Trends in the use of implantable cardioverter-defibrillator and cardiac resynchronization therapy device in advancing age: Analysis of the Japan cardiac device treatment registry database

Hisashi Yokoshiki, Akihiko Shimizu, Takeshi Mitsuhashi, Kohei Ishibashi, Tomoyuki Kabutoya, Yasuhiro Yoshiga, Ritsuko Kohno, Haruhiko Abe, Akihiko Nogami, Members of the Implantable Cardioverter-Defibrillator (ICD) Committee of the Japanese Heart Rhythm Society, Hisashi Yokoshiki, Akihiko Shimizu, Takeshi Mitsuhashi, Kohei Ishibashi, Tomoyuki Kabutoya, Yasuhiro Yoshiga, Ritsuko Kohno, Haruhiko Abe, Akihiko Nogami, Members of the Implantable Cardioverter-Defibrillator (ICD) Committee of the Japanese Heart Rhythm Society

Abstract

Background: Trends of de novo implantation of cardiac implantable electronic devices (CIEDs) including implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy with a defibrillator (CRT-D) or pacemaker (CRT-P) in advancing age are unknown.

Methods: Analysis of data from the Japan cardiac device treatment registry (JCDTR) with an implantation date between January 2006 and December 2016 was performed focusing on advancing age of ≧75 years.

Results: The cohort included 17 564 ICD, 9470 CRT-D and 1087 CRT-P recipients for de novo implantation. The rate of patients ≧75 years of age increased from 17.1% to 20.5% in ICD implantation (P = .052), from 19.7% to 30.0% in CRT-D implantation (P < .0001), and from 40.0% to 64.0% in CRT-P implantation (P = .17). There was an apparent increase in the percentage of nonischemic patients aged ≧75 years receiving ICD (10.9% in 2006 to 16.4% in 2016, P = .0008) and CRT-D (17.1% in 2006 to 27.8% in 2016, P = .0001). The implantation for primary prevention ICD (P = .059) and CRT-D (P = .012) was also associated with a temporal increase in the percentage of patients aged ≧75 years.

Conclusions: Proportion of patients ≧75 years of age for de novo CIED implantation gradually increased from 2006 to 2016, presumably because of the growing number of nonischemic cardiomyopathy and heart failure patients requiring primary prevention of sudden cardiac death.

Keywords: advancing age; cardiac resynchronization therapy with a defibrillator (CRT‐D); cardiac resynchronization therapy with a pacemaker (CRT‐P); implantable cardioverter‐defibrillator (ICD); primary prevention.

Conflict of interest statement

The authors declare no conflict of interest related to this study.

© 2020 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of Japanese Heart Rhythm Society.

Figures

FIGURE 1
FIGURE 1
Japanese trends in de novo CIEDs implantation. The number of new implantations of ICD (gray bar)/CRT‐D (blue bar)/CRT‐P (orange bar) in each year is shown based on the data from (A) Japan Arrhythmia Device Industry Association (JADIA) and (B) Japan cardiac device treatment registry (JCDTR). Percentage of registration of the JCDTR to that of JADIA (JCDTR/JADIA ratio) is given as line graphs (B).
FIGURE 2
FIGURE 2
Proportion of different age groups in CIED implantation. Groups of patients aged P < .0001).
FIGURE 3
FIGURE 3
Age‐stratified CIEDs implant trends. Implantation trends in the patient groups, aged P < .0001). The increase was marginal in ICD implantation (P = .052) and CRT‐P implantation (P = .17).
FIGURE 4
FIGURE 4
Age‐stratified CIED implant trends in ischemic and nonischemic etiologies. Implantation trends in three patient groups, aged P = .0008) and CRT‐D (right panel in B, P = .0001) implantation. The increase was not significant in nonischemic CRT‐P implantation (right panel in C, P = .21). There was no statistical significant increase in age‐stratified implant trends for ischemic ICD, CRT‐D, and CRT‐P implantation (left panels in A, B and C).
FIGURE 5
FIGURE 5
Age‐stratified CIED implant trends in primary prevention and secondary prevention for sudden cardiac death. Implantation trends in three patient groups, aged P = .012). The increase in the percentage of patients aged ≧75 y was marginal in primary prevention ICD implantation (left panel in A, P = .059).

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