11:38pm Wednesday 23 October 2019

Cardiac Devices for Elderly Heart Failure Patients: Common but Not Studied

ST. LOUIS — Studies on the effectiveness of implanting defibrillators and cardiac resynchronization therapy to treat heart failure have often excluded patients who are older than age 80 — but that should change, Saint Louis University researchers have found.

Paul J. Hauptman, M.D.

According to their study in the April 12 edition of Archives of Internal Medicine, nearly one in every five patients who received an implanted cardiac device is 80 years or older, yet major clinical trials typically analyze the effectiveness of these devices in patients who are much younger — the average has been between 58 and 67 years of age.

“The usefulness of device therapy in the expanding group of patients who are older than 80 and have heart failure has not been critically examined,” said Paul J. Hauptman, M.D., professor of internal medicine and cardiology at Saint Louis University School of Medicine, and the study’s senior author.

“Our findings indicate that procedure-related complication rates and in-hospital mortality are elevated in patients with advancing age.”

The researchers analyzed records of nearly 27,000 adults at hundreds of hospitals who received implanted devices after being diagnosed with heart failure in 2004 and 2005. They found patients who were more than 80 years old were more likely to die in the hospital after receiving an implantable cardiac device than were younger patients.

“Advanced age is an independent predictor of in-hospital mortality following device implantation, suggesting that additional study is needed to define criteria for appropriate device use in older patients,” Hauptman said.

“Given the trends in the demographics of heart failure and the costs of device therapy, additional studies are required to clarify the appropriateness of device implantation in older patients with heart failure, as well as the merits of less invasive options.”

Nancy Solomon

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