Authors: Nicoletta Riva Christian Borg Xuereb
Publish Date: 2015/07/30
Volume: 30, Issue: 12, Pages: 1852-1852
Abstract
Implantable cardioverter defibrillators ICDs have been consistently shown to reduce mortality rates in patients who survive ventricular arrhythmias or cardiac arrest secondary prevention In primary prevention of sudden cardiac death SCD the use of an ICD is recommended in selected patients with systolic heart failure ischemic or nonischemic cardiomyopathy with New York Heart Association NYHA functional class II or III and left ventricular eject fraction LVEF ≤ 35 or postischemic heart disease with NYHA class I and LVEF ≤ 30 receiving optimal medical therapy and with life expectancy of more than 1 year1Congestive heart failure is highly prevalent among older people and is the most common reason for hospitalization However this cohort of patients is underrepresented in clinical trials evaluating ICD placement as well as cardiovascular drugs2 Older patients often have several comorbidities and are at higher risk of experiencing drugrelated adverse effects periprocedural complications and noncardiac death Furthermore a recent study showed that the survival benefit associated with primaryprevention ICDs although persisting in all age categories declines with advancing age3 Hence there is a general need to increase the enrollment of the geriatric population in clinical trials and specifically to identify which older patients may benefit the most from ICDs in the primary prevention of SCDAlKhatib and colleagues developed a prioritized agenda for future research regarding ICD implantation in older patients4 Through the engagement of 18 stakeholders representing different perspectives and a forcedranking prioritization method they identified 12 areas of evidence gaps which included the safety and effectiveness of ICDs in the elderly the outcomes associated with different ICD devices different modes of death or predictors of SCD in the elderly the impact of ICDs on the quality of life patient preferences regarding ICD implantation and the shared decisionmaking process4In order to reduce the waste of resources it is crucial to clearly identify and prioritize research needs5 using qualitative and quantitative research methods to cover both the depth and breadth of these gaps The research priorities identified by AlKhatib and colleagues4 could contribute to reducing some of the concerns in SCD prevention but also to creating focused funding opportunities
Keywords: