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Kuhrt N, Stevenson LW, Akhabue E, Visaria A, Lee E, Bates B, Gandhi P, Setoguchi S. Is it time to consider a "time-out" before primary prevention implantable cardioverter-defibrillator in currently or recently hospitalized older patients with heart failure? Heart Rhythm 2024:S1547-5271(24)02562-1. [PMID: 38750911 DOI: 10.1016/j.hrthm.2024.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 05/05/2024] [Accepted: 05/08/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Trajectories of mortality after primary implantable cardioverter-defibrillator (ICD) placement for older patients with heart failure during or soon after acute hospitalization have not been assessed. OBJECTIVE The purpose of this study was to compare trajectories of mortality after primary ICD placement during or soon after acute cardiac or noncardiac hospitalization. METHODS We identified older patients with heart failure undergoing primary ICD placement using 20% Medicare data (2008-2018). Placement settings were as follows: (1) "current-H"-during current hospitalization, (2) "recent-H"-within 90 days of hospitalization, or (3) "chronic stable." Hospitalization was categorized as cardiac vs noncardiac. Interval mortality rates and hazard ratios (HRs) using Cox regression were estimated at 0-30, 31-90, and 91-365 days after ICD placement. RESULTS Of the 61,710 patients (mean age 76 years; 35% female; 85% white), 19%, 25%, and 56% had ICDs in "current-H," "recent-H," and "chronic stable" settings. Mortality rates (per 100 person-years) were highest during 0-30 days, with 38 (34-42) and 22 (19-24) for "current-H" and "recent-H," which declined to 21 (20-22) and 16 (15-17) during 91-365 days, respectively. Compared to "chronic stable," HRs were highest during 0-30 days post-ICD placement (5.5 [4.5-6.8] for "current-H" and 3.4 [2.8-4.2] for "recent-H") and decreased during 91-365 days ("current-H": 2.0 [1.8-2.1] for "current-H" and 1.6 [1.5-1.7] for "recent-H"). HR pattens were similar for cardiac and noncardiac hospitalizations. CONCLUSION Primary ICD placement during or soon after hospitalization for any reason was associated with worse mortality with diminishing risks after 90 days. Hospitalization likely identifies a sicker population in whom early mortality with or without ICD may be higher. Our results support careful consideration regarding ICD placement during the 90 days after hospitalization.
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Affiliation(s)
| | - Lynne Warner Stevenson
- Division of Advanced Heart Failure and Transplant Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ehimare Akhabue
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Aayush Visaria
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Eileen Lee
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Benjamin Bates
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; Center for Pharmacoepidemiology and Treatment Science, Rutgers Institute for Health, Health Care Policy and Aging Research, New Brunswick, New Jersey
| | - Poonam Gandhi
- Center for Pharmacoepidemiology and Treatment Science, Rutgers Institute for Health, Health Care Policy and Aging Research, New Brunswick, New Jersey
| | - Soko Setoguchi
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; Center for Pharmacoepidemiology and Treatment Science, Rutgers Institute for Health, Health Care Policy and Aging Research, New Brunswick, New Jersey.
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van der Lingen ALCJ, Verstraelen TE, van Erven L, Meeder JG, Theuns DA, Vernooy K, Wilde AAM, Maass AH, Allaart CP. Assessment of ICD eligibility in non-ischaemic cardiomyopathy patients: a position statement by the Task Force of the Dutch Society of Cardiology. Neth Heart J 2024; 32:190-197. [PMID: 38634993 DOI: 10.1007/s12471-024-01859-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 04/19/2024] Open
Abstract
International guidelines recommend implantation of an implantable cardioverter-defibrillator (ICD) in non-ischaemic cardiomyopathy (NICM) patients with a left ventricular ejection fraction (LVEF) below 35% despite optimal medical therapy and a life expectancy of more than 1 year with good functional status. We propose refinement of these recommendations in patients with NICM, with careful consideration of additional risk parameters for both arrhythmic and non-arrhythmic death. These additional parameters include late gadolinium enhancement on cardiac magnetic resonance imaging and genetic testing for high-risk genetic variants to further assess arrhythmic risk, and age, comorbidities and sex for assessment of non-arrhythmic mortality risk. Moreover, several risk modifiers should be taken into account, such as concomitant arrhythmias that may affect LVEF (atrial fibrillation, premature ventricular beats) and resynchronisation therapy. Even though currently no valid cut-off values have been established, the proposed approach provides a more careful consideration of risks that may result in withholding ICD implantation in patients with low arrhythmic risk and substantial non-arrhythmic mortality risk.
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Affiliation(s)
- Anne-Lotte C J van der Lingen
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Tom E Verstraelen
- Department of Cardiology, Heart Centre, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Lieselot van Erven
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Joan G Meeder
- Department of Cardiology, VieCuri Medical Centre Noord-Limburg, Venlo, The Netherlands
| | - Dominic A Theuns
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Arthur A M Wilde
- Department of Cardiology, Heart Centre, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Alexander H Maass
- Department of Cardiology, University Medical Centre Groningen, Heart Centre, University of Groningen, Groningen, The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
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Segar MW, Keshvani N, Singh S, Patel L, Parsa S, Betts T, Reeves GR, Mentz RJ, Forman DE, Razavi M, Saeed M, Kitzman DW, Pandey A. Frailty Status Modifies the Efficacy of ICD Therapy for Primary Prevention Among Patients With HF. JACC. HEART FAILURE 2024; 12:757-767. [PMID: 37565972 DOI: 10.1016/j.jchf.2023.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/23/2023] [Accepted: 06/02/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Implantable cardioverter-defibrillator (ICD) therapy is recommended to reduce mortality risk in patients with heart failure with reduced ejection fraction (HFrEF). Frailty is common among patients with HFrEF and is associated with increased mortality risk. Whether the therapeutic efficacy of ICD is consistent among frail and nonfrail patients with HFrEF remains unclear. OBJECTIVES The aim of this study was to evaluate the effect modification of baseline frailty burden on ICD efficacy for primary prevention among participants of the SCD-HeFT (Sudden Cardiac Death in Heart Failure Trial). METHODS Participants in SCD-HeFT with HFrEF randomized to ICD vs placebo were included. Baseline frailty was estimated using the Rockwood Frailty Index (FI), and participants were stratified into high (FI > median) vs low (FI ≤ median) frailty burden groups. Multivariable Cox models with multiplicative interaction terms (frailty × treatment arm) were constructed to evaluate whether baseline frailty status modified the treatment effect of ICD for all-cause mortality. RESULTS The study included 1,676 participants (mean age: 59 ± 12 years, 23% women) with a median FI of 0.30 (IQR: 0.23-0.37) in the low frailty group and 0.54 (IQR: 0.47-0.60) in the high frailty group. In adjusted Cox models, baseline frailty status significantly modified the treatment effect of ICD therapy (Pinteraction = 0.047). In separate stratified analysis by frailty status, ICD therapy was associated with a lower risk of all-cause mortality among participants with low frailty burden (HR: 0.56; 95% CI: 0.40-0.78) but not among those with high frailty burden (HR: 0.86; 95% CI: 0.68-1.09). CONCLUSIONS Baseline frailty modified the efficacy of ICD therapy with a significant mortality benefit observed among participants with HFrEF and a low frailty burden but not among those with a high frailty burden.
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Affiliation(s)
- Matthew W Segar
- Department of Cardiology, Texas Heart Institute, Houston, Texas, USA
| | - Neil Keshvani
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sumitabh Singh
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Lajjaben Patel
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Shyon Parsa
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Traci Betts
- School of Health Professions, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Gordon R Reeves
- Heart and Vascular Institute, Novant Health, Charlotte, North Carolina, USA
| | - Robert J Mentz
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Daniel E Forman
- Department of Medicine (Divisions of Cardiology and Geriatrics), University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Geriatrics, Research, Education, and Clinical Care, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Mehdi Razavi
- Department of Cardiology, Texas Heart Institute, Houston, Texas, USA
| | - Mohammad Saeed
- Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Dalane W Kitzman
- Division of Cardiology, Department of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
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Vijayarajan V, Hsu A, Cheng YY, Shu MWS, Hyun K, Sy R, Chow V, Brieger D, Kritharides L, Ng ACC. Outcomes Following Implantable Cardioverter-Defibrillator Insertion in Patients 80 Years of Age or Older: A Statewide Population Cohort Study. Can J Cardiol 2024; 40:389-398. [PMID: 37898173 DOI: 10.1016/j.cjca.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/10/2023] [Accepted: 10/23/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Patients ≥ 80 years of age are underrepresented in major implantable cardioverter-defibrillator (ICD) trials, and real-world data are lacking. In this study, we sought to assess ICD utilisation, outcomes, and their predictors, in an unselected statewide population including patients ≥ 80 years old. METHODS We extracted details of ICDs implanted from 2009 to 2018 in New South Wales (NSW), Australia from the Centre for Health Record Linkage administrative data sets. Analysis was stratified into age groups of < 60 years, 60-79 years, and ≥ 80 years. RESULTS A total of 9304 patients (mean age 66.1 ± 13.1 years; 12.1% ≥ 80 years) had de novo ICD placement at an average rate of 1163 ± 122 patients per annum, with more implants in men in all age groups. After adjusting for NSW population size by sex, age group, and calendar year, mean implantation rates were 5.5 ± 0.6, 63.2 ± 8.6, and 52.7 ± 10.8 per 100,000 persons per annum in patients aged < 60 years, 60-79 years, and ≥ 80 years, respectively. In-hospital mortality was 0.4% and did not differ among age groups. However, 1-year mortality was 2.1%, 5.9%, and 10.7%, in those < 60 years, 60-79 years, and ≥ 80 years of age, respectively (P < 0.001), with hazard ratios for those aged ≥ 80 years of 4.3 (95% confidence interval [CI] 3.1-6.0) and those aged 60-79 years of 2.6 (95% CI 1.9-3.5) relative to those aged < 60 years (both P < 0.001) after adjusting for ICD indications, sex, implantation year, referral source, and comorbidities. In those aged ≥ 80 years, age > 83 years, congestive cardiac failure, chronic renal failure, neurodegenerative disease, and a higher Charlson comorbidity index score were each independent predictors of 1-year mortality. CONCLUSIONS ICD use in patients aged ≥ 80 years and 60-79 years was 10-fold that in patients aged < 60 years, and perioperative outcomes were good in all ages, but there was substantially increased 1-year mortality in those aged ≥ 80 years. Careful selection based on age and comorbidity may further reduce 1-year mortality in patients ≥ 80 years old receiving ICDs.
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Affiliation(s)
- Vijayatubini Vijayarajan
- Department of Cardiology, Concord Hospital, University of Sydney, Concord, New South Wales, Australia.
| | - Arielle Hsu
- Department of Cardiology, Concord Hospital, University of Sydney, Concord, New South Wales, Australia
| | - Yeu-Yao Cheng
- Department of Cardiology, Concord Hospital, University of Sydney, Concord, New South Wales, Australia
| | - Matthew Wei Shun Shu
- Department of Cardiology, Concord Hospital, University of Sydney, Concord, New South Wales, Australia
| | - Karice Hyun
- Department of Cardiology, Concord Hospital, University of Sydney, Concord, New South Wales, Australia
| | - Raymond Sy
- Department of Cardiology, Concord Hospital, University of Sydney, Concord, New South Wales, Australia
| | - Vincent Chow
- Department of Cardiology, Concord Hospital, University of Sydney, Concord, New South Wales, Australia
| | - David Brieger
- Department of Cardiology, Concord Hospital, University of Sydney, Concord, New South Wales, Australia
| | - Leonard Kritharides
- Department of Cardiology, Concord Hospital, University of Sydney, Concord, New South Wales, Australia
| | - Austin Chin Chwan Ng
- Department of Cardiology, Concord Hospital, University of Sydney, Concord, New South Wales, Australia
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Lewenhardt M, Kreimer F, Aweimer A, Pflaumbaum A, Mügge A, Gotzmann M. Benefit of primary and secondary prophylactic implantable cardioverter defibrillator in elderly patients. Clin Cardiol 2024; 47:e24191. [PMID: 37964443 PMCID: PMC10826786 DOI: 10.1002/clc.24191] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 10/27/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND The benefit of implantable cardioverter-defibrillator (ICD) in elderly patients has been questioned. In the present study, we aimed to analyse the outcome of patients of different age groups with ICD implantation. METHODS We included all patients who received an ICD in our hospital from 2011 to 2020. Primary endpoints were (1) death from any cause and (2) appropriate ICD therapy (antitachycardia pacing/shock). A "benefit of ICD implantation" was defined as appropriate ICD therapy before death from any cause/or survival. "No benefit of ICD implantation" was defined as death from any cause without prior appropriate ICD therapy. RESULTS A total of 422 patients received an ICD (primary prophylaxis n = 323, secondary prophylaxis n = 99). At the time of implantation, 35 patients (8%) were >80 years and 106 patients were >75 years (25%). During the study period of 4.2 ± 3 years, benefit of ICD occurred in 89 patients (21%) and no benefit in 84 patients (20%). In primary prevention, the proportion of patients who had a benefit from ICD implantation decreased with increasing age, and there were no patients who benefited from ICD therapy in the group of patients >80 years. In secondary prophylaxis, the proportion of patients with a benefit from ICD implantation ranged from 20% to 30% in all age groups. CONCLUSION Our study suggests that the indication of primary prophylactic ICD in elderly and very old patients should be critically assessed. On the other hand, no patient should be denied secondary prophylactic ICD implantation because of age.
