Subcutaneous Implantable Cardioverter-Defibrillator Might Benefit Older Patients
The advent of the subcutaneous (S) implantable cardioverter-defibrillator (ICD) brings with it many benefits as well as specific limitations when compared with standard transvenous (TV) ICDs. A recent study reiterated that S-ICD has comparable outcomes with TV-ICDs in older adults. The study findings were published in the Journal of the American College of Cardiology on March 14, 2022.
"There are several unanswered questions that limit the generalizability of the S-ICD to more common ICD patients. One such question is the safety and efficacy of S-ICD implantation in older patients", wrote Dr Ahmadreza Karimianpour in an accompanying editorial. Also, there is still an age bias in enrollment, as recent prospective trials included patients with an average age of <65 years. To address the research gap, Dr Daniel J. Friedman and his team conducted a study to compare outcomes among older patients who received an S- or TV-ICD.
In this longitudinal retrospective outcomes study, the researchers included 16,063 patients with a median ejection fraction of 28.3 ± 8.9%. They used the "big data" by analyzing the National Cardiovascular Data Registry (NCDR) ICD registry to compare S-ICD (n = 991) and TV-ICD (n = 15,072) patients. Outcomes were ascertained from Medicare claims data. They used Cox regression or competing-risk models (with TV-ICD as reference) with overlap weights to compare death and nonfatal outcomes (device reoperation, device removal for infection, device reoperation without infection, and cardiovascular admission), respectively. They compared recurrent all-cause re-admissions using Anderson-Gill models.
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