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Outcomes of Subcutaneous or Transvenous ICDs in Older Patients
Quick Takes
- Among eligible older patients, subcutaneous ICDs are associated with risks of hospital readmission for cardiovascular or other reasons, reoperation, removal because of infection, and all-cause mortality that are similar to those with transvenous ICD devices.
- It remains unknown whether any differences in outcomes would emerge over longer periods of observation.
Study Questions:
What are the clinical outcomes among older patients who received a totally subcutaneous implantable cardioverter-defibrillator (S-ICD) or single-chamber transvenous ICD (TV-ICD)?
Methods:
The authors used the National Cardiovascular Data Registry ICD Registry to compare patients with S-ICD and TV-ICD implants. Outcomes were ascertained from Medicare claims data. Cox regression or competing-risk models with overlap weights were used to compare death and nonfatal outcomes (device reoperation, device removal for infection, device reoperation without infection, and cardiovascular admission).
Results:
A total of 16,063 patients were studied (mean age 73 years, 25% women, ejection fraction 28%). Compared with TV-ICD patients (n = 15,072), S-ICD patients (n = 991, 6.2% overall) were more often Black, younger, and dialysis dependent and less likely to have history of atrial fibrillation or flutter. In adjusted analyses, there were no differences between device type and risk of all-cause mortality, device reoperation, device removal for infection, device reoperation without infection, cardiovascular readmission, or recurrent all-cause readmission.
Conclusions:
In a large representative national cohort of older patients undergoing ICD implantation, risk of death, device reoperation, device removal for infection, device reoperation without infection, and cardiovascular and all-cause readmission were similar among S- and TV-ICD recipients.
Perspective:
In clinical practice, S-ICDs are more commonly used in patients who are younger due to the major benefit of S-ICD of obviating the long-term risk of indwelling leads intrinsic to TV-ICDs. Such considerations are not as compelling for elderly patients. In this study, only 6% of the implanted devices were S-ICDs. As expected, a significant number of the S-ICD patients were on dialysis (over one in five patients). The present study extends the findings of the PRAETORIAN and UNTOUCHED trials, in which the average age was much less, to the older population. It is reassuring to see that there were no differences between S-ICD and TV-ICD in all endpoints.
Clinical Topics: Arrhythmias and Clinical EP, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure
Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Death, Sudden, Cardiac, Defibrillators, Implantable, Device Removal, Infections, Geriatrics, Heart Failure, Patient Readmission, Renal Dialysis, Reoperation, Secondary Prevention, Stroke Volume, Treatment Outcome, EP Device Implant Registry
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