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Affiliation(s)
- Marie Lewenhardt
- University Hospital St Josef‐Hospital Bochum, Cardiology and RhythmologyRuhr UniversityBochumGermany
| | - Fabienne Kreimer
- University Hospital St Josef‐Hospital Bochum, Cardiology and RhythmologyRuhr UniversityBochumGermany
| | - Assem Aweimer
- University Hospital Bergmannsheil Bochum, CardiologyRuhr UniversityBochumGermany
| | - Andreas Pflaumbaum
- University Hospital St Josef‐Hospital Bochum, Cardiology and RhythmologyRuhr UniversityBochumGermany
| | - Andreas Mügge
- University Hospital St Josef‐Hospital Bochum, Cardiology and RhythmologyRuhr UniversityBochumGermany
| | - Michael Gotzmann
- University Hospital St Josef‐Hospital Bochum, Cardiology and RhythmologyRuhr UniversityBochumGermany
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Milan HFM, Almazloum AA, Bassani RA, Bassani JWM. Membrane polarization at the excitation threshold induced by external electric fields in cardiomyocytes of rats at different developmental stages. Med Biol Eng Comput 2023; 61:2637-2647. [PMID: 37405671 DOI: 10.1007/s11517-023-02868-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/07/2023] [Indexed: 07/06/2023]
Abstract
External electric fields (E), used for cardiac pacing and defibrillation/cardioversion, induce a spatially variable change in cardiomyocyte transmembrane potential (ΔVm) that depends on cell geometry and E orientation. This study investigates E-induced ΔVm in cardiomyocytes from rats at different ages, which show marked size/geometry variation. Using a tridimensional numerical electromagnetic model recently proposed (NM3D), it was possible: (a) to evaluate the suitability of the simpler, prolate spheroid analytical model (PSAM) to calculate amplitude and location of ΔVm maximum (ΔVmax) for E = 1 V.cm-1; and (b) to estimate the ΔVmax required for excitation (ΔVT) from experimentally determined threshold E values (ET). Ventricular myocytes were isolated from neonatal, weaning, adult, and aging Wistar rats. NM3D was constructed as the extruded 2D microscopy cell image, while measured minor and major cell dimensions were used for PSAM. Acceptable ΔVm estimates can be obtained with PSAM from paralelepidal cells for small θ. ET, but not ΔVT, was higher for neonate cells. ΔVT was significantly greater in the cell from older animals, which indicate lower responsiveness to E associated with aging, rather than with altered cell geometry/dimensions. ΔVT might be used as a non-invasive indicator of cell excitability as it is little affected by cell geometry/size.
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Affiliation(s)
- Hugo F M Milan
- Department of Electronics and Biomedical Engineering, School of Electrical and Computer Engineering, University of Campinas (UNICAMP), Cidade Universitária Zeferino Vaz, Av. Albert Einstein 400, Campinas, SP, 13083-852, Brazil.
| | - Ahmad A Almazloum
- Department of Electronics and Biomedical Engineering, School of Electrical and Computer Engineering, University of Campinas (UNICAMP), Cidade Universitária Zeferino Vaz, Av. Albert Einstein 400, Campinas, SP, 13083-852, Brazil
| | - Rosana A Bassani
- Department of Electronics and Biomedical Engineering, School of Electrical and Computer Engineering, University of Campinas (UNICAMP), Cidade Universitária Zeferino Vaz, Av. Albert Einstein 400, Campinas, SP, 13083-852, Brazil
- LabNECC, Center for Biomedical Engineering (CEB), University of Campinas (UNICAMP), R. Alexander Fleming 163, Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-881, Brazil
| | - José W M Bassani
- Department of Electronics and Biomedical Engineering, School of Electrical and Computer Engineering, University of Campinas (UNICAMP), Cidade Universitária Zeferino Vaz, Av. Albert Einstein 400, Campinas, SP, 13083-852, Brazil
- LabNECC, Center for Biomedical Engineering (CEB), University of Campinas (UNICAMP), R. Alexander Fleming 163, Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-881, Brazil
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7
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Weiss R, Knight BP, El-Chami M, Aasbo J, Hanon S, Sadhu A, Sidhu M, Brisben AJ, Carter N, Burke MC, Gold M. Impact of Age on Subcutaneous Implantable Cardioverter-Defibrillator in a Large Patient Cohort: Mid-Term Follow-Up. JACC Clin Electrophysiol 2023; 9:2132-2145. [PMID: 37676200 DOI: 10.1016/j.jacep.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 05/26/2023] [Accepted: 06/25/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND The subcutaneous implantable cardioverter-defibrillator (S-ICD) is an accepted alternative to transvenous (TV) ICD to provide defibrillation therapy to treat life-threatening ventricular tachyarrhythmias in high-risk patients. S-ICD outcomes by age group have not been reported. OBJECTIVES In this study, the authors sought to report S-ICD outcomes in different age groups in a multicenter S-ICD post-approval study (PAS) involving the largest cohort of patients ever reported. METHODS Patients were prospectively enrolled in the S-ICD PAS and stratified based on age: young, aged 15-34 years; adult, aged 35-69 years; and elderly, aged ≥70 years. Patient characteristics and clinical outcomes through 3 years of follow up after implantation were compared. RESULTS The S-ICD PAS enrolled 1,637 patients. Elderly patients were more likely to receive an S-ICD as a replacement of a TV-ICD (15.1% elderly vs 12.3% adult vs 7.4% young). Secondary prevention indication decreased with age (32.7% young vs 22.2% adult vs 20.5% elderly). Mortality rate was significantly higher in the elderly group (24.0% elderly vs 13.0% adult vs 7.4% young; P < 0.0001), whereas the complication rate did not differ significantly (12.3% young vs 11.3% adult vs 8.1% elderly). Rates of appropriate shock (12.7% young vs 13.0% adult vs 13.8% elderly) and inappropriate shock (7.8% young vs 9.1% adult vs 8.8% elderly) rates did not differ between groups (P = 0.96 and P = 0.98, respectively). CONCLUSIONS Implant complications and appropriate and inappropriate shock rates were similar among age groups. S-ICD for secondary prevention was more common in the young group. Replacing a TV-ICD for an S-ICD increases with age. (S-ICD System Post-Approval Study; NCT01736618).
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Affiliation(s)
- Raul Weiss
- Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
| | | | | | - Johan Aasbo
- Baptist Health Lexington, Lexington, Kentucky, USA
| | - Sam Hanon
- Mount Sinai-Beth Israel Medical Center, New York, New York, USA
| | - Ashish Sadhu
- Phoenix Cardiovascular Research Group, Phoenix, Arizona, USA
| | | | - Amy J Brisben
- Boston Scientific Corporation, Saint Paul, Minnesota, USA
| | - Nathan Carter
- Boston Scientific Corporation, Saint Paul, Minnesota, USA
| | | | - Michael Gold
- Medical University of South Carolina, Charleston, South Carolina, USA
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Ziacchi M, Spadotto A, Ghio S, Pellegrino M, Potena L, Masarone D, Merlo M, Stolfo D, Caracciolo MM, Inserra C, Ammirati F, Ciccarelli M, Colivicchi F, Bianchi S, Patti G, Oliva F, Arcidiacono G, Rordorf R, Pini D, Pacileo G, D'Onofrio A, Forleo GB, Mariani M, Adamo F, Alonzo A, Ruzzolini M, Ghiglieno C, Cipriani M, Firetto G, Aspromonte N, Clemenza F, Maria De Ferrari G, Senni M, Grazia Bongiorni M, Tondo C, Grimaldi M, Giallauria F, Rametta F, Marchese P, Biffi M, Sinagra G. Bridging the gap in the symptomatic heart failure patient journey: insights from the Italian scenario. Expert Rev Med Devices 2023; 20:951-961. [PMID: 37712650 DOI: 10.1080/17434440.2023.2258786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/19/2023] [Accepted: 08/05/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND The prognosis for heart failure (HF) patients remains poor, with a high mortality rate, and a marked reduction in quality of life (QOL) and functional status. This study aims to explore the ongoing needs of HF management and the epidemiology of patients followed by Italian HF clinics, with a specific focus on cardiac contractility modulation (CCM). RESEARCH DESIGN AND METHODS Data from patients admitted to 14 HF outpatients clinics over 4 weeks were collected and compared to the results of a survey open to physicians involved in HF management operating in Italian centers. RESULTS One hundred and five physicians took part in the survey. Despite 94% of patients receive a regular follow-up every 3-6 months, available therapies are considered insufficient in 30% of cases. Physicians reported a lack of treatment options for 23% of symptomatic patients with reduced ejection fraction (EF) and for 66% of those without reduced EF. Approximately 3% of HF population (two patients per month per HF clinic) meets the criteria for immediate CCM treatment, which is considered a useful option by 15% of survey respondents. CONCLUSIONS Despite this relatively small percentage, considering total HF population, CCM could potentially benefit numerous HF patients, particularly the elderly, by reducing hospitalizations, improving functional capacity and QOL.
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Affiliation(s)
- Matteo Ziacchi
- Cardiology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Alberto Spadotto
- Cardiology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Stefano Ghio
- Division of Cardiology, Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marta Pellegrino
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Luciano Potena
- Cardiology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Daniele Masarone
- Heart Failure Unit, AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Marco Merlo
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | - Davide Stolfo
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | | | - Corinna Inserra
- Department of Cardiovascular Disease, Unit of Cardiology, Ospedale Civile di Legnano, Legnano, Italy
| | - Fabrizio Ammirati
- Cardiology Division, Presidio Ospedaliero GB Grassi Ostia Lido, Rome, Italy
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | | | - Stefano Bianchi
- UOC Cardiologia, Ospedale Fatebenefratelli Isola Tiberina, Rome, Italy
| | - Giuseppe Patti
- Università del Piemonte Orientale, Azienda Ospedaliero Universitaria "Maggiore Della Carita", Novara, Italy
| | - Fabrizio Oliva
- De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | - Giuseppe Arcidiacono
- Dipartimento di Medicina clinica e Sperimemtale, University of Messina, Messina, Italy
| | - Roberto Rordorf
- Division of Cardiology, Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Daniela Pini
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Giuseppe Pacileo
- Heart Failure Unit, AORN dei Colli, Monaldi Hospital, Naples, Italy
| | | | | | - Matteo Mariani
- Department of Cardiovascular Disease, Unit of Cardiology, Ospedale Civile di Legnano, Legnano, Italy
| | - Francesco Adamo
- Cardiology Division, Presidio Ospedaliero GB Grassi Ostia Lido, Rome, Italy
| | | | - Matteo Ruzzolini
- UOC Cardiologia, Ospedale Fatebenefratelli Isola Tiberina, Rome, Italy
| | - Chiara Ghiglieno
- Università del Piemonte Orientale, Azienda Ospedaliero Universitaria "Maggiore Della Carita", Novara, Italy
| | | | - Giorgio Firetto
- Dipartimento di Medicina clinica e Sperimemtale, University of Messina, Messina, Italy
| | - Nadia Aspromonte
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Francesco Clemenza
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Gaetano Maria De Ferrari
- AOU Città della Salute e della Scienza di Torino and Department of Medical Sciences, University Cardiology, Torino, Italy
| | - Michele Senni
- Cardiology Division, Cardiovascular Department, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Department of Biomedical, Surgical and Dentist Sciences, University of Milan, Milan, Italy
| | - Massimo Grimaldi
- Department of Cardiology, Ospedale Generale Regionale F. Muilli, Acquaviva delle Fonti, Italy
| | - Francesco Giallauria
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | | | - Procolo Marchese
- Department of Cardiology, Mazzoni Civil Hospital, Ascoli Piceno, Italy
| | - Mauro Biffi
- Cardiology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Trieste, Italy
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9
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Malekrah A, Shafiee A, Heidari A, Vasheghani‐Farahani A, Bozorgi A, Sadeghian S, Yaminisharif A. Predictors of mortality and clinical outcomes following implantable cardioverter-defibrillator therapy in elderly patients: A retrospective single-center cohort study. Health Sci Rep 2023; 6:e1432. [PMID: 37492274 PMCID: PMC10363787 DOI: 10.1002/hsr2.1432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/30/2023] [Accepted: 07/05/2023] [Indexed: 07/27/2023] Open
Abstract
Background and aims Implantable cardioverter-defibrillators (ICDs) are frequently used to prevent sudden cardiac death in patients with high-risk arrhythmias. However, the use of ICD therapy in elderly patients beyond the predicted age of life expectancy is still controversial. We aimed to evaluate the predictors of mortality and clinical outcomes following ICD implantation in elderly patients. Methods We conducted a retrospective analysis of 145 elderly patients aged 72 years and older who received ICD implantation between January 2010 and August 2015. We collected and analyzed baseline data, including clinical, demographic, and medical history, the reason for ICD therapy, procedural data, and echocardiography results. Follow-up data included the development of complications and mortality. The predictors of mortality were identified using the univariate and multivariable Cox regression models. Results During the median follow-up duration of 30.5 [18.0-48.0] months, 141 cases completed follow-up (mean age = 76.0 ± 3.7 years). Forty-four patients experienced at least one episode of ICD therapy. Inappropriate shock, recurrent shock, and device-related infection were the most frequent complications observed in our study. Of the 145 patients, 42 died during the follow-up period, with an average survival time of 22.4 months after ICD implantation. Among these patients, 11 received ICD for primary prevention, and 31 received it for secondary prevention. Cardiovascular problems were the leading cause of death. We found that a low baseline ejection fraction (EF) was an independent predictor of mortality (hazard ratio = 0.93, 95% confidence interval: 0.90-0.98; p = 0.008). Conclusion Our study suggests that ICD therapy is a valuable treatment option for elderly patients beyond their predicted age of life expectancy. The study highlights the importance of baseline EF as a significant predictor of mortality in these patients.
