Longitudinal Outcomes of Subcutaneous or Transvenous Implantable Cardioverter-Defibrillators in Older Patients

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dc.contributor.authorFriedman, D.J.
dc.contributor.authorQin, L.
dc.contributor.authorParzynski, C.
dc.contributor.authorHeist, E.K.
dc.contributor.authorRusso, A.M.
dc.contributor.authorRanasinghe, I.
dc.contributor.authorZeitler, E.P.
dc.contributor.authorMinges, K.E.
dc.contributor.authorAkar, J.G.
dc.contributor.authorFreeman, J.V.
dc.contributor.authorCurtis, J.P.
dc.contributor.authorAl-Khatib, S.M.
dc.date.issued2022
dc.description.abstractBACKGROUND The subcutaneous (S-) implantable cardioverter-defibrillator (ICD) is an alternative to the transvenous (TV-) ICD that is increasingly implanted in younger patients; data on the safety and effectiveness of the S-ICD in older patients are lacking. OBJECTIVES The purpose of this study was to compare outcomes among older patients who received an S- or TV-ICD. METHODS The authors compared S-ICD and single-chamber TV-ICD implants in Fee-For-Service Medicare beneficiaries using the National Cardiovascular Data Registry ICD Registry. Outcomes were ascertained from Medicare claims data. Cox regression or competing-risk models (with TV-ICD as reference) with overlap weights were used to compare death and nonfatal outcomes (device reoperation, device removal for infection, device reoperation without infection, and cardio- vascular admission), respectively. Recurrent all-cause readmissions were compared using Anderson-Gill models. RESULTS A total of 16,063 patients were studied (age 72.6 ± 5.9 years, 28.4% women, ejection fraction 28.3 8.9%). Compared with TV-ICD patients (n ¼ 15,072), S-ICD patients (n ¼ 991, 6.2% overall) were more often Black, younger, and dialysis dependent and less likely to have history of atrial fibrillation or flutter. In adjusted analyses, there were no differences between device type and risk of all-cause mortality (HR: 1.020; 95% CI: 0.819-1.270), device reoperation (subdistribution [s] HR: 0.976; 95% CI: 0.645-1.479), device removal for infection (sHR: 0.614; 95% CI: 0.138-2.736), device reoperation without infection (sHR: 0.975; 95% CI: 0.632-1.506), cardiovascular readmission (sHR: 1.087; 95% CI: 0.912-1.295), or recurrent all-cause readmission (HR: 1.072; 95% CI: 0.990-1.161). CONCLUSIONS In a large representative national cohort of older patients undergoing ICD implantation, risk of death, device reoperation, device removal for infection, device reoperation without infection, and cardiovascular and all-cause readmission were similar among S- and TV-ICD recipients.
dc.description.statementofresponsibilityDaniel J. Friedman, MD, Li Qin, PHD, Craig Parzynski, MS E. Kevin Heist, MD, Andrea M. Russo, MD, Isuru Ranasinghe, MBCHB, MMED, PHD, Emily P. Zeitler, MD, MHS, Karl E. Minges, PHD, MPH, Joseph G. Akar, MD, PHD, James V. Freeman, MD, MPH, MS, Jeptha P. Curtis, MD, Sana M. Al-Khatib, MD, MHS.
dc.identifier.citationJournal of the American College of Cardiology, 2022; 79(11):1050-1059
dc.identifier.doi10.1016/j.jacc.2021.12.033
dc.identifier.issn0735-1097
dc.identifier.issn1558-3597
dc.identifier.urihttps://hdl.handle.net/2440/135075
dc.language.isoen
dc.publisherELSEVIER SCIENCE INC
dc.rightsCopyright status unknown
dc.source.urihttps://doi.org/10.1016/j.jacc.2021.12.033
dc.subjectHumans
dc.subjectDeath, Sudden, Cardiac
dc.subjectTreatment Outcome
dc.subjectRetrospective Studies
dc.subjectDefibrillators, Implantable
dc.subjectAged
dc.subjectMedicare
dc.subjectUnited States
dc.subjectFemale
dc.subjectMale
dc.subjectArrhythmias, Cardiac
dc.subject.meshHumans
dc.subject.meshDeath, Sudden, Cardiac
dc.subject.meshTreatment Outcome
dc.subject.meshRetrospective Studies
dc.subject.meshDefibrillators, Implantable
dc.subject.meshAged
dc.subject.meshMedicare
dc.subject.meshUnited States
dc.subject.meshFemale
dc.subject.meshMale
dc.subject.meshArrhythmias, Cardiac
dc.titleLongitudinal Outcomes of Subcutaneous or Transvenous Implantable Cardioverter-Defibrillators in Older Patients
dc.typeJournal article
pubs.publication-statusPublished

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