SUNY Downstate, Brooklyn, NY, USA.
New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, 150 South Huntington St, Boston, MA, 02130, USA.
J Gen Intern Med. 2019 Oct;34(10):2224-2231. doi: 10.1007/s11606-019-05100-9. Epub 2019 Jul 1.
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.
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.
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.
Existing literature suggests that individuals with frailty may not benefit from ICD placement for primary prevention of SCD.
植入式心脏复律除颤器（ICD）在预防老年人心脏性猝死（SCD）方面的益处的证据参差不齐；单纯年龄可能无法预测获益。衰弱可能有助于确定 ICD 不能降低总体死亡率的患者。
于 2019 年 1 月 31 日在 PubMed、Embase、Web of Science 和 Cochrane 对照试验中心，无语言限制，使用 ICD、衰弱和死亡率的术语进行了系统检索。使用任何经过验证的单一成分（例如，步行速度、体重减轻）或多成分工具（例如，累积缺陷指数）广义地定义衰弱。评估了每个研究的质量和偏倚风险。
我们确定并筛选了 2649 篇标题，回顾了 280 篇摘要，并提取了 71 篇文章。9 篇文章，包括 2 项 RCT、1 项前瞻性队列研究和 6 项回顾性队列研究，符合所有标准。排除的最常见原因是缺乏衰弱定义。衰弱定义存在差异，包括累积缺陷模型、低体重和步行速度。死亡率的随访时间不同：从几天到超过 6 年。所有研究都表明，无论定义如何，衰弱个体的死亡率更高。在一项 RCT 中，行动缓慢的患者在 3 年后并未从 ICD 治疗中获益。在 ICD 注册中心的一项 83792 名 Medicare 受益人的队列研究报告称，在 ICD 后，衰弱或痴呆患者的 1 年死亡率更高。四项研究报告称，体重不足与 ICD 后死亡率增加之间存在关联。
现有文献表明，衰弱患者可能不能从 ICD 放置中获益，用于预防 SCD 的一级预防。
