Abstract
In the next 20 years, the percentage of people older than 65 years of age in the United States is expected to double. Heart disease is the leading cause of mortality in developed nations, including the United States. Due to the increased incidence of cardiac disease in elderly patients, the need for special treatment considerations, including cardiac devices, may be necessary to reduce morbidity and mortality in this patient population. The purpose of this review is to provide a primer of the common cardiac devices used in the management of cardiac disorders in the geriatric patient population. In order to do this, we have performed a literature review for articles related to cardiac devices published between 2000 and 2020, in addition to reviewing guidelines and recommendations from relevant professional societies. We provide readers with an overview of several cardiac devices including implantable loop recorders, pacemakers, cardiac resynchronization therapy, automated implantable cardiac defibrillators, watchman devices, and ventricular assist devices. Indications, contraindications, clinical trial data, and general considerations in the geriatric population were included. Due to the aging population and increased incidence of cardiac disease, clinicians should be aware of the indications and contraindications of cardiac device therapy in the management of various cardiac conditions that afflict the geriatric population.
Highlights
Due to tremendous advances in the field of medicine, lifeexpectancy in many developed countries has increased over the past several decades and continues to increase
The aim of this review is to provide an overview of the main indications and contraindications for several of the most common cardiac devices for primary care reference
Other patients who may benefit from cardiac resynchronization therapy (CRT) are those with atrial fibrillation (AF) if they otherwise meet CRT criteria and those with New York Heart Association (NYHA) class I and an ischemic etiology of heart failure with ejection fraction 30% or less and left bundle branch block (LBBB) with QRS 150 ms or greater
Summary
Due to tremendous advances in the field of medicine, lifeexpectancy in many developed countries has increased over the past several decades and continues to increase. Because of the fact that the population is aging, we are managing more acute and chronic conditions in the geriatric population. Treating this patient population may not be as simple as we once believed. The elderly experience blunted renin-angiotensin systems, blunted baroreflex modulation, and variability in blood pressure which may make it difficult for elderly patients to tolerate traditional therapeutics [2]. These factors may make management of this growing patient population more challenging. Valiant efforts have been made to create age-specific recommendations by both national and international medical associations [3, 4], treating the geriatric population is an area that requires continued attention in modern day medicine
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