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Affiliation(s)
- Alireza Malekrah
- Department of Electrophysiology, Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- Cardiovascular Research CenterMazandaran University of Medical ScienceSariIran
| | - Akbar Shafiee
- Department of Cardiovascular Research, Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Amirhossein Heidari
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- Faculty of Medicine, Tehran Medical SciencesIslamic Azad UniversityTehranIran
| | - Ali Vasheghani‐Farahani
- Department of Electrophysiology, Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Ali Bozorgi
- Department of Electrophysiology, Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Saeed Sadeghian
- Department of Electrophysiology, Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Ahmad Yaminisharif
- Department of Electrophysiology, Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
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10
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Andresen H, Pagonas N, Eisert M, Patschan D, Nordbeck P, Buschmann I, Sasko B, Ritter O. Defibrillator exchange in the elderly. Heart Rhythm O2 2023; 4:382-390. [PMID: 37361620 PMCID: PMC10288028 DOI: 10.1016/j.hroo.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
Background Implantable cardioverter-defibrillator (ICD) therapy in elderly patients is controversial because survival benefits might be attenuated by nonarrhythmic causes of death. Objective The purpose of this study was to investigate the outcome of septuagenarians and octogenarians after ICD generator exchange (GE). Methods A total of 506 patients undergoing elective GE were analyzed to determine the incidence of ICD shocks and/or survival after GE. Patients were divided into a septuagenarian group (age 70-79 years) and an octogenarian group (age ≥80 years). The primary endpoint was death from any cause. Secondary endpoints were survival after appropriate ICD shock and death without experiencing ICD shocks after GE ("prior death"). Results The association of the ICD with all-cause mortality and arrhythmic death was determined for septuagenarians and octogenarians. Comparing both groups, similar left ventricular ejection fraction (35.6% ± 11.2% vs 32.4% ± 8.9%) and baseline prevalence of New York Heart Association functional class III or IV heart failure (17.1% vs 14.7%) were found. During the entire follow-up period of the study, 42.5% of patients in the septuagenarian group died compared to 79% in the octogenarian group (P <.01). Prior death was significantly more frequent in both age groups than were appropriate ICD shocks. Predictors of mortality were common in both groups and included advanced heart failure, peripheral arterial disease, and renal failure. Conclusion In clinical practice, decision-making for ICD GE among the elderly should be considered carefully for individual patients.
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Affiliation(s)
- Henrike Andresen
- Department of Internal Medicine I, Klinikum Brandenburg, Brandenburg/Havel, Germany
| | - Nikolaos Pagonas
- Department of Internal Medicine I, Klinikum Brandenburg, Brandenburg/Havel, Germany
- Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
| | - Marius Eisert
- Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
| | - Daniel Patschan
- Department of Internal Medicine I, Klinikum Brandenburg, Brandenburg/Havel, Germany
- Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg/Havel, Germany
| | - Peter Nordbeck
- Department of Internal Medicine I, University Hospital of Würzburg, Würzburg, Germany
| | - Ivo Buschmann
- Department of Internal Medicine I, Klinikum Brandenburg, Brandenburg/Havel, Germany
- Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg/Havel, Germany
| | - Benjamin Sasko
- Department of Internal Medicine I, Klinikum Brandenburg, Brandenburg/Havel, Germany
- Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
- Department of Internal Medicine IV–Cardiology, Knappschaftskrankenhaus Bottrop, Bottrop, Germany
| | - Oliver Ritter
- Department of Internal Medicine I, Klinikum Brandenburg, Brandenburg/Havel, Germany
- Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg/Havel, Germany
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11
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Savelieva I, Fumagalli S, Kenny RA, Anker S, Benetos A, Boriani G, Bunch J, Dagres N, Dubner S, Fauchier L, Ferrucci L, Israel C, Kamel H, Lane DA, Lip GYH, Marchionni N, Obel I, Okumura K, Olshansky B, Potpara T, Stiles MK, Tamargo J, Ungar A. EHRA expert consensus document on the management of arrhythmias in frailty syndrome, endorsed by the Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), Latin America Heart Rhythm Society (LAHRS), and Cardiac Arrhythmia Society of Southern Africa (CASSA). Europace 2023; 25:1249-1276. [PMID: 37061780 PMCID: PMC10105859 DOI: 10.1093/europace/euac123] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 06/27/2022] [Indexed: 04/17/2023] Open
Abstract
There is an increasing proportion of the general population surviving to old age with significant chronic disease, multi-morbidity, and disability. The prevalence of pre-frail state and frailty syndrome increases exponentially with advancing age and is associated with greater morbidity, disability, hospitalization, institutionalization, mortality, and health care resource use. Frailty represents a global problem, making early identification, evaluation, and treatment to prevent the cascade of events leading from functional decline to disability and death, one of the challenges of geriatric and general medicine. Cardiac arrhythmias are common in advancing age, chronic illness, and frailty and include a broad spectrum of rhythm and conduction abnormalities. However, no systematic studies or recommendations on the management of arrhythmias are available specifically for the elderly and frail population, and the uptake of many effective antiarrhythmic therapies in these patients remains the slowest. This European Heart Rhythm Association (EHRA) consensus document focuses on the biology of frailty, common comorbidities, and methods of assessing frailty, in respect to a specific issue of arrhythmias and conduction disease, provide evidence base advice on the management of arrhythmias in patients with frailty syndrome, and identifies knowledge gaps and directions for future research.
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Affiliation(s)
- Irina Savelieva
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Stefano Fumagalli
- Department of Experimental and Clinical Medicine, Geriatric Intensive Care Unit and Geriatric Arrhythmia Unit, University of Florence and AOU Careggi, Florence, Italy
| | - Rose Anne Kenny
- Mercer’s Institute for Successful Ageing, Department of Medical Gerontology, St James’s Hospital, Dublin, Ireland
| | - Stefan Anker
- Department of Cardiology (CVK), Germany
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Germany
- German Centre for Cardiovascular Research (DZHK) partner site Berlin, Germany
- Charité Universitätsmedizin Berlin, Germany
| | - Athanase Benetos
- Department of Geriatric Medicine CHRU de Nancy and INSERM U1116, Université de Lorraine, Nancy, France
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Jared Bunch
- (HRS representative): Intermountain Medical Center, Cardiology Department, Salt Lake City,Utah, USA
- Stanford University, Department of Internal Medicine, Palo Alto, CA, USA
| | - Nikolaos Dagres
- Heart Center Leipzig, Department of Electrophysiology, Leipzig, Germany
| | - Sergio Dubner
- (LAHRS representative): Clinica Suizo Argentina, Cardiology Department, Buenos Aires Capital Federal, Argentina
| | - Laurent Fauchier
- Centre Hospitalier Universitaire Trousseau et Université François Rabelais, Tours, France
| | | | - Carsten Israel
- Evangelisches Krankenhaus Bielefeld GmbH, Bielefeld, Germany
| | - Hooman Kamel
- Department of Neurology, Weill Cornell Medical College, New York, NY, USA
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Niccolò Marchionni
- Department of Experimental and Clinical Medicine, General Cardiology Division, University of Florence and AOU Careggi, Florence, Italy
| | - Israel Obel
- (CASSA representative): Milpark Hospital, Cardiology Unit, Johannesburg, South Africa
| | - Ken Okumura
- (APHRS representative): Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Brian Olshansky
- University of Iowa Hospitals and Clinics, Iowa CityIowa, USA
- Covenant Hospital, Waterloo, Iowa, USA
- Mercy Hospital Mason City, Iowa, USA
| | - Tatjana Potpara
- School of Medicine, Belgrade University, Serbia
- Cardiology Clinic, Clinical Center of Serbia, Serbia
| | - Martin K Stiles
- (APHRS representative): Waikato Clinical School, University of Auckland and Waikato Hospital, Hamilton, New Zealand
| | - Juan Tamargo
- Department of Pharmacology, School of Medicine, CIBERCV, Universidad Complutense, Madrid, Spain
| | - Andrea Ungar
- Department of Experimental and Clinical Medicine, Geriatric Intensive Care Unit and Geriatric Arrhythmia Unit, University of Florence and AOU Careggi, Florence, Italy
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12
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Teixeira RA, Fagundes AA, Baggio Junior JM, Oliveira JCD, Medeiros PDTJ, Valdigem BP, Teno LAC, Silva RT, Melo CSD, Elias Neto J, Moraes Júnior AV, Pedrosa AAA, Porto FM, Brito Júnior HLD, Souza TGSE, Mateos JCP, Moraes LGBD, Forno ARJD, D'Avila ALB, Cavaco DADM, Kuniyoshi RR, Pimentel M, Camanho LEM, Saad EB, Zimerman LI, Oliveira EB, Scanavacca MI, Martinelli Filho M, Lima CEBD, Peixoto GDL, Darrieux FCDC, Duarte JDOP, Galvão Filho SDS, Costa ERB, Mateo EIP, Melo SLD, Rodrigues TDR, Rocha EA, Hachul DT, Lorga Filho AM, Nishioka SAD, Gadelha EB, Costa R, Andrade VSD, Torres GG, Oliveira Neto NRD, Lucchese FA, Murad H, Wanderley Neto J, Brofman PRS, Almeida RMS, Leal JCF. Brazilian Guidelines for Cardiac Implantable Electronic Devices - 2023. Arq Bras Cardiol 2023; 120:e20220892. [PMID: 36700596 PMCID: PMC10389103 DOI: 10.36660/abc.20220892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | - Rodrigo Tavares Silva
- Universidade de Franca (UNIFRAN), Franca, SP - Brasil
- Centro Universitário Municipal de Franca (Uni-FACEF), Franca, SP - Brasil
| | | | - Jorge Elias Neto
- Universidade Federal do Espírito Santo (UFES), Vitória, ES - Brasil
| | - Antonio Vitor Moraes Júnior
- Santa Casa de Ribeirão Preto, Ribeirão Preto, SP - Brasil
- Unimed de Ribeirão Preto, Ribeirão Preto, SP - Brasil
| | - Anisio Alexandre Andrade Pedrosa
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Luis Gustavo Belo de Moraes
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | - Mauricio Pimentel
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | | | - Eduardo Benchimol Saad
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil
- Hospital Samaritano, Rio de Janeiro, RJ - Brasil
| | | | | | - Mauricio Ibrahim Scanavacca
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Martino Martinelli Filho
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Carlos Eduardo Batista de Lima
- Hospital Universitário da Universidade Federal do Piauí (UFPI), Teresina, PI - Brasil
- Empresa Brasileira de Serviços Hospitalares (EBSERH), Brasília, DF - Brasil
| | | | - Francisco Carlos da Costa Darrieux
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Sissy Lara De Melo
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Eduardo Arrais Rocha
- Hospital Universitário Walter Cantídio, Universidade Federal do Ceará (UFC), Fortaleza, CE - Brasil
| | - Denise Tessariol Hachul
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Silvana Angelina D'Orio Nishioka
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Roberto Costa
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Gustavo Gomes Torres
- Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN - Brasil
| | | | | | - Henrique Murad
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | - Rui M S Almeida
- Centro Universitário Fundação Assis Gurgacz, Cascavel, PR - Brasil
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13
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Aktaş MK, Younis A, Saxena S, Diamond A, Ojo A, Kutyifa V, Steiner H, Steinberg JS, Zareba W, McNitt S, Polonsky B, Rosero SZ, Huang DT, Goldenberg I. Age and the Risk of Ventricular Tachyarrhythmia in Patients With an Implantable Cardioverter-Defibrillator. JACC Clin Electrophysiol 2022:S2405-500X(22)01052-0. [PMID: 36752470 DOI: 10.1016/j.jacep.2022.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/01/2022] [Accepted: 11/20/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND The benefit of implantable cardioverter-defibrillators (ICDs) in elderly patients is controversial. OBJECTIVES The aims of this study were to evaluate the risk for ventricular tachyarrhythmia (VTA) and ICD shocks by age groups and to assess the competing risk for VTA and death without prior VTA. METHODS The study included 5,170 primary prevention ICD recipients enrolled in 5 landmark ICD trials (MADIT [Multicenter Automatic Defibrillator Implantation Trial] II, MADIT-Risk, MADIT-CRT [MADIT Cardiac Resynchronization Therapy], MADIT-RIT [MADIT Reduce Inappropriate Therapy], and RAID [Ranolazine in High-Risk Patients With Implanted Cardioverter-Defibrillator]). Fine and Gray regression analysis was used to evaluate the risk for fast VTA (ventricular tachycardia ≥200 beats/min or ventricular fibrillation) vs death without prior fast VTA in 3 prespecified age groups: <65, 65 to <75, and ≥75 years. RESULTS The cumulative incidence of fast VTA at 3 years was similar for patients <65 years of age and those 65 to <75 years of age (17% vs 15%) and was lowest among patients ≥75 years of age (10%) (P < 0.001). Multivariate Fine and Gray analysis showed a 40% lower risk for fast VTA in patients ≥75 years of age (HR: 0.60; 95% CI: 0.46-0.78; P < 0.001) compared with patients <65 years of age. In patients ≥75 years of age, a risk reversal was observed whereby the risk for death without prior fast VTA exceeded the risk for developing fast VTA. A history of nonsustained ventricular tachycardia, male sex, and the presence of nonischemic cardiomyopathy were identified as predictors of fast VTA in patients ≥75 years of age. CONCLUSIONS Patients ≥75 years of age have a significantly lower risk for VTA and ICD shocks compared with younger patients. Aging is associated with a higher risk for death compared with the risk for fast VTA, the reverse of what is seen in younger patients.
