Charlson Comorbidity Index Predicts Survival after ICD Implant in Veterans Over the Age of 70

Abstract

Background ICDs for prevention of sudden death are associated with improved survival in patients with chronic heart failure (HF). Outcomes of patients over 70 years age are underrepresented in registries and randomized trials. Older age and comorbidities are known markers of higher risk of death; however, little is known about ICD outcomes in the elderly. Methods Using data in the VA Eastern Pacemaker Surveillance database, patients were evaluated for the influence of comorbidities and age on survival over a 10 year period. Medical records were reviewed for mortality predictors including age, and 17 comorbidity variables in the Charlson Comorbidity index (CCI). Kaplan Meier survival analysis was conducted and logistic regression models were used to assess risk of death. When available, the mode of death (arrhythmic, non-arrhythmic cardiac and non-cardiac death) was analyzed. Results Of 518 patients identified, 363 had full datasets: 83% had systolic HF, mean (SD) EF was 26% (11.2), and mean (SD) age was 64 (10.4) years. During the study period 156 patients died (43%), with mean time to death of 6.06 (3.34) years. Total CCI Score was associated with increased mortality, r=.254, p<.0005, and age, r=.338, p<.0005. In Kaplan Meier analysis, patients aged ≥80 years had worse survival than those aged <60, 60-69, and 70-79, X 2(3) = 32.14, p Conclusion In well treated post ICD patients with systolic HF, age and CCI score were associated with shorter survival. To determine benefit to elderly patients, more research is needed on the specific comorbidities that should be assessed.