Primary Prevention ICD Consideration in a Frail Octogenarian
An 84-year-old man is referred to your clinic for primary prevention implantable cardiac defibrillator (ICD) implantation. Medical history includes distantly revascularized coronary artery disease with a current ejection fraction of 30%, congestive heart failure (CHF) with New York Heart Association (NYHA) functional class III symptoms, stage III chronic kidney disease, hypertension, and atrial fibrillation (AF) treated with systemic anticoagulation. Over the past year, he had two admissions for heart failure decompensations. He lives with his wife of 60 years, and used to smoke but quit after a previous heart attack. He previously walked outside every day, but now is largely confined to the house due to fatigue with exertion. He still drives short distances into town, always accompanied by his wife. Medications include carvedilol, lisinopril, spironolactone, twice-daily furosemide, aspirin, atorvastatin, and warfarin. On physical examination, vitals are blood pressure 100/60 mm Hg, heart rate 65 per minute, respiration rate 16 breaths per minute, oxygen saturation 96% on room air. Body mass index is 22 kg/m2. There is no jugular venous distention, and there are no rales or wheezes upon inspiration. The heart rate is regular, and there is an S3 with a soft holosystolic murmur at the apex. Extremities are warm with mild edema. Dorsalis pedis pulse is palpable on the right foot, but not the left. He ambulates slowly (gait speed 0.6/msec) and 6 seconds are required to rise from a seated position. Pertinent labs include a hemoglobin of 10.9 g/dL, sodium of 135 mEq/L, blood urea nitrogen of 43 mg/dL, and creatinine of 1.8 mg/dL with an eGFR of 34 mL/min/1.73m2. Liver function tests are unremarkable. An electrocardiogram shows evidence of an old inferior myocardial infarction, and the QRS duration is 110 ms. An echocardiogram reveals moderately depressed systolic function with moderate left ventricular dilation, eccentric remodeling, moderate mitral regurgitation, and normal right ventricular function.
Which of the following statements is true regarding primary prevention ICD placement for this patient?