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Affiliation(s)
- Mehmet K Aktaş
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York, USA.
| | - Arwa Younis
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York, USA
| | - Shireen Saxena
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York, USA
| | - Alexander Diamond
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York, USA
| | - Amole Ojo
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York, USA
| | - Valentina Kutyifa
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York, USA
| | - Hillel Steiner
- The Edith Wolfson Medical Center, Holon, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan S Steinberg
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York, USA
| | - Wojciech Zareba
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York, USA
| | - Scott McNitt
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York, USA
| | - Bronislava Polonsky
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York, USA
| | - Spencer Z Rosero
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York, USA
| | - David T Huang
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York, USA
| | - Ilan Goldenberg
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York, USA
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14
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Implantation of Implantable Cardioverter Defibrillators in Kazakhstan. Glob Heart 2022; 17:30. [PMID: 35586742 PMCID: PMC9104561 DOI: 10.5334/gh.1119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 04/16/2022] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives: Implantation of implantable cardioverter-defibrillators (ICD) has increased significantly over the past decade. However, limited data exist regarding practices and policies of ICD implantations in Kazakhstan. We aimed to provide an overview of the current use of ICD in Kazakhstan. Methods: Using the Unified Healthcare Information System database of the entire Kazakh adult population, statistical and cost data of ICD implantations in 2017–2019 were evaluated. Cardiologists and electrophysiologists working in cardio surgery centers and departments were asked to go through an online survey focused on subcutaneous-ICD (S-ICD) experience. Results: Implantation of traditional transvenous cardioverter-defibrillators for residents of Kazakhstan is fully reimbursed. A total of 2,263 ICD interventions (2,252 new implantations and 11 reimplantations) were performed across the country during the study period. According to the tariffs approved by the Ministry of Health, the reimbursement cost for one ICD case is about 14,061.80 US dollars. The survey showed that only two hospitals have implanted S-ICDs. Among the main reasons why S-ICD is not widely used in the country the following were named: lack of trained staff (61.1% of respondents); the cost of device and lack of reimbursement (38.7%); and lack of pacing function (27.8%). Conclusion: The number of ICD implantation in Kazakhstan is steadily continuing to grow, although, compared to developed countries, the implantation rate especially for S-ICD remains low. There is a need in deliberate strategies to remove policy barriers for implementation the most innovative cardiac implantable electronic devices implantations such as S-ICD in the country.
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15
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Maille B, Bodin A, Bisson A, Herbert J, Pierre B, Clementy N, Klein V, Franceschi F, Deharo JC, Fauchier L. Predicting outcome after cardiac resynchronisation therapy defibrillator implantation: the CRT-D Futility score. BRITISH HEART JOURNAL 2022; 108:1186-1193. [PMID: 35410895 DOI: 10.1136/heartjnl-2021-320532] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/04/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Risk-benefit for cardiac resynchronisation therapy (CRT) defibrillator (CRT-D) over CRT pacemaker remains a matter of debate. We aimed to identify patients with a poor outcome within 1 year of CRT-D implantation, and to develop a CRT-D Futility score. METHODS Based on an administrative hospital-discharge database, all consecutive patients treated with prophylactic CRT-D implantation in France (2010-2019) were included. A prediction model was derived and validated for 1-year all-cause death after CRT-D implantation (considered as futility) by using split-sample validation. RESULTS Among 23 029 patients (mean age 68±10 years; 4873 (21.2%) women), 7016 deaths were recorded (yearly incidence rate 7.2%), of which 1604 (22.8%) occurred within 1 year of CRT-D implantation. In the derivation cohort (n=11 514), the final logistic regression model included-as main predictors of futility-older age, diabetes, mitral regurgitation, aortic stenosis, history of hospitalisation with heart failure, history of pulmonary oedema, atrial fibrillation, renal disease, liver disease, undernutrition and anaemia. Area under the curve for the CRT-D Futility score was 0.716 (95% CI: 0.698 to 0.734) in the derivation cohort and 0.692 (0.673 to 0.710) in the validation cohort. The Hosmer-Lemeshow test had a p-value of 0.57 suggesting accurate calibration. The CRT-D Futility score outperformed the Goldenberg and EAARN scores for identifying futility. Based on the CRT-D Futility score, 15.9% of these patients were categorised at high risk (predicted futility of 16.6%). CONCLUSIONS The CRT-D Futility score, established from a large nationwide cohort of patients treated with CRT-D, may be a relevant tool for optimising healthcare decision-making.
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Affiliation(s)
- Baptiste Maille
- Cardiology, Assistance Publique Hopitaux de Marseille, Marseille, France .,C2VN, Aix-Marseille University, Marseille, France
| | - Alexandre Bodin
- Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Arnaud Bisson
- Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Julien Herbert
- Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Bertrand Pierre
- Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Nicolas Clementy
- Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Victor Klein
- Cardiology, Assistance Publique Hopitaux de Marseille, Marseille, France
| | - Frédéric Franceschi
- Cardiology, Assistance Publique Hopitaux de Marseille, Marseille, France.,C2VN, Aix-Marseille University, Marseille, France
| | - Jean-Claude Deharo
- Cardiology, Assistance Publique Hopitaux de Marseille, Marseille, France.,C2VN, Aix-Marseille University, Marseille, France
| | - Laurent Fauchier
- Cardiology, Trousseau University Hospital, Tours, France.,François Rabelais University, Tours, France
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16
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Deckers JW, Arshi B, van den Berge JC, Constantinescu AA. Preventive implantable cardioverter defibrillator therapy in contemporary clinical practice: need for more stringent selection criteria. ESC Heart Fail 2021; 8:3656-3662. [PMID: 34337903 PMCID: PMC8497353 DOI: 10.1002/ehf2.13506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 12/03/2022] Open
Abstract
While the efficacy of the intracardiac defibrillators (ICDs) for primary prevention is not disputed, the relevant studies were carried out a long time ago. Most pertinent trials, including MADIT‐II, SCD‐Heft, and DEFINITE, recruited patients more than 20 years ago. Since then, improved therapeutic modalities including, in addition to cardiac resynchronization therapy, mineralocorticoid receptor antagonists, angiotensin receptor‐neprilysin inhibitors, and, most recently, inhibitors of sodium‐glucose cotransporter 2, have lowered present‐day rates of mortality and of sudden cardiac death. Thus, nowadays, ICD therapy may be less effective than previously reported, and not as beneficial as many people currently believe. However, criteria for ICD implantation remain very inclusive. The patient must (only) be symptomatic and have ejection fraction (EF) ≤ 35%. The choice of EF 35% is notable because the average EF in all large trials was much lower, and clinical benefit was mainly limited to EF ≤ 30%. This EF cut‐off value defines a substantial portion of potential ICD recipients. It seems therefore reasonable to limit ICD eligibility criteria in the EF range 30–35% to patients at highest risk only. We discuss and present some rational criteria to assist the clinician in improving risk stratification for preventive ICD implantation.
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Affiliation(s)
- Jaap W Deckers
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands.,Department of Epidemiology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Banafsheh Arshi
- Department of Epidemiology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan C van den Berge
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands
| | - Alina A Constantinescu
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands
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17
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Marini M, Martin M, Strazzanti M, Quintarelli S, Guarracini F, Coser A, Valsecchi S, Bonmassari R. Implantable cardioverter-defibrillators in elderly patients: outcome and predictors of mortality. J Interv Card Electrophysiol 2021; 64:573-580. [PMID: 34212276 DOI: 10.1007/s10840-021-01017-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/30/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE The implantable cardioverter-defibrillator (ICD) is the therapy of choice for the prevention of sudden cardiac death. The number of elderly patients receiving ICDs is increasing. This study aimed to assess the outcome of patients according to their age at the time of implantation, and to identify variables potentially associated with patient survival. METHODS Between June 2009 and December 2019, we retrospectively enrolled all consecutive patients in whom ICD implantation had been performed for primary or secondary prevention at our center. RESULTS During the study period, 670 patients underwent ICD implantation. We stratified the population into four age-classes: Class 1 (23%) (pts aged less than 60 years), Class 2 (28%) (pts aged between 60 and 70 years), Class 3 (39%) (pts aged between 70 and 80 years) and Class 4 (9%) (pts aged 80 years or older). Over a median follow-up of 42 months, the rate of deaths in Class 4 was higher than in Classes 1 and 2 (log-rank test, P < 0.01), but was comparable to that in Class 3 (P = 0.407). With increasing age, we observed more complications at the time of implantation and during follow-up. On multivariate analysis, higher NYHA class, creatinine level and CHA2DS2-VASc score were identified as independent predictors of death, while age was not associated with worse prognosis. Higher body mass index, higher NYHA class and CHA2DS2-VASc score were also confirmed as independent predictors of hospitalizations or death due to any cause. CONCLUSION This study showed good survival in ICD patients in all age-groups, including those aged ≥80 years. The CHA2DS2-VASc score seems to be a stronger predictor of death than age.
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Affiliation(s)
| | - Marta Martin
- Department of Cardiology, S. Chiara Hospital, Trento, Italy
| | | | | | | | - Alessio Coser
- Department of Cardiology, S. Chiara Hospital, Trento, Italy
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18
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Canterbury A, Saba S. Cardiac resynchronization therapy using a pacemaker or a defibrillator: Patient selection and evidence to support it. Prog Cardiovasc Dis 2021; 66:46-52. [PMID: 33865865 DOI: 10.1016/j.pcad.2021.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 11/25/2022]
Abstract
Cardiac resynchronization therapy (CRT) is an established treatment for patients with heart failure (HF), myocardial dysfunction and prolonged ventricular depolarization on surface electrocardiogram. CRT can be delivered by a pacemaker (CRT-P) or a combined pacemaker-defibrillator (CRT-D). Although these two types of devices are very different in size, function, and cost, current published guidelines do not distinguish between them, leaving the choice of which device to implant to the treating physician and the informed patient. In this paper, we review the published CRT clinical trial literature with focus on the outcomes of HF patients treated with CRT-P versus CRT-D. We also attempt to provide guidance as to the appropriate choice of CRT device type, in the absence of randomized prospective trials geared to answer this specific question.
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Affiliation(s)
- Ann Canterbury
- Heart and Vascular Institute at the University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - Samir Saba
- Heart and Vascular Institute at the University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America.
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19
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Strisciuglio T, Stabile G, Pecora D, Arena G, Caico SI, Marini M, Pepi P, D’Onofrio A, De Simone A, Ricciardi G, Badolati S, Spotti A, Casu G, Solimene F, La Greca C, Ammirati G, Pergola V, Addeo L, Malacrida M, Bertaglia E, Rapacciuolo A. Does the Age Affect the Outcomes of Cardiac Resynchronization Therapy in Elderly Patients? J Clin Med 2021; 10:jcm10071451. [PMID: 33916276 PMCID: PMC8036418 DOI: 10.3390/jcm10071451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/23/2021] [Accepted: 03/29/2021] [Indexed: 11/25/2022] Open
Abstract
Background: More and more heart failure (HF) patients aged ≥ 75 years undergo cardiac resynchronization therapy (CRT) device implantation, however the data regarding the outcomes and their predictors are scant. We investigated the mid- to long-term outcomes and their predictors in CRT patients aged ≥ 75 years. Methods: Patients in the Cardiac Resynchronization Therapy Modular (CRT MORE) Registry were divided into three age-groups: <65 (group A), 65–74 (group B) and ≥75 years (group C). Mortality, hospitalization, and composite event rate were evaluated at 1 year and during long-term follow-up. Results: Patients (n = 934) were distributed as follows: group A 242; group B 347; group C 345. On 12-month follow-up examination, 63% of patients ≥ 75 years displayed a positive clinical response. Mortality was significantly higher in patients ≥ 75 years than in the other two groups, although the rate of hospitalizations for HF worsening was similar to that of patients aged 65–74 (7 vs. 9.5%, respectively; p = 0.15). Independent predictors of death and of negative clinical response were age >80 years, chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD). Over long-term follow-up (1020 days (IQR 680-1362)) mortality was higher in patients ≥ 75 years than in the other two groups. Hospitalization and composite event rates were similar in patients ≥ 75 years and those aged 65–74 (9 vs. 11.8%; p = 0.26, and 26.7 vs. 20.5%; p = 0.06). Conclusion: Positive clinical response and hospitalization rates do not differ between CRT recipients ≥ 75 years and those aged 65–74. However, age > 80 years, COPD and CKD are predictors of worse outcomes.
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Affiliation(s)
- Teresa Strisciuglio
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80138 Naples, Italy; (T.S.); (G.A.); (V.P.); (L.A.)
| | | | - Domenico Pecora
- Fondazione Poliambulanza, 25124 Brescia, Italy; (D.P.); (C.L.G.)
| | - Giuseppe Arena
- Department of Cardiology, Apuane Hospital, 54100 Massa, Italy;
| | - Salvatore Ivan Caico
- Department of Cardiology, ASST Valle Olona, Gallarate Hospital, 21013 Gallarate, Italy;
| | | | | | | | | | - Giuseppe Ricciardi
- Heart and Vessels Department, University of Florence, 50121 Firenze, Italy;
| | | | | | - Gavino Casu
- Department of Cardiology, Ospedale San Francesco, 08100 Nuoro, Italy;
| | | | - Carmelo La Greca
- Fondazione Poliambulanza, 25124 Brescia, Italy; (D.P.); (C.L.G.)
| | - Giuseppe Ammirati
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80138 Naples, Italy; (T.S.); (G.A.); (V.P.); (L.A.)
| | - Valerio Pergola
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80138 Naples, Italy; (T.S.); (G.A.); (V.P.); (L.A.)
| | - Lucio Addeo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80138 Naples, Italy; (T.S.); (G.A.); (V.P.); (L.A.)
| | | | - Emanuele Bertaglia
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, 35122 Padova, Italy;
| | - Antonio Rapacciuolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80138 Naples, Italy; (T.S.); (G.A.); (V.P.); (L.A.)
