Implantable cardiac device procedures in older patients: Use and in-hospital outcomes

Jason P. Swindle, Michael W. Rich, Patrick McCann, Thomas E. Burroughs, Paul Hauptman

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

Background: Although the effectiveness of implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy (CRT) alone or in combination is well established, limited data are available on device use and short-term outcomes in older patients.Wesought to characterize age-specific practices and outcomes among patients with heart failure undergoing device implantation using a large nationally representative administrative database. Methods: The cohort comprised patients older than 18 years with a diagnosis of heart failure who underwent implantation of an ICD or CRT between January 1, 2004, and December 31, 2005. Data included patient demographics, comorbidities, type of device, procedural complications, length of stay, total cost of hospitalization, and hospital characteristics. Multivariate stepwise logistic regression analysis was used to identify risk factors for in-hospital mortality. Results: We identified 26 887 patients who received an implantable device. The median age was 70.0 years (17.5% were ≥80 years), 72.6% were male, and 31.3% were of nonwhite race/ethnicity. Compared with younger patients, those 80 years or older were more likely to receive CRT alone. In-hospital mortality increased from 0.7% among patients younger than 80 years to 1.2% among those aged 80 to 85 years and 2.2% among those older than 85 years (P<.001). Independent predictors of in-hospital mortality included age 80 years or older, elevated comorbidity score, inotrope use, and procedure-related complications. Conclusions: Despite the fact that most device trials have excluded patients 80 years or older, more than one-fifth of ICD and CRT devices are implanted in this age group. Advanced age is an independent predictor of in-hospital mortality following device implantation, suggesting that additional study is needed to define criteria for appropriate device use in older patients.

Original languageEnglish (US)
Pages (from-to)631-637
Number of pages7
JournalArchives of Internal Medicine
Volume170
Issue number7
DOIs
StatePublished - Apr 12 2010

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Equipment and Supplies
Hospital Mortality
Cardiac Resynchronization Therapy
Implantable Defibrillators
Comorbidity
Cardiac Resynchronization Therapy Devices
Heart Failure
Hospital Costs
Length of Stay
Hospitalization
Age Groups
Logistic Models
Regression Analysis
Demography
Databases

All Science Journal Classification (ASJC) codes

  • Internal Medicine

Cite this

Implantable cardiac device procedures in older patients : Use and in-hospital outcomes. / Swindle, Jason P.; Rich, Michael W.; McCann, Patrick; Burroughs, Thomas E.; Hauptman, Paul.

In: Archives of Internal Medicine, Vol. 170, No. 7, 12.04.2010, p. 631-637.

Research output: Contribution to journalArticle

Swindle, Jason P. ; Rich, Michael W. ; McCann, Patrick ; Burroughs, Thomas E. ; Hauptman, Paul. / Implantable cardiac device procedures in older patients : Use and in-hospital outcomes. In: Archives of Internal Medicine. 2010 ; Vol. 170, No. 7. pp. 631-637.
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abstract = "Background: Although the effectiveness of implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy (CRT) alone or in combination is well established, limited data are available on device use and short-term outcomes in older patients.Wesought to characterize age-specific practices and outcomes among patients with heart failure undergoing device implantation using a large nationally representative administrative database. Methods: The cohort comprised patients older than 18 years with a diagnosis of heart failure who underwent implantation of an ICD or CRT between January 1, 2004, and December 31, 2005. Data included patient demographics, comorbidities, type of device, procedural complications, length of stay, total cost of hospitalization, and hospital characteristics. Multivariate stepwise logistic regression analysis was used to identify risk factors for in-hospital mortality. Results: We identified 26 887 patients who received an implantable device. The median age was 70.0 years (17.5{\%} were ≥80 years), 72.6{\%} were male, and 31.3{\%} were of nonwhite race/ethnicity. Compared with younger patients, those 80 years or older were more likely to receive CRT alone. In-hospital mortality increased from 0.7{\%} among patients younger than 80 years to 1.2{\%} among those aged 80 to 85 years and 2.2{\%} among those older than 85 years (P<.001). Independent predictors of in-hospital mortality included age 80 years or older, elevated comorbidity score, inotrope use, and procedure-related complications. Conclusions: Despite the fact that most device trials have excluded patients 80 years or older, more than one-fifth of ICD and CRT devices are implanted in this age group. Advanced age is an independent predictor of in-hospital mortality following device implantation, suggesting that additional study is needed to define criteria for appropriate device use in older patients.",
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AU - Swindle, Jason P.

AU - Rich, Michael W.

AU - McCann, Patrick

AU - Burroughs, Thomas E.

AU - Hauptman, Paul

PY - 2010/4/12

Y1 - 2010/4/12

N2 - Background: Although the effectiveness of implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy (CRT) alone or in combination is well established, limited data are available on device use and short-term outcomes in older patients.Wesought to characterize age-specific practices and outcomes among patients with heart failure undergoing device implantation using a large nationally representative administrative database. Methods: The cohort comprised patients older than 18 years with a diagnosis of heart failure who underwent implantation of an ICD or CRT between January 1, 2004, and December 31, 2005. Data included patient demographics, comorbidities, type of device, procedural complications, length of stay, total cost of hospitalization, and hospital characteristics. Multivariate stepwise logistic regression analysis was used to identify risk factors for in-hospital mortality. Results: We identified 26 887 patients who received an implantable device. The median age was 70.0 years (17.5% were ≥80 years), 72.6% were male, and 31.3% were of nonwhite race/ethnicity. Compared with younger patients, those 80 years or older were more likely to receive CRT alone. In-hospital mortality increased from 0.7% among patients younger than 80 years to 1.2% among those aged 80 to 85 years and 2.2% among those older than 85 years (P<.001). Independent predictors of in-hospital mortality included age 80 years or older, elevated comorbidity score, inotrope use, and procedure-related complications. Conclusions: Despite the fact that most device trials have excluded patients 80 years or older, more than one-fifth of ICD and CRT devices are implanted in this age group. Advanced age is an independent predictor of in-hospital mortality following device implantation, suggesting that additional study is needed to define criteria for appropriate device use in older patients.

AB - Background: Although the effectiveness of implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy (CRT) alone or in combination is well established, limited data are available on device use and short-term outcomes in older patients.Wesought to characterize age-specific practices and outcomes among patients with heart failure undergoing device implantation using a large nationally representative administrative database. Methods: The cohort comprised patients older than 18 years with a diagnosis of heart failure who underwent implantation of an ICD or CRT between January 1, 2004, and December 31, 2005. Data included patient demographics, comorbidities, type of device, procedural complications, length of stay, total cost of hospitalization, and hospital characteristics. Multivariate stepwise logistic regression analysis was used to identify risk factors for in-hospital mortality. Results: We identified 26 887 patients who received an implantable device. The median age was 70.0 years (17.5% were ≥80 years), 72.6% were male, and 31.3% were of nonwhite race/ethnicity. Compared with younger patients, those 80 years or older were more likely to receive CRT alone. In-hospital mortality increased from 0.7% among patients younger than 80 years to 1.2% among those aged 80 to 85 years and 2.2% among those older than 85 years (P<.001). Independent predictors of in-hospital mortality included age 80 years or older, elevated comorbidity score, inotrope use, and procedure-related complications. Conclusions: Despite the fact that most device trials have excluded patients 80 years or older, more than one-fifth of ICD and CRT devices are implanted in this age group. Advanced age is an independent predictor of in-hospital mortality following device implantation, suggesting that additional study is needed to define criteria for appropriate device use in older patients.

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