Abstract 65: Use of Implantable Cardioverter-Defibrillators Among Older Patients Hospitalized with Heart Failure

Abstract

Background: Practice guidelines recommend the use of implantable cardioverter defibrillators (ICDs) in patients with heart failure (HF) and a left ventricular ejection fraction (LVEF) of ≤ 35% across all age groups in the absence of contraindications. The influence of age on ICD use among eligible patients, including sex differences, has not been fully explored. Methods: We performed an analysis of patients admitted with HF and a 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. Results: Among 35,772 eligible patients, 17,639 (49.3%) had ICDs at discharge (10,886 with ICDs present on admission, 4,876 with ICDs placed during the hospitalization, and 1,877 with referral for ICDs post discharge). Among those eligible, ICDs were used in 3,383 of 7,153 (47.3%) aged <55 years; 4,003 of 7,360 (54.4%) aged ≥ 55 to 64 years; 4,828 of 3,843 (55.7%) aged ≥ 65 to 74 years; 4,394 of 8,890 (49.4%) aged ≥ 75 to 84 years; and 1,031 of 3,698 (27.9%) aged ≥ 85 years. After adjustment for patient characteristics and hospital factors, the odds ratio (OR) of ICD use was 0.89 (95% confidence interval (CI), 0.87-0.91) for every 5-year increase in age. Compared with males in the same age group, females were statistically significantly less likely to receive an ICD; this disparity is more marked with increasing age (p-value for interaction=0.006). There was an overall temporal increase in ICD use (adjusted OR of ICD use per year=1.23, 95% CI 1.15-1.31), mainly driven by a rise in the proportion of ICDs present on admission. The temporal increase in ICD use was similar in each age group (p-value for interaction =0.67) ( Table ). Conclusions: After accounting for patient and hospital characteristics, eligible older patients were significantly less likely to receive an ICD. With increasing age, females were less likely to receive ICDs. Despite an overall increase in ICD use over time, age- and sex-related differences in ICD use persist.