- Correspondence: ; Tel.: +39-081-746-2235
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20
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Is there a benefit of ICD treatment in patients with persistent severely reduced systolic left ventricular function after TAVI? Clin Res Cardiol 2021; 111:492-501. [PMID: 33758967 PMCID: PMC9054877 DOI: 10.1007/s00392-021-01826-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/21/2021] [Indexed: 10/25/2022]
Abstract
BACKGROUND In patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) and heart failure with severely reduced ejection fraction, prediction of postprocedural left ventricular ejection fraction (LVEF) improvement is challenging. Decision-making and timing for implantable cardioverter defibrillator (ICD) treatment are difficult and benefit is still unclear in this patient population. OBJECTIVE Aims of the study were to analyse long-term overall mortality in TAVI-patients with a preprocedural LVEF ≤ 35% regarding LVEF improvement and effect of ICD therapy. METHODS AND RESULTS Retrospective analysis of a high-risk TAVI-population suffering from severe AS and heart failure with a LVEF ≤ 35%. Out of 1485 TAVI-patients treated at this center between January 2013 and April 2018, 120 patients revealed a preprocedural LVEF ≤ 35% and had sufficient follow-up. 36.7% (44/120) of the patients suffered from persistent reduced LVEF without a postprocedural increase above 35% within 1 year after TAVI or before death, respectively. Overall mortality was neither significantly reduced by LVEF recovery above 35% (p = 0.31) nor by additional ICD treatment in patients with persistent LVEF ≤ 35% (p = 0.33). CONCLUSION In high-risk TAVI-patients suffering from heart failure with LVEF ≤ 35%, LVEF improvement to more than 35% did not reduce overall mortality. Patients with postprocedural persistent LVEF reduction did not seem to benefit from ICD treatment. Effects of LVEF improvement and ICD treatment on mortality are masked by the competing risk of death from relevant comorbidities.
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21
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Poupin P, Bouleti C, Degand B, Paccalin M, Le Gal F, Bureau ML, Alos B, Roumegou P, Christiaens L, Ingrand P, Garcia R. Prognostic value of Charlson Comorbidity Index in the elderly with a cardioverter defibrillator implantation. Int J Cardiol 2020; 314:64-69. [PMID: 32291172 DOI: 10.1016/j.ijcard.2020.03.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/19/2020] [Accepted: 03/23/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Elderly patients are often underrepresented in implantable cardioverter defibrillator (ICD) trials, and ICD implantation in patients ≥75 years consequently remains controversial. We aimed to evaluate mortality, appropriate ICD therapy rates and survival gain in an elderly population after risk stratification according to the Charlson Comorbidity Index (CCI). METHODS This monocentric retrospective study included elderly ICD patients ≥75 years. They were subdivided according to their CCI score into 3 categories (0-1, 2-3 or ≥4 points). Elderly patients were matched 1:2 with younger control ICD patients on gender, type of prevention (primary or secondary) and type of device (associated cardiac resynchronization therapy or not). RESULTS Between January 2009 and July 2017, 121 elderly patients (mean age 78 ± 3; 83% male) matched with 242 controls (mean age 66 ± 5) were included. At 5 year follow-up after ICD implantation, overall survival was 78%, 57%, and 29% (P = 0.002) in the elderly with a CCI score of 0-1, 2-3 and ≥4 respectively, and 72% in controls. There was no significant difference regarding ICD appropriate therapy between the 3 subgroups despite a trend towards lower rates of therapy in CCI ≥ 4 points patients (34.2%, 39.7% and 22.8% respectively; P = 0.45). Median potential survival gain after an appropriate therapy was >5, 4.7 and 1.4 years, with a CCI score of 0-1, 2-3 and ≥4 respectively (P = 0.01). CONCLUSION Elderly patients with CCI score ≥ 4 had the lowest survival after ICD implantation and little survival gain in case of appropriate defibrillator therapy. More than age alone, the burden of comorbidities assessed by the CCI could be helpful to better select elderly patients for ICD implantation.
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Affiliation(s)
- Pierre Poupin
- CHU Poitiers, Unité Médico-Chirurgicale Pôle Montmorillon, 2 rue de la Milétrie, F-86021 Poitiers, France
| | - Claire Bouleti
- CHU Poitiers, Service de Cardiologie, 2 rue de la Milétrie, F-86021 Poitiers, France; Univ Poitiers, Faculté de Médecine et Pharmacie, F-86021 Poitiers, France; INSERM CIC 1402, CHU Poitiers, 2 rue de la Milétrie, F-86021 Poitiers, France
| | - Bruno Degand
- CHU Poitiers, Service de Cardiologie, 2 rue de la Milétrie, F-86021 Poitiers, France.
| | - Marc Paccalin
- Univ Poitiers, Faculté de Médecine et Pharmacie, F-86021 Poitiers, France; CHU Poitiers, Service de Gériatrie, 2 rue de la Milétrie, F-86021 Poitiers, France.
| | - François Le Gal
- CHU Poitiers, Service de Cardiologie, 2 rue de la Milétrie, F-86021 Poitiers, France.
| | - Marie-Laure Bureau
- CHU Poitiers, Service de Cardiologie, 2 rue de la Milétrie, F-86021 Poitiers, France; Univ Poitiers, Faculté de Médecine et Pharmacie, F-86021 Poitiers, France.
| | - Benjamin Alos
- CHU Poitiers, Service de Cardiologie, 2 rue de la Milétrie, F-86021 Poitiers, France; Univ Poitiers, Faculté de Médecine et Pharmacie, F-86021 Poitiers, France; INSERM CIC 1402, CHU Poitiers, 2 rue de la Milétrie, F-86021 Poitiers, France
| | - Pierre Roumegou
- CHU Poitiers, Service de Cardiologie, 2 rue de la Milétrie, F-86021 Poitiers, France.
| | - Luc Christiaens
- CHU Poitiers, Service de Cardiologie, 2 rue de la Milétrie, F-86021 Poitiers, France; Univ Poitiers, Faculté de Médecine et Pharmacie, F-86021 Poitiers, France; INSERM CIC 1402, CHU Poitiers, 2 rue de la Milétrie, F-86021 Poitiers, France.
| | - Pierre Ingrand
- Univ Poitiers, Faculté de Médecine et Pharmacie, F-86021 Poitiers, France; Epidemiology and Biostatistics, INSERM CIC 1402, CHU Poitiers, 2 rue de la Milétrie, F-86021 Poitiers, France.
| | - Rodrigue Garcia
- CHU Poitiers, Service de Cardiologie, 2 rue de la Milétrie, F-86021 Poitiers, France; Univ Poitiers, Faculté de Médecine et Pharmacie, F-86021 Poitiers, France; INSERM CIC 1402, CHU Poitiers, 2 rue de la Milétrie, F-86021 Poitiers, France.
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22
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Lin AY, Lupercio F, Ho G, Pollema T, Pretorius V, Birgersdotter-Green U. Safety and Efficacy of Cardiovascular Implantable Electronic Device Extraction in Elderly Patients: A Meta-Analysis and Systematic Review. Heart Rhythm O2 2020; 1:250-258. [PMID: 33604584 PMCID: PMC7889020 DOI: 10.1016/j.hroo.2020.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Transvenous lead extraction of cardiovascular implantable electronic device (CIED) has been proven safe in the general patient population with the advances in extraction techniques. Octogenarians present a unique challenge given their comorbidities and the perceived increase in morbidity and mortality. Objective To assess the safety and outcomes of CIED extraction in octogenarians to younger patients. Methods We performed an extensive literature search and systematic review of studies that compared CIED extraction in octogenarians versus non-octogenarians. We separately assessed the rate of complete procedure success, clinical success, procedural mortality, major and minor complications. Risk ratio (RR) 95% confidence intervals were measured using the Mantel-Haenszel method. The random effects model was used due to heterogeneity across study cohorts. Results Seven studies with a total of 4,182 patients were included. There was no difference between octogenarians and non-octogenarians in complete procedure success (RR 1.01, 95% CI 1.00 - 1.02, p = 0.19) and clinical success (RR 1.01, 95% CI 1.00 - 1.01, p = 0.13). There was also no difference in procedural mortality (RR 1.43, 95% CI 0.46 - 4.39, p = 0.54), major complication (RR 1.40, 95% CI 0.68 - 2.88, p = 0.36), and minor complication (RR 1.43, 95% CI 0.90 - 2.29, p = 0.13). Conclusion In this study, there was no evidence to suggest a difference in procedural success and complication rates between octogenarians and younger patients. Transvenous lead extraction can be performed safely and effectively in the elderly population.
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Affiliation(s)
- Andrew Y Lin
- Division of Cardiology, University of California San Diego, La Jolla, California
| | - Florentino Lupercio
- Division of Cardiology, University of California San Diego, La Jolla, California
| | - Gordon Ho
- Division of Cardiology, University of California San Diego, La Jolla, California
| | - Travis Pollema
- Division of Cardiothoracic Surgery, University of California San Diego, La Jolla, California
| | - Victor Pretorius
- Division of Cardiothoracic Surgery, University of California San Diego, La Jolla, California
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Frailty, Implantable Cardioverter Defibrillators, and Mortality: a Systematic Review. J Gen Intern Med 2019; 34:2224-2231. [PMID: 31264082 PMCID: PMC6816602 DOI: 10.1007/s11606-019-05100-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 03/08/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Evidence for the benefit of implantable cardioverter defibrillators (ICD) in preventing sudden cardiac death (SCD) in older adults is mixed; age alone may not predict benefit. Frailty may help identify patients in whom an ICD does not improve overall mortality risk. METHODS Structured search of PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials on 1/31/2019, without language restriction, with terms for ICD, frailty, and mortality. Frailty was defined broadly using any validated single component (e.g., walking speed, weight loss) or multi-component tool (e.g., cumulative deficit index). Each study was assessed for quality and risk of bias. RESULTS We identified and screened 2649 titles, reviewed 280 abstracts, and extracted 71 articles. Nine articles, including two RCTs, one prospective cohort, and six retrospective cohort studies met all criteria. The most common reason for exclusion was a lack of frailty definition. Frailty definitions were heterogeneous, including cumulative deficit models, low weight, and walking speed. Follow-up time for mortality differed: from days to > 6 years. All studies indicated that mortality was higher amongst individuals identified as frail, regardless of definition. In one RCT, slow walkers did not benefit from ICD therapy after 3 years. A cohort of 83,792 Medicare beneficiaries in an ICD registry reported higher 1-year mortality following ICD in those with frailty or dementia. Four studies reported an association between being underweight and increased mortality following ICD placement. CONCLUSION Existing literature suggests that individuals with frailty may not benefit from ICD placement for primary prevention of SCD.
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24
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Coiro S, Girerd N, Sharma A, Rossignol P, Tritto I, Pitt B, Pfeffer MA, McMurray JJV, Ambrosio G, Dickstein K, Moss A, Zannad F. Association of diabetes and kidney function according to age and systolic function with the incidence of sudden cardiac death and non-sudden cardiac death in myocardial infarction survivors with heart failure. Eur J Heart Fail 2019; 21:1248-1258. [PMID: 31476097 DOI: 10.1002/ejhf.1541] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 05/29/2019] [Indexed: 12/19/2022] Open
Abstract
AIMS An implantable cardioverter-defibrillator (ICD) is recommended for reducing the risk of sudden cardiac death (SCD) in myocardial infarction (MI) patients with a left ventricular ejection fraction (LVEF) ≤ 30%, as well as patients with a LVEF ≤ 35% and heart failure symptoms. Diabetes and/or impaired kidney function may confer additional SCD risk. We assessed the association between these two risk factors with SCD and non-SCD among MI survivors taking account of age and LVEF. METHODS AND RESULTS A total of 17 773 patients from the High-Risk MI Database were evaluated. Overall, diabetes and estimated glomerular filtration rate < 60 mL/min/1.73 m2 , individually and together, conferred a higher risk of SCD [adjusted competing risk: hazard ratio (HR) 1.23, 1.23, and 1.32, respectively; all P < 0.03] and non-SCD (HR 1.34, 1.52, and 2.13, respectively; all P < 0.0001). Annual SCD rates in patients with LVEF > 35% and with diabetes, impaired kidney function, or both (2.0%, 2.5% and 2.7%, respectively) were comparable to rates observed in patients with LVEF 30-35% but no such risk factors (1.7%). However, these patients had also similarly higher non-SCD rates, such that the ratio of SCD to non-SCD was not increased. Importantly, this ratio was mostly dependent on age, with higher overall ratios in youngest subgroups (0.89 in patients < 55 years vs. 0.38 in patients ≥ 75 years), regardless of risk factors. CONCLUSION Although MI survivors with LVEF > 35% with diabetes, impaired kidney function, or both are at increased risk of SCD, the risk of non-SCD risk is even higher, suggesting an extension of the current indication for an ICD to them is unlikely to be worthwhile. MI survivors with low LVEF and aged < 55 years are likely to have the greatest potential benefit from ICD implantation.
