Octogenarians are a growing section of the community. Implantable cardioverter defibrillator (ICD) implantations and replacements in this age group are becoming frequent. There are no randomised control trials or large observational studies of octogenarians and indications for ICD implantations are extrapolated from published primary and secondary prevention trials, where the age group has been in its sixties. About 75% of ICDs are implanted for primary prevention guided by patient's ejection fraction.
Most patients who have ICDs do not have a clear idea about the function and limitation of ICDs. Patient education about ICDs is an important aspect which deserves consideration, particularly in this age group.
The use of ICDs in octogenarians should be individualised and carefully scrutinised. It should take into consideration overall health status, symptom severity, co-morbidities and intermediate and long-term prognosis. There should be detailed discussion about patient preference and expectations. Physicians must provide a realistic appraisal of potential benefits and risks and address device management issues at end of life. This discussion should also take place when ICD replacement is considered.
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- Implantable cardioverter-defibrillator prescription in the elderly.Heart Rhythm. 2009; 6: 1136-1143
- Implantable cardiac device procedures in older patients; use and in-hospital outcomes.Arch Intern Med. 2010; 170: 631-637
- Implantable cardioverter-defibrillators for primary prevention of sudden death: the quest to identify patients most likely to benefit.J Am Coll Cardiol. 2012; 60: 1656-1658
- ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines.Circulation. 2008; 117: e350-e408
- Role of implantable defibrillator among elderly patients with a history of life threatening ventricular arrhythmias.Eur Heart J. 2007; 28: 1746-1749
- Improved survival associated with prophylactic implantable defibrillators in elderly patients with prior myocardial infarction and depressed ventricular function: a MADIT-II substudy.J Cardiovasc Electrophysiol. 2007; 18: 833-838
- Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure.N Engl J Med. 2005; 352: 225-237
- Effectiveness of implantable defibrillators in octogenarians and nonagenarians for primary prevention of sudden cardiac death.Am J Cardiol. 2011; 108: 718-722
- Impact of advanced age on survival in patients with implantable cardioverter defibrillators.Europace. 2008; 10: 1296-1301
- Diminishing proportional risk of sudden death with advancing age: implications for prevention of sudden death.Am Heart J. 2004; 147: 837-840
- Safety and effectiveness of primary prevention cardioverter defibrillators in octogenarians.Pacing Clin Electrophysiol. 2011; 34: 900-906
- Predictors of early mortality in patients age 80 and over receiving implantable defibrillators.Pacing Clin Electrophysiol. 2010; 33: 981-987
- Improved outcome with preventive cardiac resynchronization therapy in the elderly: a MADIT-CRT substudy.J Cardiovasc Electrophysiol. 2011; 22: 892-897
- Prediction of mortality in clinical practice for medicare patients undergoing defibrillator implantation for primary prevention of sudden cardiac death.J Am Coll Cardiol. 2012; 60: 1647-1655
- A critical appraisal of implantable cardioverter-defibrillator therapy for the prevention of sudden cardiac death.J Am Coll Cardiol. 2008; 52: 1111-1121
- Implantation related complications of implantable cardioverter defibrillators and cardiac resynchronization therapy devices.J Am Coll Cardiol. 2011; 58: 995-1000
- Inappropriate implantable cardioverter-defibrillator shocks: incidence, predictors, and impact on mortality.J Am Coll Cardiol. 2011; 1: 556-562
- Cost effectiveness of implantable cardioverter defibrillators.N Engl J Med. 2005; 353: 1471-1480
- 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities.J Am Coll Cardiol. 2013; 61: e6-e75
- Management of implantable cardioverter defibrillators in the end-of-life care.Ann Intern Med. 2004; 141: 835-838
- “Its like crossing a bridge” complexities preventing physicians from discussing deactivation of implantable defibrillators at the end of life.J Gen Intern Med. 2008; 23: 2-6
- Patient preferences for deactivation of implantable cardioverter-defibrillators.JAMA Intern Med. 2013; 173: 377-379
- Time for a change—a new approach to ICD replacement.N Engl J Med. 2012; 366: 291-293
Published online: November 21, 2013
Accepted: September 23, 2013
Received: June 24, 2013
© 2013 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved.