Age Differences in the Use of Implantable Cardioverter-Defibrillators Among Older Patients Hospitalized with Heart Failure

Authors

  • PAUL L. HESS M.D.,

    Corresponding author
    1. Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
    • Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
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  • MARIA V. GRAU-SEPULVEDA M.D., M.P.H.,

    1. Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
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  • ADRIAN F. HERNANDEZ M.D., M.H.S.,

    1. Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
    2. Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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  • ERIC D. PETERSON M.D., M.P.H.,

    1. Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
    2. Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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  • DEEPAK L. BHATT M.D., M.P.H.,

    1. Veterans Affairs Boston Health System, Boston, Massachusetts, USA
    2. Harvard Medical School, Boston, Massachusetts, USA
    3. Brigham and Women's Hospital, Boston, Massachusetts, USA
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  • LEE H. SCHWAMM M.D.,

    1. Harvard Medical School, Boston, Massachusetts, USA
    2. Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
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  • CLYDE W. YANCY M.D., M.Sc.,

    1. Department of Medicine, Northwestern University, Chicago, Illinois, USA
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  • GREGG C. FONAROW M.D.,

    1. Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
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  • SANA M. AL-KHATIB M.D., M.H.S.,

    1. Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
    2. Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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  • for the Get with The Guidelines Steering Committee and Hospitals


  • Funding for the GWTG-HF program is provided by the American Heart Association. The GWTG-HF program is supported in part by Medtronic, Ortho-McNeil, and the American Heart Association Pharmaceuticals Roundtable. GWTG-HF was funded in the past by GlaxoSmithKline. This analysis was funded by the GWTG Young Investigator Database Research Seed Grant. The sponsors of GWTG-HF had no role in the design or conduct of the study or the management, analysis, or interpretation of the data. P.L. Hess was funded by NIH T-32 training grant HL069749-09.

  • E.D. Peterson reports participation on research grants supported by Janssen Pharmaceuticals, Pfizer, and Boehringer Ingelheim. D.L. Bhatt. reports participation on research grants supported by Amarin, AstraZeneca, Bristol-Meyers Squibb, Eisai, Ethicon, Medtronic, Sanofi Aventis, The Medicines Company, as well as unfunded support from FlowCo, PLx Pharma, and Takeda. G.C. Fonarow serves as consultant/advisory board member of Novartis, Medtronic, and Gambro. Other authors: No disclosures.

Address for correspondence: Paul L. Hess, MD, Duke Clinical Research Institute, Duke University School of Medicine, PO Box 17969, Durham, NC 27715, USA. Fax: +919-668-7058; E-mail: p.hess@duke.edu

Age and ICD Use Among Older HF Patients

Introduction

Practice guidelines recommend the use of ICDs in patients with heart failure (HF) and a left ventricular ejection fraction (LVEF) of ≤ 35% in the absence of contraindications.

Methods and Results

We performed an analysis of ICD use among patients admitted with HF with LVEF of ≤ 35% and discharged alive from 251 hospitals participating in the American Heart Association's Get With The Guidelines-HF Program between January 2005 and September 2011. Among 35,772 guideline-eligible patients, 17,639 received an ICD prior to hospitalization (10,886), during hospitalization (4,876), or were discharged with plans to undergo ICD placement after hospitalization (1,877). After adjustment, increasing age was associated with lower ICD use (odds ratio [OR] 0.89, 95% confidence interval [CI] 0.87–0.91 per 5-year increase in age, P  <  0.0001). Compared with patient age < 55 years, older age groups ≥ 65 years were less likely to receive an ICD (P  <  0.003). Compared with men in the same age group, women were significantly less likely to receive an ICD; this difference was more marked with increasing age (P value for interaction = 0.006). There was a temporal increase in ICD use (adjusted OR 1.23, 95% CI 1.15–1.31 of ICD use per year) that was similar in each age group (P value for interaction = 0.665).

Conclusions

Eligible older HF patients age ≥ 65 years were significantly less likely to receive an ICD. With increasing age, women were less likely to receive an ICD than men. ICD use significantly increased over time in all age groups; however, age-related differences in ICD use persisted.

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