Distribution and impact of age in patients with implantable cardioverter-defibrillators regarding early complications an
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Distribution and impact of age in patients with implantable cardioverter-defibrillators regarding early complications and 1-year clinical outcome: results from the German Device Registry Elif Kaya 1 & Jochen Senges 2 & Matthias Hochadel 2 & Lars Eckardt 3 & Dietrich Andresen 4 & Hüseyin Ince 5,6 & Stefan G. Spitzer 7 & Thomas Kleemann 8 & Sebastian S. K. Maier 9 & Werner Jung 10 & Christoph Stellbrink 11 & Tienush Rassaf 1 & Reza Wakili 1 Received: 29 March 2020 / Accepted: 14 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Patients receiving implantable-cardioverter-defibrillators (ICD) in clinical practice are often older or younger than in clinical trials. Whether older patients benefit from ICD-therapy in a similar way as younger patients is under debate. The objective of this study was to provide real-world data regarding outcomes with respect to age in a large cohort in the German Device Registry. Methods Within the registry data from 50 German centers were collected between January 2007 and February 2014. Results Our analysis included 3239 ICD patients representing a group of young (28%; group I: < 58 years), intermediate aged (50%; group II: 58–74 years), and elderly patients (22%; group III: 75–92 years). Intergroup comparison of all groups was performed followed by individual comparison vs. group II serving as age-reference group. Procedure-related complications did not differ between all groups. Analysis of the primary endpoint, 1-year all-cause mortality, revealed an increased mortality in the elderly and a decreased mortality in the young cohort vs. the reference group II (group I 2.1%, group II 6.2%, group III 13.2%; p < 0.001). While all-cause rehospitalizations did not differ, we observed a difference in reported device revisions showing more device revisions required in younger patients (group I 8.9%, group II 6.8%, group III 4.0%; p = 0.001). Conclusions One-year mortality was doubled in elderly ICD patients probably due to non-cardiac causes. These results further underpin the need for re-evaluating the primary prevention ICD indication in octo- and nonagenarians. Young patients show lower mortality rates but seem to bear higher risk of device-related complications, which highlights the need for improved measures to reduce device-related complications in the young. Keywords Implantable cardioverter defibrillator . Age . Complication . Outcome . Registry
* Reza Wakili [email protected] 1
Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University of Duisburg- Essen, Essen, Germany
5
Department of Cardiology and Internal Medicine, Vivantes Klinikum Am Urban, Berlin, Germany
6
Rostock University Medical Center, Rostock, Germany
7
Institut of Medical Technology, Praxisklinik Herz und Gefäße Dresden and Brandenburg, University of Technology Cottbus-Senftenberg, Senftenberg, Germany
2
Stiftung Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen am Rhein, Germany
8
Department of Card
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