Background
The use of cardiac implantable electronic devices (CIED), which includes pacemakers,
implantable cardioverter-defibrillators (ICD), cardiac resynchronisation therapy pacemakers
(CRT-P) and cardiac resynchronisation therapy defibrillators (CRT-D) has increased
over the past 20 years, but there is a lack of real world evidence on the longevity
of these devices in the older population which is essential to inform health care
delivery and support clinical decisions.
Methods and Results
We conducted a retrospective cohort study using data from the Australian Government
Department of Veterans’ Affairs database. The cohort consisted of people who had a
CIED procedure between 2005 and 2015. The cumulative risk of generator replacement/reoperations
was estimated accounting for the competing risk of death. A total of 16,662 patients
were included. In pacemaker recipients with an average age of 85 years, the 5-year
risk of reoperation ranged from 2.8% in single chamber, 3.6% in dual chamber to 7.6%
in CRT-P recipients, while the 5-year risk of dying with the index pacemaker in situ
was 63% in single chamber, 46% in dual chamber and 56% in CRT-P recipients. In defibrillator
recipients with an average age of 80 years, the 5-year risk of reoperation ranged
from 11% in single chamber, 13% in dual chamber to 24% in CRT-D recipients, while
the 5-year risk of dying with the index defibrillator in situ was 46% in single chamber,
40% in dual chamber and 41% in CRT-D recipients.
Conclusion
In this cohort of older patients the 5-year risk of generator reoperation was low
in pacemaker recipients whereas up to one in four CRT-D recipients would have a reoperation
within 5 years.
Keywords
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References
- The 11th world survey of cardiac pacing and implantable cardioverter-defibrillators: calendar year 2009--a World Society of Arrhythmia's project.Pacing Clin Electrophysiol. 2011; 34: 1013-1027
- Implant rates of cardiac implantable electrical devices in Europe: a systematic literature review.Health Policy. 2016; 120: 1-15
- The Australian and New Zealand cardiac pacemaker and implantable cardioverter-defibrillator survey: calendar year 2013.Heart Lung Circ. 2015; 24: 291-297
- Cardiac resynchronisation therapy in patients with atrioventricular nodal disease and reduced ejection fraction - can we afford it?.Heart Lung Circ. 2015; 24: 354-358
- 2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy: the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA).Europace. 2013; 15: 1070-1118
- Causes and prevention of sudden cardiac death in the elderly.Nat Rev Cardiol. 2013; 10: 135-142
- Impact of advanced age on survival in patients with implantable cardioverter defibrillators.Europace. 2008; 10: 1296-1301
- Effectiveness of implantable defibrillators in octogenarians and nonagenarians for primary prevention of sudden cardiac death.Am J Cardiol. 2011; 108: 718-722
- Survival after implantable cardioverter-defibrillator implantation in the elderly.Circulation. 2013; 127: 2383-2392
- Effect of cardiac and noncardiac conditions on survival after defibrillator implantation.J Am Coll Cardiol. 2007; 49: 2408-2415
- Role of the implantable defibrillator among elderly patients with a history of life-threatening ventricular arrhythmias.Eur Heart J. 2007; 28: 1746-1749
- Position paper for management of elderly patients with pacemakers and implantable cardiac defibrillators: Groupe de Rythmologie et Stimulation Cardiaque de la Societe Francaise de Cardiologie and Societe Francaise de Geriatrie et Gerontologie.Arch Cardiovasc Dis. 2016; 109: 563-585
- Implantable cardioverter-defibrillator prescription in the elderly.Heart Rhythm. 2009; 6: 1136-1143
- Influence of patients' age at implantation on mortality and defibrillator shocks.Europace. 2017; 19: 802-807
- 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA).Eur Heart J. 2013; 34: 2281-2329
- DVA Data for Research.https://www.dva.gov.au/health-and-wellbeing/research-and-development/dva-data-researchDate accessed: August , 2018
- Australian Government Department of Health.http://www.health.gov.au/internet/main/publishing.nsf/Content/health-privatehealth-prostheseslist.htmDate accessed: January , 2016
- Validity of medication-based co-morbidity indices in the Australian elderly population.Aust N Z J Public Health. 2009; 33: 126-130
- Introduction to the analysis of survival data in the presence of competing risks.Circulation. 2016; 133: 601-609
- Quality of life and clinical outcomes in elderly patients treated with ventricular pacing as compared with dual-chamber pacing. Pacemaker Selection in the Elderly Investigators.N Engl J Med. 1998; 338: 1097-1104
- Increasing age does not affect time to appropriate therapy in primary prevention ICD/CRT-D: a competing risks analysis.Europace. 2017; 19: 275-281
- Long-term risk for device-related complications and reoperations after implantable cardioverter-defibrillator implantation: an observational cohort study.Ann Intern Med. 2016; 165: 20-29
- Defibrillator shocks and their effect on objective and subjective patient outcomes: results of the PainFree SST clinical trial.Heart Rhythm. 2018; 15: 734-740
- Effects of implantable cardioverter/defibrillator shock and antitachycardia pacing on anxiety and quality of life: a MADIT-RIT substudy.Am Heart J. 2017; 189: 75-84
- Cardioverter-defibrillator implantation and generator replacement in the octogenarian.Europace. 2015; 17: 409-416
- Clinical characteristics and outcomes of elderly patients treated with an implantable cardioverter-defibrillator or cardiac resynchronization therapy in a real-world setting: data from the Israeli ICD Registry.Heart Rhythm. 2014; 11: 435-441
- Predicting defibrillator benefit in patients with cardiac resynchronization therapy: a competing risk study.Heart Rhythm. 2019; 16: 1057-1064
- Trends in the incidence and prevalence of cardiac pacemaker insertions in an ageing population.Open Heart. 2014; 1: e000177
- Use and long-term outcomes of implantable cardioverter-defibrillators, 1990 to 2009.Am Heart J. 2013; 165: 816-822
- Trends in the use of implantable cardioverter defibrillators in Australia: a 10-year nationwide study from 2000-2009.Intern Med J. 2013; 43: 888-895
- Trends in service time of pacemakers in the Netherlands: a long-term nationwide follow-up study.Neth Heart J. 2017; 25: 581-591
- Device longevity in a contemporary cohort of ICD/CRT-D patients undergoing device replacement.J Cardiovasc Electrophysiol. 2016; 27: 840-845
- Predicted longevity of contemporary cardiac implantable electronic devices: a call for industry-wide “standardized” reporting.Heart Rhythm. 2018; 15: 1756-1763
- Current use of implantable electrical devices in Sweden: data from the Swedish pacemaker and implantable cardioverter-defibrillator registry.Europace. 2015; 17: 69-77
- Longevity of implantable cardioverter-defibrillators for cardiac resynchronization therapy in current clinical practice: an analysis according to influencing factors, device generation, and manufacturer.Europace. 2015; 17: 1251-1258
- Characteristics and outcomes of patients receiving new and replacement implantable cardioverter-defibrillators: results from the NCDR.Circ Cardiovasc Qual Outcomes. 2013; 6: 488-497
- “Real life” longevity of implantable cardioverter-defibrillator devices.Clin Cardiol. 2017; 40: 759-764
- Longevity of implantable cardioverter defibrillators: a comparison among manufacturers and over time.Europace. 2016; 18: 710-717
Article info
Publication history
Published online: October 18, 2021
Accepted:
August 22,
2021
Received in revised form:
July 28,
2021
Received:
November 25,
2020
Identification
Copyright
© 2021 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
