High Survival Rate for Elderly Patients with Implantable Defibrillator
Of patients over age 65 who received an implantable cardioverter-defibrillator (ICD) after surviving sudden cardiac arrest or a near-fatal arrhythmia, almost 80 percent survived two years–a higher rate than reported in past trials performed to demonstrate the efficacy of the devices in this situation. That is the finding of ac a study published January 16th 2015 in the Journal of the American College of Cardiology.
A release from the American College of Cardiology reports that patients who survived sudden cardiac arrest or had a near-fatal fast heart rhythm, called an arrhythmia, are sometimes treated with an ICD to prevent future cardiac arrest. An ICD is placed under the skin and connected to the heart with wires. The device detects when the heartbeat is irregular and can return the heart rhythm to normal with an electrical shock — also known as defibrillation.
The release quotes the study’s lead author, Frederick Masoudi, MD, MSPH, professor of medicine at the University of Colorado Anschutz Medical Campus and the Chief Science Officer of the American College of Cardiology’s National Cardiovascular Data Registry, as saying, “In this population, there is a very high risk for these cardiac events to happen again. I was surprised to see the survival rates in our study were as high as they were.”
Masoudi said the findings suggest that physicians are doing a good job of selecting elderly patients for the implantable defibrillators.
Past randomized clinical trials of ICDs were relatively small, were conducted several decades ago and did not include many older patients. ICD technology and treatment for underlying heart disease have since improved, Masoudi said. In an analysis of these clinical trials, the risk of death for patients at least 75 years of age was approximately 35 percent among those receiving an ICD, compared with 22 percent in the current study, in which 75 percent of the population was at least 75 years old.
“It’s important to study older patients, because they often have other co-existing medical conditions, which may have an impact on their outcomes,” Masoudi said.
Using data from NCDR’s ICD Registry, the study included 12,420 Medicare beneficiaries undergoing an ICD implantation after surviving sudden cardiac arrest or a near-fatal ventricular arrhythmia, between 2006 and 2009 in almost 1,000 U.S. hospitals.
The researchers found 65.4 percent of patients were hospitalized during the two years after receiving an ICD, ranging from 60.5 percent in those less than age 70 to 71.5 percent in those 80 and older. In addition, 13.1 percent among those less than 70 years old and 21.9 percent of those 80 and older were admitted to a skilled nursing facility. The risk of admission to a skilled nursing facility was greatest in the first 30 days after the procedure. The risks of hospitalization and admission to skilled nursing facility were all greater with increasing patient age.