Is subcutaneous better than transvenous ICD in older patients?

Older patients undergoing subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation have a comparable risk of death, device reoperation, device removal for infection, device reoperation without infection, and cardiovascular and all-cause readmission with those receiving transvenous ICD (TV-ICD), a study has shown.

Using the National Cardiovascular Data Registry ICD Registry, a team of investigators compared S-ICD and single-chamber TV-ICD implants in Fee-For-Service Medicare beneficiaries and verified outcomes from Medicare claims data.

Death and nonfatal outcomes (ie, device reoperation, device removal for infection, device reoperation without infection, and cardiovascular admission) were compared using Cox regression or competing-risk models (with TV-ICD as reference) with overlap weights. The investigators also compared recurrent all-cause readmissions using Anderson-Gill models.

A total of 16,603 patients (mean age 72.6 years, 28.4 percent women, ejection fraction 28.3 percent) were included in the analysis. S-ICD patients (n=991, 6.2 percent), compared with TV-ICD counterparts (n=15,072), were more often Black, younger, and dialysis dependent and less likely to have a history of atrial fibrillation or flutter.

Adjusted analyses revealed no differences between device type and risk of all-cause mortality (hazard ratio [HR], 1.020, 95 percent confidence interval [CI], 0.819‒1.270), device reoperation (subdistribution [s]HR, 0.976, 95 percent CI, 0.645‒1.479), device removal for infection (sHR, 0.614, 95 percent CI, 0.138‒2.736), device reoperation without infection (sHR, 0.975, 95 percent CI, 0.632‒1.506), cardiovascular readmission (sHR, 1.087, 95 percent CI, 0.912‒1.295), or recurrent all-cause readmission (HR, 1.072, 95 percent CI, 0.990‒1.161).

“The S-ICD is an alternative to the TV-ICD that is increasingly implanted in younger patients,” the authors said.