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Affiliation(s)
- Stefano Coiro
- Division of Cardiology, University of Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy.,INSERM, Centred'Investigation Clinique -1433 and Unité 1116, Nancy, France.,CHU Nancy, Institut Lorraindu Cœur et des Vaisseaux, Vandoeuvre lès, Nancy, France.,Université de Lorraine, Nancy, France.,F-CRIN INI-CRCT (Cardiovascular and RenalClinical Trialists) Network, Nancy, France
| | - Nicolas Girerd
- INSERM, Centred'Investigation Clinique -1433 and Unité 1116, Nancy, France.,CHU Nancy, Institut Lorraindu Cœur et des Vaisseaux, Vandoeuvre lès, Nancy, France.,Université de Lorraine, Nancy, France.,F-CRIN INI-CRCT (Cardiovascular and RenalClinical Trialists) Network, Nancy, France
| | - Abhinav Sharma
- Duke Clinical Research Institute, Duke University, Durham, NC, USA.,University of Alberta, Edmonton, Alberta, Canada.,Stanford University, Palo Alto, CA, USA
| | - Patrick Rossignol
- INSERM, Centred'Investigation Clinique -1433 and Unité 1116, Nancy, France.,CHU Nancy, Institut Lorraindu Cœur et des Vaisseaux, Vandoeuvre lès, Nancy, France.,Université de Lorraine, Nancy, France.,F-CRIN INI-CRCT (Cardiovascular and RenalClinical Trialists) Network, Nancy, France
| | - Isabella Tritto
- Division of Cardiology, University of Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy
| | | | - Marc A Pfeffer
- Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Giuseppe Ambrosio
- Division of Cardiology, University of Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy
| | - Kenneth Dickstein
- Division of Cardiology, Stavanger University Hospital, Stavanger, Norway.,Institute of Internal Medicine, University of Bergen, Bergen, Norway
| | - Arthur Moss
- Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY, USA
| | - Faiez Zannad
- INSERM, Centred'Investigation Clinique -1433 and Unité 1116, Nancy, France.,CHU Nancy, Institut Lorraindu Cœur et des Vaisseaux, Vandoeuvre lès, Nancy, France.,Université de Lorraine, Nancy, France.,F-CRIN INI-CRCT (Cardiovascular and RenalClinical Trialists) Network, Nancy, France
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25
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Sandhu A, Levy A, Varosy PD, Matlock D. Implantable Cardioverter-Defibrillators and Cardiac Resynchronization Therapy in Older Adults With Heart Failure. J Am Geriatr Soc 2019; 67:2193-2199. [PMID: 31403714 DOI: 10.1111/jgs.16099] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/04/2019] [Accepted: 06/26/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) are cardiac implantable electronic devices that may improve morbidity and mortality in select patients with heart failure. Although the benefits of these devices have been well defined, competing mortality risks, comorbid conditions, and frailty pose difficulty in determining risk-benefit trade-offs when these options are considered for older adults. CONCLUSION In this review, we focus on the benefit, risk, and use of ICD and CRT in older adults, particularly because the goals of care for many older adults include a shift away from life-prolonging interventions. Additionally, we discuss periprocedural risk, cost, and maintenance in older populations. Finally, we introduce a framework for helping clinicians and older adults make these challenging decisions collectively. J Am Geriatr Soc 67:2193-2199, 2019.
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Affiliation(s)
- Amneet Sandhu
- Section of Electrophysiology, Rocky Mountain Regional Veterans Affairs (VA) Medical Center, Aurora, Colorado.,Section of Electrophysiology, University of Colorado School of Medicine, Aurora, Colorado.,Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Andrew Levy
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Paul D Varosy
- Section of Electrophysiology, Rocky Mountain Regional Veterans Affairs (VA) Medical Center, Aurora, Colorado.,Section of Electrophysiology, University of Colorado School of Medicine, Aurora, Colorado.,Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Daniel Matlock
- Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado.,Veterans Affairs (VA) Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado.,Adult and Child Consortium for Outcomes Research and Delivery Science, Aurora, Colorado
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Abstract
The foundation of the treatment of heart failure with reduced ejection fraction is a number of pharmacotherapies shown to reduce morbidity and mortality in large randomised multinational clinical trials. These include angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, mineralocorticoid receptor antagonists, and more recently, a combined angiotensin receptor blocker neprilysin inhibitor, sacubitril/valsartan. In select cases, digoxin, ivabradine and hydralazine with isosorbide dinitrate have a role to play in the treatment of heart failure with reduced ejection fraction. On this foundation, other more advanced treatments such as implantable cardioverter defibrillators and cardiac resynchronisation therapy are recommended in guidelines for the treatment of heart failure with reduced ejection fraction (i.e. an ejection fraction of ≤ 40%) and for a select few there remains the option of mechanical circulatory support and cardiac transplantation. The efficacy of pharmacotherapy does not vary by age and each of these therapies should be considered in all patients, irrespective of age. Other factors such as co-morbidities like renal dysfunction may limit the use of some of these drugs in the elderly. Decision making with regard to device therapy is more complex; the likelihood of competing non-cardiovascular causes of death and life expectancy need to be considered. Despite multiple treatment options for heart failure with reduced ejection fraction, the options for heart failure with preserved ejection fraction are limited. In the absence of robust outcomes data from a large randomised trial, a mineralocorticoid receptor antagonist is a reasonable therapy to reduce the risk of hospitalisation for heart failure in patients with heart failure with preserved ejection fraction.
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Zakine C, Garcia R, Narayanan K, Gandjbakhch E, Algalarrondo V, Lellouche N, Perier MC, Fauchier L, Gras D, Bordachar P, Piot O, Babuty D, Sadoul N, Defaye P, Deharo JC, Klug D, Leclercq C, Extramiana F, Boveda S, Marijon E. Prophylactic implantable cardioverter-defibrillator in the very elderly. Europace 2019; 21:1063-1069. [DOI: 10.1093/europace/euz041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 02/22/2019] [Indexed: 12/31/2022] Open
Abstract
Aims
Current guidelines do not propose any age cut-off for the primary prevention implantable cardioverter-defibrillator (ICD). However, the risk/benefit balance in the very elderly population has not been well studied.
Methods and results
In a multicentre French study assessing patients implanted with an ICD for primary prevention, outcomes among patients aged ≥80 years were compared with <80 years old controls matched for sex and underlying heart disease (ischaemic and dilated cardiomyopathy). A total of 300 ICD recipients were enrolled in this specific analysis, including 150 patients ≥80 years (mean age 81.9 ± 2.0 years; 86.7% males) and 150 controls (mean age 61.8 ± 10.8 years). Among older patients, 92 (75.6%) had no more than one associated comorbidity. Most subjects in the elderly group got an ICD as part of a cardiac resynchronization therapy procedure (74% vs. 46%, P < 0.0001). After a mean follow-up of 3.0 ± 2 years, 53 patients (35%) in the elderly group died, including 38.2% from non cardiovascular causes of death. Similar proportion of patients received ≥1 appropriate therapy (19.4% vs. 21.6%; P = 0.65) in the elderly group and controls, respectively. There was a trend towards more early perioperative events (P = 0.10) in the elderly, with no significant increase in late complications (P = 0.73).
Conclusion
Primary prevention ICD recipients ≥80 years in the real world had relatively low associated comorbidity. Rates of appropriate therapies and device-related complications were similar, compared with younger subjects. Nevertheless, the inherent limitations in interpreting observational data on this particular competing risk situation call for randomized controlled trials to provide definitive answers. Meanwhile, a careful multidisciplinary evaluation is needed to guide patient selection for ICD implantation in the elderly population.
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Affiliation(s)
- Cyril Zakine
- Paris Cardiovascular Research Center, Paris, France
| | | | - Kumar Narayanan
- Paris Cardiovascular Research Center, Paris, France
- Maxcure Hospitals, Hyderabad, India
| | | | | | | | - Marie-Cécile Perier
- Paris Cardiovascular Research Center, Paris, France
- European Georges Pompidou Hospital, Cardiology Department, Paris, France
| | | | | | | | - Olivier Piot
- Centre Cardiologique du Nord, Saint Denis, France
| | | | | | | | | | | | | | | | | | - Eloi Marijon
- Paris Cardiovascular Research Center, Paris, France
- European Georges Pompidou Hospital, Cardiology Department, Paris, France
- Paris Descartes University, Paris, France
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Padmanabhan D, Asirvatham SJ. Non-ischemic cardiomyopathy in the elderly: A shocking conundrum. Indian Pacing Electrophysiol J 2019; 19:1-3. [PMID: 30615931 PMCID: PMC6354215 DOI: 10.1016/j.ipej.2019.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Deepak Padmanabhan
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India.
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29
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Daimee UA, Vermilye K, Moss AJ, Goldenberg I, Klein HU, McNitt S, Zareba W, Kutyifa V. Experience with the wearable cardioverter-defibrillator in older patients: Results from the Prospective Registry of Patients Using the Wearable Cardioverter-Defibrillator. Heart Rhythm 2018; 15:1379-1386. [DOI: 10.1016/j.hrthm.2018.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Indexed: 10/17/2022]
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30
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Levy WC, Hellkamp AS, Mark DB, Poole JE, Shadman R, Dardas TF, Anderson J, Johnson G, Fishbein DP, Lee KL, Linker DT, Bardy GH. Improving the Use of Primary Prevention Implantable Cardioverter-Defibrillators Therapy With Validated Patient-Centric Risk Estimates. JACC Clin Electrophysiol 2018; 4:1089-1102. [DOI: 10.1016/j.jacep.2018.04.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/03/2018] [Accepted: 04/30/2018] [Indexed: 11/24/2022]
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31
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Blanch B, Lago LP, Sy R, Harris PJ, Semsarian C, Ingles J. Implantable cardioverter–defibrillator therapy in Australia, 2002–2015. Med J Aust 2018; 209:123-129. [DOI: 10.5694/mja17.01183] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 05/02/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Bianca Blanch
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, NSW
| | - Luise P Lago
- Centre for Health Research, University of Wollongong, Wollongong, NSW
| | - Raymond Sy
- Sydney Medical School, University of Sydney, Sydney, NSW
| | | | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, NSW
- Sydney Medical School, University of Sydney, Sydney, NSW
- Royal Prince Alfred Hospital, Sydney, NSW
| | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, NSW
- Sydney Medical School, University of Sydney, Sydney, NSW
- Royal Prince Alfred Hospital, Sydney, NSW
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Saba S, Adelstein E, Wold N, Stein K, Jones P. Influence of patients' age at implantation on mortality and defibrillator shocks. Europace 2018; 19:802-807. [PMID: 27256416 DOI: 10.1093/europace/euw085] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 03/09/2016] [Indexed: 02/05/2023] Open
Abstract
Aims Patients have increasing comorbidities and competing causes of death with advancing age, raising questions about the effectiveness of the implantable cardioverter defibrillators (ICD) in older age. We therefore investigated the effect of patients' age at initial device implantation on all-cause mortality and on the risk of ICD shocks in single-chamber (V-ICD), dual-chamber (D-ICD), and cardiac resynchronization therapy defibrillator (CRT-D) recipients. Methods and results We reviewed de-identified records of 67 128 ICD recipients enrolled in the Boston Scientific ALTITUDE database of remote monitored patients [V-ICD (n = 11 422), D-ICD (n = 23 974), and CRT-D (n = 31 732)]. Over a mean follow-up of 2.3 ± 1.4 years, patients in all ICD groups had increased all-cause mortality but decreased risk of defibrillator shocks and/or anti-tachycardia pacing per 10 year increase in age. Compared with the youngest age group (<50 years), patients in the oldest age group (≥80 years) had a 6.8-fold, 5.9-fold, and 3.4-fold increase in all-cause mortality (P < 0.001 for all comparisons) and a 31, 45, and 53% decrease in the risk of ICD shock (P ≤ 0.002 for all comparisons) for the V-ICD, D-ICD, and CRT-D groups, respectively. Conclusion Older recipients of standard and CRT defibrillators have higher mortality but fewer ICD shocks and/or therapies compared with younger patients. These data highly suggest less benefit of ICD therapy with increasing age, presumably because of competing risks of non-arrhythmic mortality. The role of defibrillator therapy in older patients may need to be evaluated with randomized controlled trials.
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Affiliation(s)
- Samir Saba
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Evan Adelstein
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | | | - Paul Jones
- Boston Scientific Inc., Minneapolis, MN, USA
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33
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Eiser AR, Kirkpatrick JN, Patton KK, McLain E, Dougherty CM, Beattie JM. Putting the “Informed” in the informed consent process for implantable cardioverter-defibrillators: Addressing the needs of the elderly patient. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:312-320. [DOI: 10.1111/pace.13288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 11/14/2017] [Accepted: 01/15/2018] [Indexed: 12/26/2022]
Affiliation(s)
- Arnold R. Eiser
- Department of Medicine; Drexel University College of Medicine; Philadelphia PA USA
- Leonard Davis Institute; University of Pennsylvania; Philadelphia PA USA
| | - James N. Kirkpatrick
- Division of Cardiology; University of Washington School of Medicine; Seattle WA USA
| | - Kristen K. Patton
- Division of Cardiology; University of Washington School of Medicine; Seattle WA USA
| | - Emily McLain
- Summit Cardiology; Northwest Hospital; Seattle WA USA
| | - Cynthia M. Dougherty
- Research Biobehavioral and Health Systems; University of Washington School of Nursing; Seattle WA USA
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AlTurki A, Proietti R, Alturki H, Essebag V, Huynh T. Implantable cardioverter-defibrillator use in elderly patients receiving cardiac resynchronization: A meta-analysis. Hellenic J Cardiol 2018; 60:276-281. [PMID: 29292244 DOI: 10.1016/j.hjc.2017.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/09/2017] [Accepted: 12/07/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) reduce sudden cardiac death and all-cause mortality in patients with heart failure with reduced ejection fraction (HFrEF). Current guidelines do not suggest any upper age limit for ICD and CRT but recommend avoidance of ICD and CRT in frail patients with a life expectancy of less than 1 year. It remains unclear whether elderly patients undergoing CRT derive the same additional benefit from ICDs as younger patients. We aimed to assess the use of ICDs in elderly compared to younger patients receiving CRT. METHODS We searched electronic databases, up to April 11, 2016, for all studies reporting on ICD use stratified by age in patients who received CRT. We used random-effects meta-analysis models to calculate the summarized baseline characteristics and rates of implantation of ICD among patients enrolled in the studies. RESULTS We retained six observational studies enrolling 613 patients ≥75 years old and 2810 patients <75 years old. The aggregate mean age was 82.7 years for the elderly patients compared to 66.3 years in the younger patients. There was a significantly lower use of ICDs in elderly patients compared to that in younger patients (37.9% versus 64.3%) (odds ratio: 0.26; 95% confidence intervals: 0.14-0.46; p < 0.0001). CONCLUSIONS In conclusion, ICD was less frequently used in patients ≥75 years old receiving CRT compared to younger patients receiving CRT. Future studies that evaluate the efficacy and effectiveness of ICDs in elderly patients with indications for CRT are needed to guide management of this increasing population.
