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April 23, 2013

Clinical Characteristics and Outcomes of Elderly Patients Treated With ICD and CRTD in Real World Setting: Data From the Israeli ICD Registry . M. Suleiman, M. Haim, JE. Schliamser, M. Boulos, S. Viskin, M. Swissa, N. Gavrielov-Yusim, T. Fuchs, M. Ilan, I. Goldenberg6, and M. Glikson6.

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April 23, 2013

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  1. Clinical Characteristics and Outcomes of Elderly Patients Treated With ICD and CRTD in Real World Setting: Data From the Israeli ICD Registry M. Suleiman, M. Haim, JE. Schliamser, M. Boulos, S. Viskin, M. Swissa, N. Gavrielov-Yusim, T. Fuchs, M. Ilan, I. Goldenberg6, and M. Glikson6 April 23, 2013

  2. Background • Elderly patients (eg, age ≥75 or 80 years) and patients with major co-morbidities were excluded from some of the major ICD/CRTD trials, and few patients over age 75 were enrolled in any of the trials • It is not known, therefore, what survival benefit elderly patients derive from device-based therapy

  3. Purpose To evaluate, the outcomes of elderly patients who received device-based therapy (ICD or CRT-D) in a “real-world” scenario

  4. Methods • Israeli ICD Registry Database • Period: Jul 2010-June 2012 • Study end points • Death • Appropriate ICD therapies for VA • Readmission to hospital for HF • The combined endpoints of HF or death, VA or death • Need for device related surgical re-intervention.

  5. Baseline Characteristics

  6. Baseline Characteristics (cont’)

  7. Baseline Characteristics (cont’)

  8. Device implanted Indication P<0.001 P<0.001

  9. Outcomes • 1218 (84% male; age≤65, n=612; 66-75, n=376; >75, n=230) unselected registry patients were prospectively followed for the occurrence of clinical outcomes.

  10. Death o HF in the General Population

  11. Death or HF According to Device Type In ICD recipients In RCTD recipients

  12. Death or VA in the General Population

  13. Device-Related Complications Aassociatedwith Surgical Re-interventions

  14. Multivariate analysis: Risk of HF/Death by age category (reference group =age<65)

  15. Multivariate analysis: Risk of VA/Death by age category (reference group =age<65)

  16. Main Findings • Of new ICDs and CRTDs implanted in Israel, >50% are in patients >65 yo and >20% in patients >75 yo • Elderly patients • have higher risk profile • more likely to receive CRTD device • > secondary prevention indication

  17. Main Findings • Our data add to and support the existing evidence from previous studies that the association between advanced age and adverse clinical outcomes is attenuated in elderly patients implanted with CRT-D devices.

  18. Main Findings • Elderly patients implanted with ICDs experienced a significant increase in the cumulative probability of the combined end-points of appropriate ICD therapy or death and HF or death • In contrast, the risk of both HF and arrhythmic outcomes was attenuated among elderly patients implanted with CRT-D devices.

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