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Outcomes Among Older Patients Receiving Implantable Cardioverter-Defibrillators for Secondary Prevention: From the NCDR ICD Registry.

Publication ,  Journal Article
Betz, JK; Katz, DF; Peterson, PN; Borne, RT; Al-Khatib, SM; Wang, Y; Hansen, CM; McManus, DD; Mathew, JS; Masoudi, FA
Published in: J Am Coll Cardiol
January 24, 2017

BACKGROUND: Clinical trials of implantable cardioverter-defibrillators (ICDs) for secondary prevention of sudden cardiac death were conducted nearly 2 decades ago and enrolled few older patients. OBJECTIVES: This study assessed morbidity and mortality of older patients receiving ICDs for secondary prevention in contemporary clinical practice. METHODS: We identified 12,420 Medicare beneficiaries from the National Cardiovascular Data Registry ICD Registry undergoing first-time secondary prevention ICD implantation between 2006 and 2009 in 956 U.S. hospitals. Risks of death, hospitalization, and admission to a skilled nursing facility (SNF) were assessed over 2 years in age strata (65 to 69, 70 to 74, 75 to 79, and ≥80 years of age) using Medicare claims. The adjusted association between age and outcomes was evaluated using multivariable models. RESULTS: The mean age was 75 years at the time of implantation; 25.3% were <70 years of age and 25.7% were ≥80 years of age. Overall, the risk of death at 2 years was 21.8%, ranging from 14.7% among those <70 years of age to 28.9% among those ≥80 years of age (adjusted risk ratio [aRR]: 2.01; 95% confidence interval [CI]: 1.85 to 2.33; p for trend <0.001). The cumulative incidence of hospitalizations was 65.4%, ranging from 60.5% in those <70 years of age to 71.5% in those ≥80 years of age (aRR: 1.27; 95% CI: 1.19 to 1.36; p for trend <0.001). The cumulative incidence of admission to a SNF ranged from 13.1% among those <70 years of age to 31.9% among those ≥80 years of age (aRR: 2.67; 95% CI: 2.37 to 3.01; p for trend <0.001); SNF admission risk was highest in the first 30 days. CONCLUSIONS: Almost 4 in 5 older patients receiving a secondary prevention ICD survives at least 2 years. High hospitalization and SNF admission rates, particularly among the oldest patients, identify substantial care needs after device implantation.

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

January 24, 2017

Volume

69

Issue

3

Start / End Page

265 / 274

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Skilled Nursing Facilities
  • Secondary Prevention
  • Registries
  • Male
  • Humans
  • Hospitalization
  • Female
  • Defibrillators, Implantable
  • Death, Sudden, Cardiac
 

Citation

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Chicago
ICMJE
MLA
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Betz, J. K., Katz, D. F., Peterson, P. N., Borne, R. T., Al-Khatib, S. M., Wang, Y., … Masoudi, F. A. (2017). Outcomes Among Older Patients Receiving Implantable Cardioverter-Defibrillators for Secondary Prevention: From the NCDR ICD Registry. J Am Coll Cardiol, 69(3), 265–274. https://doi.org/10.1016/j.jacc.2016.10.062
Betz, Jarrod K., David F. Katz, Pamela N. Peterson, Ryan T. Borne, Sana M. Al-Khatib, Yongfei Wang, Carolina Malta Hansen, David D. McManus, Jehu S. Mathew, and Frederick A. Masoudi. “Outcomes Among Older Patients Receiving Implantable Cardioverter-Defibrillators for Secondary Prevention: From the NCDR ICD Registry.J Am Coll Cardiol 69, no. 3 (January 24, 2017): 265–74. https://doi.org/10.1016/j.jacc.2016.10.062.
Betz JK, Katz DF, Peterson PN, Borne RT, Al-Khatib SM, Wang Y, et al. Outcomes Among Older Patients Receiving Implantable Cardioverter-Defibrillators for Secondary Prevention: From the NCDR ICD Registry. J Am Coll Cardiol. 2017 Jan 24;69(3):265–74.
Betz, Jarrod K., et al. “Outcomes Among Older Patients Receiving Implantable Cardioverter-Defibrillators for Secondary Prevention: From the NCDR ICD Registry.J Am Coll Cardiol, vol. 69, no. 3, Jan. 2017, pp. 265–74. Pubmed, doi:10.1016/j.jacc.2016.10.062.
Betz JK, Katz DF, Peterson PN, Borne RT, Al-Khatib SM, Wang Y, Hansen CM, McManus DD, Mathew JS, Masoudi FA. Outcomes Among Older Patients Receiving Implantable Cardioverter-Defibrillators for Secondary Prevention: From the NCDR ICD Registry. J Am Coll Cardiol. 2017 Jan 24;69(3):265–274.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

January 24, 2017

Volume

69

Issue

3

Start / End Page

265 / 274

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Skilled Nursing Facilities
  • Secondary Prevention
  • Registries
  • Male
  • Humans
  • Hospitalization
  • Female
  • Defibrillators, Implantable
  • Death, Sudden, Cardiac