■随着年龄的增长,患者的合并症和死亡原因的竞争增加,提出了关于老年人植入式心律转复除颤器(ICD)有效性的疑问。因此,我们研究了初始植入装置时患者年龄对全因死亡率和单腔ICD(V-ICD)电击风险的影响。双腔(D-ICD),和心脏再同步治疗除颤器(CRT-D)接受者。
■我们审查了波士顿科学水平远程监测患者数据库中登记的67128名ICD接受者的去识别记录[V-ICD(n=11422),D-ICD(n=23974),和CRT-D(n=31732)]。平均随访2.3±1.4年,所有ICD组患者的全因死亡率均增加,但除颤器电击和/或抗心动过速起搏的风险均降低.与最年轻年龄组(<50岁)相比,年龄最大的年龄组(≥80岁)的患者为6.8倍,5.9倍,V-ICD的全因死亡率增加3.4倍(所有比较均P<0.001),ICD休克风险降低31%、45%和53%(所有比较均P≤0.002),D-ICD,和CRT-D组,分别。
与年轻患者相比,接受标准和CRT除颤器的老年患者死亡率较高,但ICD电击和/或治疗较少。这些数据高度表明,随着年龄的增长,ICD治疗的益处较小,可能是因为非心律失常死亡率的竞争风险。除颤器治疗在老年患者中的作用可能需要通过随机对照试验进行评估。
UNASSIGNED: Patients have increasing comorbidities and competing causes of death with advancing age, raising questions about the effectiveness of the implantable cardioverter defibrillators (ICD) in older age. We therefore investigated the effect of patients\' age at initial device implantation on all-cause mortality and on the risk of ICD shocks in single-chamber (V-ICD), dual-chamber (D-ICD), and cardiac resynchronization therapy defibrillator (CRT-D) recipients.
UNASSIGNED: We reviewed de-identified records of 67 128 ICD recipients enrolled in the Boston Scientific ALTITUDE database of remote monitored patients [V-ICD (n = 11 422), D-ICD (n = 23 974), and CRT-D (n = 31 732)]. Over a mean follow-up of 2.3 ± 1.4 years, patients in all ICD groups had increased all-cause mortality but decreased risk of defibrillator shocks and/or anti-tachycardia pacing per 10 year increase in age. Compared with the youngest age group (<50 years), patients in the oldest age group (≥80 years) had a 6.8-fold, 5.9-fold, and 3.4-fold increase in all-cause mortality (P < 0.001 for all comparisons) and a 31, 45, and 53% decrease in the risk of ICD shock (P ≤ 0.002 for all comparisons) for the V-ICD, D-ICD, and CRT-D groups, respectively.
UNASSIGNED: Older recipients of standard and CRT defibrillators have higher mortality but fewer ICD shocks and/or therapies compared with younger patients. These data highly suggest less benefit of ICD therapy with increasing age, presumably because of competing risks of non-arrhythmic mortality. The role of defibrillator therapy in older patients may need to be evaluated with randomized controlled trials.