The highest risk of complications was observed in patients with ICD implants and aged 85 years or older. The lowest risk group was patients aged 65 to 74 with CRT-D implants. Bbleeding was the most common complication, detected in 5-8% of patients.
When examining the endpoint of hospitalization for HF, the authors found no differences associated with device type for patients younger than 85 years. For patients 85 years and older, however, CRT-D was associated with fewer HF hospitalizations.
Another key finding from the team was that the mortality rate was high after 90 days and one year, only increasing as the patient’s age increased. After one year, 18-33% of patients in each age group and device type had died.
“The reasons for the high mortality rate are unknown as the cause of death was not available, but it likely reflects significant concurrent nonarrhythmic mortality risk, which is difficult to measure from claims data,” wrote writers. “This is problematic because relevant professional guidelines routinely recommend ICD (with or without CRT) only when life expectancy is at least 1 year, but the estimate of survival is notoriously unreliable and is generally based on clinical gestalt.
The group also noted that one-year mortality was similar between CRT-D and ICD patients aged 65 to 74 years. For patients 74 years and older, however, one-year mortality was lower in CRT-D patients.
“These results demonstrate significant improvements in CRT-D-associated HF mortality and hospitalization in older patients,” wrote the authors. “Overall mortality and complications attributable to device implantation are higher than previously reported, which, in part, likely reflects an evolving IC population that is increasingly older and comorbid. Thus, the inclusion of elderly patients in future randomized clinical trials of IC interventions would improve understanding of therapies in this growing population.”
Read the full study here.