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Use and In-Hospital Outcomes

Jason P. Swindle, MPH; Michael W. Rich, MD; Patrick McCann, MD; Thomas E. Burroughs, PhD; Paul J. Hauptman, MD

Arch Intern Med. 2010;170(7):631-637.

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. We sought 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.

Author Affiliations: Center for Outcomes Research (Mr Swindle and Drs Burroughs and Hauptman), Departments of Internal Medicine (Drs McCann and Hauptman), Saint Louis University School of Medicine and Washington University School of Medicine (Dr Rich), St Louis, Missouri.

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