Implantable cardioverter-defibrillator therapy in primary prevention in the elderly

Abstract

In elderly patients with heart failure and an indication for implantable cardioverter defibrillator (ICD) implantation, the incidence of sudden cardiac death (SCD) increases progressively with age, up to 80-85 years. ICD implantation is a recognized therapy, included in the guidelines for the prevention of SCD in the general population, which is also applied to elderly patients, albeit in an uneven manner, given the lack of robust data in the literature. In fact, the average age of patients included in the main randomized trials on ICDs is about 60 years. All this brings to a series of doubts in this regard, compounded by recent studies that have raised the suspicion of therapeutic futility in the implantation of ICDs in primary prevention in subjects aged ≥70 years, especially in the absence of ischemic heart disease. In the elderly, although the risk of SCD does not vary, the mortality rate for other causes tends progressively to increase with age, as the main consequence of the simultaneous presence of situations such as frailty syndrome and comorbidity. In order to avoid an ageistic attitude, it is therefore necessary to promote randomized controlled trials aimed at a multidimensional evaluation of the elderly patients with an indication for ICD implantation, from which more robust data can be obtained to allow the heart team a selectively targeted evaluation of elderly patients.