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Affiliation(s)
- Ahmed AlTurki
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Division of Cardiology, McGill University Health Center, Quebec, Canada.
| | - Riccardo Proietti
- Cardiology Department, Morriston Hospital, Swansea University, Swansea, UK
| | - Hasan Alturki
- University College Dublin. School of Medicine, Dublin, Ireland
| | - Vidal Essebag
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Division of Cardiology, McGill University Health Center, Quebec, Canada
| | - Thao Huynh
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Division of Cardiology, McGill University Health Center, Quebec, Canada
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35
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New Innovations in Treatment and Monitoring of Heart Failure With Guidelines on the Use of Sacubitril/Valsartan and Ivabradine. Am J Ther 2018. [DOI: 10.1097/mjt.0000000000000672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fumagalli S, Potpara TS, Bjerregaard Larsen T, Haugaa KH, Dobreanu D, Proclemer A, Dagres N. Frailty syndrome: an emerging clinical problem in the everyday management of clinical arrhythmias. The results of the European Heart Rhythm Association survey. Europace 2017; 19:1896-1902. [DOI: 10.1093/europace/eux288] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 08/22/2017] [Indexed: 11/15/2022] Open
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37
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Elming MB, Nielsen JC, Haarbo J, Videbæk L, Korup E, Signorovitch J, Olesen LL, Hildebrandt P, Steffensen FH, Bruun NE, Eiskjær H, Brandes A, Thøgersen AM, Gustafsson F, Egstrup K, Videbæk R, Hassager C, Svendsen JH, Høfsten DE, Torp-Pedersen C, Pehrson S, Køber L, Thune JJ. Age and Outcomes of Primary Prevention Implantable Cardioverter-Defibrillators in Patients With Nonischemic Systolic Heart Failure. Circulation 2017; 136:1772-1780. [PMID: 28877914 DOI: 10.1161/circulationaha.117.028829] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 08/19/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND The DANISH study (Danish Study to Assess the Efficacy of ICDs [Implantable Cardioverter Defibrillators] in Patients With Non-Ischemic Systolic Heart Failure on Mortality) did not demonstrate an overall effect on all-cause mortality with ICD implantation. However, the prespecified subgroup analysis suggested a possible age-dependent association between ICD implantation and mortality with survival benefit seen only in the youngest patients. The nature of this relationship between age and outcome of a primary prevention ICD in patients with nonischemic systolic heart failure warrants further investigation. METHODS All 1116 patients from the DANISH study were included in this prespecified subgroup analysis. We assessed the relationship between ICD implantation and mortality by age, and an optimal age cutoff was estimated nonparametrically with selection impact curves. Modes of death were divided into sudden cardiac death and nonsudden death and compared between patients younger and older than this age cutoff with the use of χ2 analysis. RESULTS Median age of the study population was 63 years (range, 21-84 years). There was a linearly decreasing relationship between ICD and mortality with age (hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.003-1.06; P=0.03). An optimal age cutoff for ICD implantation was present at ≤70 years. There was an association between reduced all-cause mortality and ICD in patients ≤70 years of age (HR, 0.70; 95% CI, 0.51-0.96; P=0.03) but not in patients >70 years of age (HR, 1.05; 95% CI, 0.68-1.62; P=0.84). For patients ≤70 years old, the sudden cardiac death rate was 1.8 (95% CI, 1.3-2.5) and nonsudden death rate was 2.7 (95% CI, 2.1-3.5) events per 100 patient-years, whereas for patients >70 years old, the sudden cardiac death rate was 1.6 (95% CI, 0.8-3.2) and nonsudden death rate was 5.4 (95% CI, 3.7-7.8) events per 100 patient-years. This difference in modes of death between the 2 age groups was statistically significant (P=0.01). CONCLUSIONS In patients with systolic heart failure not caused by ischemic heart disease, the association between the ICD and survival decreased linearly with increasing age. In this study population, an age cutoff for ICD implantation at ≤70 years yielded the highest survival for the population as a whole. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT00542945.
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Affiliation(s)
- Marie Bayer Elming
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.).
| | - Jens C Nielsen
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Jens Haarbo
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Lars Videbæk
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Eva Korup
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - James Signorovitch
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Line Lisbeth Olesen
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Per Hildebrandt
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Flemming H Steffensen
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Niels E Bruun
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Hans Eiskjær
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Axel Brandes
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Anna M Thøgersen
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Finn Gustafsson
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Kenneth Egstrup
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Regitze Videbæk
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Christian Hassager
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Jesper Hastrup Svendsen
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Dan E Høfsten
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Christian Torp-Pedersen
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Steen Pehrson
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Lars Køber
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Jens Jakob Thune
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
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Frontera A, Panniker S, Breitenstein A, Bruno VD, Connolly GM, Wilson D, Rio T, Dhinoja MB, Hussain W, Schilling RJ, Thomas G, Wong T, Hunter RJ, Sacher F, Jaïs P, Duncan E. Safety and mid-term outcome of catheter ablation of ventricular tachycardia in octogenarians. Europace 2017; 19:1369-1377. [PMID: 27974359 DOI: 10.1093/europace/euw236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 06/20/2016] [Indexed: 11/12/2022] Open
Abstract
Aims Radiofrequency (RF) catheter ablation (CA) is superior to standard medical therapy in controlling recurrent ventricular tachycardia (VT). The majority of procedures have been performed in a middle-aged population. The outcome of VT ablation in the elderly has not been described. Methods and results We retrospectively studied the outcome and safety of CA of VT in octogenarians performed in four European centres. The population consisted of patients presenting with recurrent VT refractory to medical therapy. Patients aged over 80 years were compared with younger patients undergoing CA. Clinical characteristics, procedural data, complications, and outcomes were examined. Implantable cardioverter-defibrillator (ICD) therapy data were collected. A total of 54 consecutive octogenarian patients underwent RF CA of VT and represented the study group (42 males, age 82.8 ± 2.7 years) compared with a control group of 104 younger patients (85 males, age 66.7 ± 8.9 years). Mean follow-up was 33 ± 48 months. Implantable cardioverter-defibrillators were present in 81 and 86% of patients, respectively (P = 0.93). Left ventricular ejection fraction was 29% ± 8.2 in octogenarians vs. 34% ± 10.2 in the younger group (P < 0.01). More major complications occurred in octogenarians (18 vs. 2%, P < 0.01). During follow-up, there were more ICD shocks in the octogenarians (28 vs. 15%, P < 0.01). The Kaplan-Meier curve of survival after VT ablation confirms comparable survival rates at 1 year, but the elderly have poor survival in the mid-term. Survival in the elderly post VT ablation is comparable with that in an age-matched cohort with ICDs but no VT storm. Conclusion Octogenarians undergoing CA of VT have more risk factors, higher risk of complications and ICD shocks, but demonstrate comparable short-term survival rates.
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Affiliation(s)
| | | | | | | | | | | | - Teresa Rio
- St Bartholomew's Hospital, Barts Heart Center, London EC1A 7BE, UK
| | - Mehul B Dhinoja
- St Bartholomew's Hospital, Barts Heart Center, London EC1A 7BE, UK
| | | | | | | | - Tom Wong
- Royal Brompton Hospital, London SW3 6NP, UK
| | - Ross J Hunter
- St Bartholomew's Hospital, Barts Heart Center, London EC1A 7BE, UK
| | | | - Pierre Jaïs
- Hôpital Haut Léveque, CHU Bordeaux, Pessac, France
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Levy WC. Should Nonischemic CRT Candidates Receive CRT-P or CRT-D? ∗. J Am Coll Cardiol 2017; 69:1679-1682. [DOI: 10.1016/j.jacc.2017.01.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 01/30/2017] [Indexed: 01/14/2023]
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Pfeiffer D, Neef M, Jurisch D, Hagendorff A. [Electrophysiologic procedure complications in the elderly]. Herzschrittmacherther Elektrophysiol 2017; 28:3-8. [PMID: 28185081 DOI: 10.1007/s00399-017-0486-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 01/12/2017] [Indexed: 06/06/2023]
Abstract
Published registries give limited information on age-dependent complication rates. There are several reasons for this, including limited numbers of patients in subgroups (e.g., contractility management), experience-dependent procedures (e.g., catheter ablation), or in changing indications (e.g., resynchronization). Finally, severely ill and very old patients with limited prognosis are often excluded from electrophysiologic procedures. Therefore, published data are difficult to interpret. Meta-analyses of randomized trials give more precise information on included patient cohorts, but do not necessarily reflect daily practice because elderly patients are often excluded from trials. Therefore, the individual risk of elderly patients has to be estimated on an individual case basis. In summary, the age of patients is not relevant regarding possible complications; thus, there is no age limit for electrophysiologic interventions. Therefore, there is no alternative to the individual estimation of procedural risks of interventions of an informed patient by an experienced cardiologist.
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Affiliation(s)
- Dietrich Pfeiffer
- Abt. Kardiologie & Angiologie, Department für Innere Medizin, Neurologie und Dermatologie, Universität Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland.
| | - Martin Neef
- Abt. Kardiologie & Angiologie, Department für Innere Medizin, Neurologie und Dermatologie, Universität Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - Daniel Jurisch
- Abt. Kardiologie & Angiologie, Department für Innere Medizin, Neurologie und Dermatologie, Universität Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - Andreas Hagendorff
- Abt. Kardiologie & Angiologie, Department für Innere Medizin, Neurologie und Dermatologie, Universität Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
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Wilson DG, Zeljko HM, Leventopoulos G, Nauman A, Sylvester GEH, Yue A, Roberts PR, Thomas G, Duncan ER, Roderick PJ, Morgan JM. Increasing age does not affect time to appropriate therapy in primary prevention ICD/CRT-D: a competing risks analysis. Europace 2017; 19:275-281. [PMID: 28173045 DOI: 10.1093/europace/euw034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 02/02/2016] [Indexed: 11/14/2022] Open
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.
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Affiliation(s)
- David G Wilson
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | | | - Ahmed Nauman
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | - Arthur Yue
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Paul R Roberts
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Glyn Thomas
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Edward R Duncan
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Paul J Roderick
- Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - John M Morgan
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Kramer DB, Steinhaus DA. Cardiac Resynchronization Therapy in Older Patients: Age Is Just a Number, and Yet …. J Card Fail 2016; 22:978-980. [PMID: 27765669 PMCID: PMC5398279 DOI: 10.1016/j.cardfail.2016.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 10/12/2016] [Accepted: 10/14/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Daniel B Kramer
- Richard and Susan Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
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Fauchier L, Alonso C, Anselme F, Blangy H, Bordachar P, Boveda S, Clementy N, Defaye P, Deharo JC, Friocourt P, Gras D, Halimi F, Klug D, Mansourati J, Obadia B, Pasquié JL, Pavin D, Sadoul N, Taieb J, Piot O, Hanon O. Position paper for management of elderly patients with pacemakers and implantable cardiac defibrillators: Groupe de Rythmologie et Stimulation Cardiaque de la Société Française de Cardiologie and Société Française de Gériatrie et Gérontologie. Arch Cardiovasc Dis 2016; 109:563-585. [PMID: 27595465 DOI: 10.1016/j.acvd.2016.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 04/01/2016] [Indexed: 02/03/2023]
Abstract
Despite the increasingly high rate of implantation of pacemakers (PMs) and implantable cardioverter defibrillators (ICDs) in elderly patients, data supporting their clinical and cost-effectiveness in this age stratum are ambiguous and contradictory. We reviewed the data regarding the applicability, safety and effectiveness of conventional pacing, ICDs and cardiac resynchronization therapy (CRT) in elderly patients. Although periprocedural risk may be slightly higher in the elderly, the implantation procedure for PMs and ICDs is still relatively safe in this age group. In older patients with sinus node disease, the general consensus is that DDD pacing with the programming of an algorithm to minimize ventricular pacing is preferred. In very old patients presenting with intermittent or suspected atrioventricular block, VVI pacing may be appropriate. In terms of correcting potentially life-threatening arrhythmias, the effectiveness of ICD therapy is similar in older and younger individuals. However, the assumption of persistent ICD benefit in the elderly population is questionable, as any advantageous effect of the device on arrhythmic death may be attenuated by higher total non-arrhythmic mortality. While septuagenarians and octogenarians have higher annual all-cause mortality rates, ICD therapy may remain effective in selected patients at high risk of arrhythmic death and with minimum comorbidities despite advanced age. ICD implantation among the elderly, as a group, may not be cost-effective, but the procedure may reach cost-effectiveness in those expected to live more than 5-7years after implantation. Elderly patients usually experience significant functional improvement after CRT, similar to that observed in middle-aged patients. Management of CRT non-responders remains globally the same, while considering a less aggressive approach in terms of reinterventions (revision of left ventricular [LV] lead placement, addition of a right ventricular or LV lead, LV endocardial pacing configuration). Overall, physiological age, general status and comorbidities rather than chronological age per se should be the decisive factors in making a decision about device implantation selection for survival and well-being benefit in elderly patients.
