Department of Medicine, University of Colorado, Denver, Colorado.
Division of Cardiology, University of Colorado, Denver, Colorado; Colorado Cardiovascular Outcomes Research Group, Denver, Colorado.
J Am Coll Cardiol. 2017 Jan 24;69(3):265-274. doi: 10.1016/j.jacc.2016.10.062.
Clinical trials of implantable cardioverter-defibrillators (ICDs) for secondary prevention of sudden cardiac death were conducted nearly 2 decades ago and enrolled few older patients.
This study assessed morbidity and mortality of older patients receiving ICDs for secondary prevention in contemporary clinical practice.
We identified 12,420 Medicare beneficiaries from the National Cardiovascular Data Registry ICD Registry undergoing first-time secondary prevention ICD implantation between 2006 and 2009 in 956 U.S. hospitals. Risks of death, hospitalization, and admission to a skilled nursing facility (SNF) were assessed over 2 years in age strata (65 to 69, 70 to 74, 75 to 79, and ≥80 years of age) using Medicare claims. The adjusted association between age and outcomes was evaluated using multivariable models.
The mean age was 75 years at the time of implantation; 25.3% were <70 years of age and 25.7% were ≥80 years of age. Overall, the risk of death at 2 years was 21.8%, ranging from 14.7% among those <70 years of age to 28.9% among those ≥80 years of age (adjusted risk ratio [aRR]: 2.01; 95% confidence interval [CI]: 1.85 to 2.33; p for trend <0.001). The cumulative incidence of hospitalizations was 65.4%, ranging from 60.5% in those <70 years of age to 71.5% in those ≥80 years of age (aRR: 1.27; 95% CI: 1.19 to 1.36; p for trend <0.001). The cumulative incidence of admission to a SNF ranged from 13.1% among those <70 years of age to 31.9% among those ≥80 years of age (aRR: 2.67; 95% CI: 2.37 to 3.01; p for trend <0.001); SNF admission risk was highest in the first 30 days.
Almost 4 in 5 older patients receiving a secondary prevention ICD survives at least 2 years. High hospitalization and SNF admission rates, particularly among the oldest patients, identify substantial care needs after device implantation.
植入式心脏复律除颤器（ICD）用于二级预防心源性猝死的临床试验是在近 20 年前进行的，仅纳入了少数老年患者。
本研究评估了在当代临床实践中，接受 ICD 二级预防的老年患者的发病率和死亡率。
我们从国家心血管数据注册 ICD 登记处确定了 12420 名接受 Medicare 福利的患者，这些患者在 2006 年至 2009 年期间在美国 956 家医院接受了首次 ICD 二级预防植入。在 2 年的时间内，根据 Medicare 索赔评估了 65 至 69 岁、70 至 74 岁、75 至 79 岁和≥80 岁年龄组患者的死亡、住院和入住熟练护理机构（SNF）的风险。使用多变量模型评估了年龄与结果之间的调整关联。
植入时的平均年龄为 75 岁；25.3%的患者年龄<70 岁，25.7%的患者年龄≥80 岁。总的来说，2 年时的死亡风险为 21.8%，<70 岁患者的死亡风险为 14.7%，≥80 岁患者的死亡风险为 28.9%（调整后的风险比[aRR]：2.01；95%置信区间[CI]：1.85 至 2.33；p<0.001）。住院的累积发生率为 65.4%，<70 岁患者的住院率为 60.5%，≥80 岁患者的住院率为 71.5%（aRR：1.27；95%CI：1.19 至 1.36；p<0.001）。入住 SNF 的累积发生率<70 岁患者为 13.1%，≥80 岁患者为 31.9%（aRR：2.67；95%CI：2.37 至 3.01；p<0.001）；SNF 入院风险在 30 天内最高。
近 4/5 的接受二级预防 ICD 的老年患者至少存活 2 年。高住院率和 SNF 入院率，尤其是在最年长的患者中，表明设备植入后存在大量的护理需求。
