Department of Medicine, McGill University, Montreal, Quebec, Canada; Division of Cardiology, McGill University Health Center, Quebec, Canada.
Cardiology Department, Morriston Hospital, Swansea University, Swansea, UK.
Hellenic J Cardiol. 2019 Sep-Oct;60(5):276-281. doi: 10.1016/j.hjc.2017.12.003. Epub 2017 Dec 29.
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.
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.
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).
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.
植入式心脏复律除颤器（ICD）和心脏再同步治疗（CRT）可降低射血分数降低的心力衰竭（HFrEF）患者的心脏性猝死和全因死亡率。目前的指南并未建议 ICD 和 CRT 的年龄上限，但建议在预期寿命少于 1 年的虚弱患者中避免使用 ICD 和 CRT。目前尚不清楚接受 CRT 的老年患者是否与年轻患者一样从 ICD 中获得相同的额外益处。我们旨在评估与年轻患者相比，老年患者接受 CRT 时使用 ICD 的情况。
我们检索了电子数据库，截至 2016 年 4 月 11 日，检索了所有报告按 CRT 治疗患者年龄分层的 ICD 使用情况的研究。我们使用随机效应荟萃分析模型计算了纳入研究患者的汇总基线特征和 ICD 植入率。
我们保留了 6 项观察性研究，共纳入 613 名年龄≥75 岁和 2810 名年龄<75 岁的患者。老年患者的平均年龄为 82.7 岁，而年轻患者的平均年龄为 66.3 岁。与年轻患者相比，老年患者 ICD 的使用率明显较低（37.9%对 64.3%）（比值比：0.26；95%置信区间：0.14-0.46；p<0.0001）。
总之，与年轻患者接受 CRT 相比，接受 CRT 的年龄≥75 岁的患者 ICD 的使用频率较低。需要进一步开展评估 CRT 适应证的老年患者 ICD 的疗效和有效性的研究，以指导对这一不断增长人群的管理。
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