardioverter-defibrillator (ICD) placement is uncertain. METHODS AND RESULTS: Data from 5 major ICD trials were merged: the Multicenter Automatic Defibrillator Implantation Trial I (MADIT-I), the Multicenter UnSustained Tachycardia Trial (MUSTT), the Multicenter Automatic Defibrillator Implantation Trial II (MADIT-II), the Defibrillators in Nonischemic Cardiomyopathy Treatment Evaluation Trial (DEFINITE), and the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT). Median age at enrollment was 62 (interquartile range 53-70) years. Compared with their younger counterparts, older patients had a greater burden of comorbid illness. In unadjusted exploratory analyses, ICD recipients were less likely to die than nonrecipients in all age groups: among patients aged <55 years: hazard ratio 0.48, 95% posterior credible interval 0.33 to 0.69; among patients aged 55 to 64 years: hazard ratio 0.69, 95% posterior credible interval 0.53 to 0.90; among patients aged 65 to 74 years: hazard ratio 0.67, 95% posterior credible interval, 0.53 to 0.85; and among patients aged ≥75 years: hazard ratio 0.54, 95% posterior credible interval 0.37 to 0.78. Sample sizes were limited among patients aged ≥75 years. In adjusted Bayesian-Weibull modeling, point estimates indicate ICD efficacy persists but is attenuated with increasing age. There was evidence of an interaction between age and ICD treatment on survival (two-sided posterior tail probability of no interaction <0.01). Using an adjusted Bayesian logistic regression model, there was no evidence of an interaction between age and ICD treatment on rehospitalization (two-sided posterior tail probability of no interaction 0.44). CONCLUSIONS: In this analysis, the survival benefit of the ICD exists but is attenuated with increasing age. The latter finding may be because of the higher burden of comorbid illness, competing causes of death, or limited sample size of older patients. There was no evidence that age modifies the association between ICD treatment and rehospitalization.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

March 2015

Volume

8

Issue

2

Start / End Page

179 / 186

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Proportional Hazards Models
  • Primary Prevention
  • Patient Readmission
  • Middle Aged
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Hess, P. L., Al-Khatib, S. M., Han, J. Y., Edwards, R., Bardy, G. H., Bigger, J. T., … Sanders, G. (2015). Survival benefit of the primary prevention implantable cardioverter-defibrillator among older patients: does age matter? An analysis of pooled data from 5 clinical trials. Circ Cardiovasc Qual Outcomes, 8(2), 179–186. https://doi.org/10.1161/CIRCOUTCOMES.114.001306
Hess, Paul L., Sana M. Al-Khatib, Joo Y. Han, Rex Edwards, Gust H. Bardy, J Thomas Bigger, Alfred Buxton, et al. “Survival benefit of the primary prevention implantable cardioverter-defibrillator among older patients: does age matter? An analysis of pooled data from 5 clinical trials.Circ Cardiovasc Qual Outcomes 8, no. 2 (March 2015): 179–86. https://doi.org/10.1161/CIRCOUTCOMES.114.001306.
Hess PL, Al-Khatib SM, Han JY, Edwards R, Bardy GH, Bigger JT, et al. Survival benefit of the primary prevention implantable cardioverter-defibrillator among older patients: does age matter? An analysis of pooled data from 5 clinical trials. Circ Cardiovasc Qual Outcomes. 2015 Mar;8(2):179–86.
Hess, Paul L., et al. “Survival benefit of the primary prevention implantable cardioverter-defibrillator among older patients: does age matter? An analysis of pooled data from 5 clinical trials.Circ Cardiovasc Qual Outcomes, vol. 8, no. 2, Mar. 2015, pp. 179–86. Pubmed, doi:10.1161/CIRCOUTCOMES.114.001306.
Hess PL, Al-Khatib SM, Han JY, Edwards R, Bardy GH, Bigger JT, Buxton A, Cappato R, Dorian P, Hallstrom A, Kadish AH, Kudenchuk PJ, Lee KL, Mark DB, Moss AJ, Steinman R, Inoue LYT, Sanders G. Survival benefit of the primary prevention implantable cardioverter-defibrillator among older patients: does age matter? An analysis of pooled data from 5 clinical trials. Circ Cardiovasc Qual Outcomes. 2015 Mar;8(2):179–186.

Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

March 2015

Volume

8

Issue

2

Start / End Page

179 / 186

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Proportional Hazards Models
  • Primary Prevention
  • Patient Readmission
  • Middle Aged
  • Male