Should More-Typical and Older Patients Receive ICDs?

In clinical trials, patients who receive implantable cardioverter defibrillators (ICDs) for heart failure achieve a survival benefit (N Engl J Med 2005; 352:225 and N Engl J Med 2002; 346:877). However, patients who typically receive these devices are much older than those in the trials.

To determine the effectiveness of these devices in the real world, researchers conducted a retrospective cohort study involving 23,111 patients (age, ≥66) hospitalized with heart failure or other comorbidities. Of these patients, 5258 (mean age, 75.5) received an ICD, and 17,853 (mean age, 80.0) did not. The median ejection fraction in both groups was <30%.

At 1 year, 34% of the patients had died. After a sophisticated adjustment for selection bias, those who…