Goal 2: Reduce Human Disease

Cardiac Defibrillator Therapy Management in the Elderly

Older patients have been largely under represented in the landmark clinical trials that have established the beneficial effects of ICD therapy on survival. With older age, comorbidities increase leading to a higher incidence of non-cardiac mortality. This is supported by very well documented decrease in the incidence of appropriate defibrillator shocks.

Based on the above, it is important to know whether defibrillator therapy is beneficial in patients above the age of 75 or 80 years. Similarly, it is important to examine if CRT-P is non-inferior to CRT-D therapy in older patients.

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Compelling Question (CQ)

Details on the impact of addressing this CQ or CC

Given the increase in the proportion of older patients in the US, addressing these important questions regarding the value of defibrillator therapy in this stratum of the population is critical to:

  1. Avoid unnecessary surgeries with its complications (short term and long term)
  2. Reduce the cost of health care, primarily in a Medicare population
Feasibility and challenges of addressing this CQ or CC

A large multi-center non-inferiority trial of CRT-P vs. CRT-D ( and at alater stage of ICD vs. No ICD) in the elderly is needed to answer these questions. These trials are feasible but require comittment and resources.

Name of idea submitter and other team members who worked on this idea Samir Saba

Tags (Keywords associated with the idea)



4 net votes
16 up votes
12 down votes
Idea No. 405