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Affiliation(s)
- Laurent Fauchier
- CHU Trousseau, université François-Rabelais, 37044 Tours, France.
| | | | | | - Hugues Blangy
- Institut Lorrain du Cœur et des Vaisseaux, CHU de Nancy, 54500 Vandœuvre-lès-Nancy, France
| | | | | | - Nicolas Clementy
- CHU Trousseau, université François-Rabelais, 37044 Tours, France
| | | | | | | | - Daniel Gras
- Nouvelles cliniques nantaises, 44202 Nantes, France
| | | | | | | | | | | | | | - Nicolas Sadoul
- Institut Lorrain du Cœur et des Vaisseaux, CHU de Nancy, 54500 Vandœuvre-lès-Nancy, France
| | - Jerome Taieb
- Centre hospitalier, 13616 Aix-en-Provence, France
| | - Olivier Piot
- Centre cardiologique du Nord, 93200 Saint-Denis, France
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Bibas L, Levi M, Touchette J, Mardigyan V, Bernier M, Essebag V, Afilalo J. Implications of Frailty in Elderly Patients With Electrophysiological Conditions. JACC Clin Electrophysiol 2016; 2:288-294. [PMID: 29766886 DOI: 10.1016/j.jacep.2016.04.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 03/25/2016] [Accepted: 04/27/2016] [Indexed: 01/22/2023]
Abstract
A growing number of complex older adults are referred for electrophysiological conditions and age alone is insufficient to guide management decisions such as implantable cardioverter-defibrillator (ICD) implantation or atrial fibrillation anticoagulation. The concept of frailty has emerged as a geriatric vital sign to gain insight into physiological reserve and prognostic risk beyond chronological age and comorbidities. To date, a number of published studies have evaluated frailty in patients with electrophysiological conditions. These studies collectively demonstrate that frail patients have an increased prevalence of atrial fibrillation, lower use of oral anticoagulation, higher risk of bleeding complications from oral anticoagulation, and higher risk of stroke and mortality. A paucity of studies have explored frailty in the setting of device implantation, with a signal suggesting that frail heart failure patients may have a lower likelihood of being considered for ICD and cardiac resynchronization therapy devices, and a higher risk of fatal and nonfatal events after ICD and cardiac resynchronization therapy implantation. Whether frailty modulates the risks and benefits of these devices is a critical knowledge gap for which further study is clearly warranted.
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Affiliation(s)
- Lior Bibas
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Division of Cardiology, McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - Michael Levi
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Division of Cardiology, McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - Jacynthe Touchette
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
| | - Vartan Mardigyan
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Martin Bernier
- Division of Cardiology, McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - Vidal Essebag
- Division of Cardiology, McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - Jonathan Afilalo
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.
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Kramer DB, Reynolds MR, Normand SL, Parzynski CS, Spertus JA, Mor V, Mitchell SL. Hospice Use Following Implantable Cardioverter-Defibrillator Implantation in Older Patients: Results From the National Cardiovascular Data Registry. Circulation 2016; 133:2030-7. [PMID: 27016104 PMCID: PMC4872640 DOI: 10.1161/circulationaha.115.020677] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 03/23/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Older recipients of implantable cardioverter-defibrillators (ICDs) are at increased risk for short-term mortality in comparison with younger patients. Although hospice use is common among decedents aged >65, its use among older ICD recipients is unknown. METHODS AND RESULTS Medicare patients aged >65 matched to data in the National Cardiovascular Data Registry - ICD Registry from January 1, 2006 to March 31, 2010 were eligible for analysis (N=194 969). The proportion of ICD recipients enrolled in hospice, cumulative incidence of hospice admission, and factors associated with time to hospice enrollment were evaluated. Five years after device implantation, 50.9% of patients were either deceased or in hospice. Among decedents, 36.8% received hospice services. The cumulative incidence of hospice enrollment, accounting for the competing risk of death, was 4.7% (95% confidence interval [CI], 4.6%-4.8%) within 1 year and 21.3% (95% CI, 20.7%-21.8%) at 5 years. Factors most strongly associated with shorter time to hospice enrollment were older age (adjusted hazard ratio, 1.77; 95% CI, 1.73-1.81), class IV heart failure (versus class I; adjusted hazard ratio, 1.79; 95% CI, 1.66-1.94); ejection fraction <20 (adjusted hazard ratio, 1.57; 95% CI, 1.48-1.67), and greater hospice use among decedents in the patients' health referral region. CONCLUSIONS More than one-third of older patients dying with ICDs receive hospice care. Five years after implantation, half of older ICD recipients are either dead or in hospice. Hospice providers should be prepared for ICD patients, whose clinical trajectories and broader palliative care needs require greater focus.
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Affiliation(s)
- Daniel B Kramer
- From Hebrew SeniorLife Institute for Aging Research, Boston MA (D.B.K., S.L.M.); Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Boston MA (D.B.K.); Harvard Medical School, Boston MA (D.B.K., S.L.M.); Harvard Clinical Research Institute, Boston MA (M.R.R.); Lahey Hospital & Medical Center, Burlington, MA (M.R.R.); Department of Health Care Policy, Harvard Medical School, Boston, MA (S.-L.N.); Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA (S.-L.N.); Center for Outcomes Research and Evaluation, Yale New Haven Hospital, Yale University, New Haven, CT (C.S.P.); Mid America Heart Institute, Kansas City, MO (J.A.S.); and Department of Health Services, Policy & Practice, Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, RI (V.M.).
| | - Matthew R Reynolds
- From Hebrew SeniorLife Institute for Aging Research, Boston MA (D.B.K., S.L.M.); Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Boston MA (D.B.K.); Harvard Medical School, Boston MA (D.B.K., S.L.M.); Harvard Clinical Research Institute, Boston MA (M.R.R.); Lahey Hospital & Medical Center, Burlington, MA (M.R.R.); Department of Health Care Policy, Harvard Medical School, Boston, MA (S.-L.N.); Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA (S.-L.N.); Center for Outcomes Research and Evaluation, Yale New Haven Hospital, Yale University, New Haven, CT (C.S.P.); Mid America Heart Institute, Kansas City, MO (J.A.S.); and Department of Health Services, Policy & Practice, Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, RI (V.M.)
| | - Sharon-Lise Normand
- From Hebrew SeniorLife Institute for Aging Research, Boston MA (D.B.K., S.L.M.); Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Boston MA (D.B.K.); Harvard Medical School, Boston MA (D.B.K., S.L.M.); Harvard Clinical Research Institute, Boston MA (M.R.R.); Lahey Hospital & Medical Center, Burlington, MA (M.R.R.); Department of Health Care Policy, Harvard Medical School, Boston, MA (S.-L.N.); Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA (S.-L.N.); Center for Outcomes Research and Evaluation, Yale New Haven Hospital, Yale University, New Haven, CT (C.S.P.); Mid America Heart Institute, Kansas City, MO (J.A.S.); and Department of Health Services, Policy & Practice, Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, RI (V.M.)
| | - Craig S Parzynski
- From Hebrew SeniorLife Institute for Aging Research, Boston MA (D.B.K., S.L.M.); Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Boston MA (D.B.K.); Harvard Medical School, Boston MA (D.B.K., S.L.M.); Harvard Clinical Research Institute, Boston MA (M.R.R.); Lahey Hospital & Medical Center, Burlington, MA (M.R.R.); Department of Health Care Policy, Harvard Medical School, Boston, MA (S.-L.N.); Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA (S.-L.N.); Center for Outcomes Research and Evaluation, Yale New Haven Hospital, Yale University, New Haven, CT (C.S.P.); Mid America Heart Institute, Kansas City, MO (J.A.S.); and Department of Health Services, Policy & Practice, Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, RI (V.M.)
| | - John A Spertus
- From Hebrew SeniorLife Institute for Aging Research, Boston MA (D.B.K., S.L.M.); Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Boston MA (D.B.K.); Harvard Medical School, Boston MA (D.B.K., S.L.M.); Harvard Clinical Research Institute, Boston MA (M.R.R.); Lahey Hospital & Medical Center, Burlington, MA (M.R.R.); Department of Health Care Policy, Harvard Medical School, Boston, MA (S.-L.N.); Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA (S.-L.N.); Center for Outcomes Research and Evaluation, Yale New Haven Hospital, Yale University, New Haven, CT (C.S.P.); Mid America Heart Institute, Kansas City, MO (J.A.S.); and Department of Health Services, Policy & Practice, Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, RI (V.M.)
| | - Vincent Mor
- From Hebrew SeniorLife Institute for Aging Research, Boston MA (D.B.K., S.L.M.); Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Boston MA (D.B.K.); Harvard Medical School, Boston MA (D.B.K., S.L.M.); Harvard Clinical Research Institute, Boston MA (M.R.R.); Lahey Hospital & Medical Center, Burlington, MA (M.R.R.); Department of Health Care Policy, Harvard Medical School, Boston, MA (S.-L.N.); Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA (S.-L.N.); Center for Outcomes Research and Evaluation, Yale New Haven Hospital, Yale University, New Haven, CT (C.S.P.); Mid America Heart Institute, Kansas City, MO (J.A.S.); and Department of Health Services, Policy & Practice, Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, RI (V.M.)
| | - Susan L Mitchell
- From Hebrew SeniorLife Institute for Aging Research, Boston MA (D.B.K., S.L.M.); Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Boston MA (D.B.K.); Harvard Medical School, Boston MA (D.B.K., S.L.M.); Harvard Clinical Research Institute, Boston MA (M.R.R.); Lahey Hospital & Medical Center, Burlington, MA (M.R.R.); Department of Health Care Policy, Harvard Medical School, Boston, MA (S.-L.N.); Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA (S.-L.N.); Center for Outcomes Research and Evaluation, Yale New Haven Hospital, Yale University, New Haven, CT (C.S.P.); Mid America Heart Institute, Kansas City, MO (J.A.S.); and Department of Health Services, Policy & Practice, Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, RI (V.M.)
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Balmain S, Hawkins NM. Shocks, Resynchronization, or Both for Elderly Patients With Heart Failure? J Card Fail 2016; 22:150-2. [DOI: 10.1016/j.cardfail.2015.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 12/04/2015] [Accepted: 12/04/2015] [Indexed: 11/26/2022]
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Forman DE, Alexander K, Brindis RG, Curtis AB, Maurer M, Rich MW, Sperling L, Wenger NK. Improved Cardiovascular Disease Outcomes in Older Adults. F1000Res 2016; 5. [PMID: 26918183 PMCID: PMC4755414 DOI: 10.12688/f1000research.7088.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/25/2016] [Indexed: 12/11/2022] Open
Abstract
Longevity is increasing and the population of older adults is growing. The biology of aging is conducive to cardiovascular disease (CVD), such that prevalence of coronary artery disease, heart failure, valvular heart disease, arrhythmia and other disorders are increasing as more adults survive into old age. Furthermore, CVD in older adults is distinctive, with management issues predictably complicated by multimorbidity, polypharmacy, frailty and other complexities of care that increase management risks (e.g., bleeding, falls, and rehospitalization) and uncertainty of outcomes. In this review, state-of-the-art advances in heart failure, acute coronary syndromes, transcatheter aortic valve replacement, atrial fibrillation, amyloidosis, and CVD prevention are discussed. Conceptual benefits of treatments are considered in relation to the challenges and ambiguities inherent in their application to older patients.
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Affiliation(s)
- Daniel E Forman
- Geriatric Cardiology Section, University of Pittsburgh Medical Center, Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Karen Alexander
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Ralph G Brindis
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA
| | - Anne B Curtis
- Department of Medicine, University at Buffalo, Buffalo, New York, USA
| | - Mathew Maurer
- Department of Medicine, Columbia University Medical Center, New York, USA
| | - Michael W Rich
- Washington University School of Medicine, St Louis, MO, USA
| | - Laurence Sperling
- Emory University School of Medicine and Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Nanette K Wenger
- Division of Cardiology, Department of Medicine, Emory University, Atlanta, GA, USA
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Expósito V, Rodríguez-Mañero M, González-Enríquez S, Arias MA, Sánchez-Gómez JM, Andrés La Huerta A, Bertomeu-González V, Arce-León Á, Barrio-López MT, Arguedas-Jiménez H, Seara JG, Rodriguez-Entem F. Primary prevention implantable cardioverter-defibrillator and cardiac resynchronization therapy-defibrillator in elderly patients: results of a Spanish multicentre study. Europace 2015; 18:1203-10. [PMID: 26566939 DOI: 10.1093/europace/euv337] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 09/07/2015] [Indexed: 11/13/2022] Open
Abstract
AIMS Currently, there continues to be a lack of evidence regarding outcomes associated with device-based therapy for ventricular arrhythmias in elderly patients, even more in primary-prevention indications. We aimed to describe the follow-up in terms of efficacy and safety of implantable cardioverter-defibrillator (ICD) therapy in a large cohort of elderly patients. METHODS AND RESULTS Retrospective multicentre study performed in 15 Spanish hospitals. Consecutive patients referred for ICD implantation before 2011 were included. One hundred and sixty-two of 1174 patients (13.8%) ≥75 years were considered as 'elderly'. When compared with those patients <75, this subgroup presented more co-morbid conditions, including hypertension, chronic obstructive pulmonary disease , and renal failure, and more previous hospitalizations due to heart failure (HF). During a mean follow-up of 104.4 ± 3.3 months, 162 patients (14%) died, 120 in the younger age (12.4%), and 42 (24.4%) in the elderly. Kaplan-Meier analysis showed an increased probability of death with increasing age (17, 24, 28, and 69% at 12, 24, 48, and 60 months of follow-up in the elderly group). There was neither difference regarding the rate of appropriate nor inappropriate ICD intervention. CONCLUSION In a real-world scenario, elderly patients comprise ∼15% of ICD implantations for primary prevention of sudden cardiac death (SCD). Although the rate of appropriate therapy is similar between groups, the benefit of ICD is attenuated for a major increase in mortality risk among those patients ≥75 years at the moment of device implantation.
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Affiliation(s)
- Víctor Expósito
- Hospital Universitario Marqués de Valdecilla, Av. Hospital s/n, Santander, Spain
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Adelstein EC, Liu J, Jain S, Schwartzman D, Althouse AD, Wang NC, Gorcsan J, Saba S. Clinical outcomes in cardiac resynchronization therapy-defibrillator recipients 80 years of age and older. Europace 2015; 18:420-7. [DOI: 10.1093/europace/euv222] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/29/2015] [Indexed: 11/12/2022] Open
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Barra S, Providência R, Paiva L, Heck P, Agarwal S. Authors' reply. Europace 2015; 17:1456. [DOI: 10.1093/europace/euv023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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