Implantable cardioverter-defibrillator use in elderly patients receiving cardiac resynchronization: A meta-analysis

Abstract

Background: Implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) reduce sudden cardiac death and all-cause mortality in patients with heart failure with reduced ejection fraction (HFrEF). Current guidelines do not suggest any upper age limit for ICD and CRT but recommend avoidance of ICD and CRT in frail patients with a life expectancy of less than 1 year. It remains unclear whether elderly patients undergoing CRT derive the same additional benefit from ICDs as younger patients. We aimed to assess the use of ICDs in elderly compared to younger patients receiving CRT. Methods: We searched electronic databases, up to April 11, 2016, for all studies reporting on ICD use stratified by age in patients who received CRT. We used random-effects meta-analysis models to calculate the summarized baseline characteristics and rates of implantation of ICD among patients enrolled in the studies. Results: We retained six observational studies enrolling 613 patients ≥75 years old and 2810 patients <75 years old. The aggregate mean age was 82.7 years for the elderly patients compared to 66.3 years in the younger patients. There was a significantly lower use of ICDs in elderly patients compared to that in younger patients (37.9% versus 64.3%) (odds ratio: 0.26; 95% confidence intervals: 0.14-0.46; p < 0.0001). Conclusions: In conclusion, ICD was less frequently used in patients ≥75 years old receiving CRT compared to younger patients receiving CRT. Future studies that evaluate the efficacy and effectiveness of ICDs in elderly patients with indications for CRT are needed to guide management of this increasing population. : Condensed abstract: It remains unclear whether elderly patients undergoing cardiac resynchronization therapy derive the same additional benefit from implantable cardioverter-defibrillators as younger patients. We summarized six observational studies of cardiac resynchronization, which enrolled 613 elderly patients ≥75 years old and 2810 patients <75 years old. There was a significantly lower use of defibrillators in elderly patients compared to that in younger patients (37.9% versus 64.3%) (odds ratio: 0.26; 95% confidence intervals: 0.14-0.46; p < 0.0001). We concluded that implantable cardioverter-defibrillators were less frequently utilized in elderly patients who underwent cardiac resynchronization therapy than younger patients. Keywords: Implantable cardioverter-defibrillator, Elderly, Cardiac resynchronization therapy, Heart failure