Europace Advance Access originally published online on September 24, 2008
Europace 2008 10(11):1296-1301; doi:10.1093/europace/eun253
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Implantable cardioverter-defibrillators
Impact of advanced age on survival in patients with implantable cardioverter defibrillators
1 Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, USA; 2 Division of Cardiology, Department of Medicine, Stanford University, Palo Alto, CA, USA; 3 Section of Cardiology, VA Medical Center, San Francisco, CA, USA 4150 Clement St (Cardiology 111C), San Francisco, CA 94121, USA
Aims: Given the selectivity of clinical trial patients and meager representation of elderly in the major implantable cardioverter defibrillator (ICD) randomized trials (<25%), whether such data apply to elderly patients overall is unclear. The purpose of our study is to understand the influence of age on mortality after ICD implantation.
Methods and results: We performed a retrospective cohort study of 502 consecutive patients receiving ICDs from 1993 to 2003 at a single university hospital. The primary predictor was patient age, categorized as <65, 65–75, and >75 years at ICD implantation. The primary outcome was time to death. Mean follow-up was 4 years. Median survival after ICD implantation was 5.3 years among subjects >75 years, less than half that of the youngest group. After adjusting for potential confounders, compared with subjects <65 years of age, patients >75 years [hazard ratio (HR), 4.7; 95% confidence interval (CI), 2.8–7.9; P < 0.001] and those 65–75 years (HR, 2.8; 95% CI, 1.7–4.8; P < 0.001) were at greater risk of death. Increased age was associated with higher total, cardiac, and non-cardiac mortality (all P 
0.001).
Conclusion: Age at ICD implantation is strongly and independently associated with mortality. Age should be considered among potential co-morbidities in anticipating survival of the elderly patient prior to ICD implantation.
Key Words: Implantable cardioverter defibrillator, Age, Mortality, Predictor, Elderly, Sudden cardiac death
* Corresponding author. Tel: +1 415 221 4810 ext. 3178; fax: +1 415 750 6950. E-mail address: paul.varosy{at}ucsf.edu
Manuscript submitted 11 June 2008. Accepted after revision 11 August 2008.
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