New post up over at TheHeart.org — Do elderly patients benefit from ICDs?

If I had to be another kind of doctor, I’d be a geriatrician. I enjoy taking care of older people. Older folks impress me because they got to be old. They survived, and more often than not, gained wisdom. I’m drawn to wisdom.

When I see an elderly patient referred to me for an arrhythmia, I worry most about making them worse. My imaginary friend says: “John, this guy made it to 80, don’t mess him up getting fancy.”

Sometimes it’s easy. The elder may be suffering with an SVT (supraventricular tachycardia), atrial flutter or heart block. Fixing those problems results in immediate improvement in quality of life. A win.

The ICD decision in the elderly is not so easy. In this case, you are considering exposing the elder to the risks of an ICD for a potential extension of life. But, by definition, an elder has already had an extension of life. The trade-offs with ICDs in this group are great: One is the risk of removing the ability to die painlessly. The second is the pain from a shock. Third, the extension of life, especially in the elderly with other conditions, may not be ideal. There are many more, but the idea is that the elderly are at higher risk of any sort of death, not just arrhythmic death. ICDs only improve lifespan in patients with a high risk of arrhythmic death and low risk of other deaths.

These factors make the decision to implant an ICD in an elderly patent a highly preference-sensitive one. The patient is the expert on what it most important to them.

This week, researchers from Ontario Canada published a new study in the journal of the American Heart Association, Circulation. The press release and headline declared that the elderly may benefit from an ICD as much as younger patients. I don’t think the data supported that.

I wrote about it over at theHeart.org. The title of the post is: Elderly patients considered for an ICD: Facing facts, mastering the obvious, and sharing the decision.

JMM

5 comments

  1. Nice post John. In a word – just because you can make an older individual live longer by implanting an ICD – doesn’t mean that implanting an ICD is the best thing for that older individual. Whether it is or is not the “best thing” for that older individual is something that the patient should have greatest voice in deciding.

  2. Sudden cardiac death in the elderly is the way to go. Everybody wants in the end to go to bed one night and not wake up the next morning. If I make it to 65 I plan to have my ICD removed.

    1. Lisa – I hope you do make it to 65 – and if you do, I bet the chances are good that you might think it really isn’t all that “elderly” … – : )

    2. If you find an emdee who will do that, please post his name and what insurance he takes so that everyone else who’s had unnecessary implants inflicted on them can do something about it.

  3. I know this is not exactly on topic, but it reminds me of a 90+ woman in my Mom’s assisted living center that was so upset that the staff would not let her have stuffing or pumpkin pie at Thanksgivng because “the doctor was worried about her cholesterol”.

    At some point you just have to be realistic . . . .

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