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Causes and prevention of sudden cardiac death in the elderly

Nature Reviews Cardiology volume 10, pages 135–142 (2013)Cite this article

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Abstract

Sudden cardiac death (SCD) is a major cause of mortality in elderly individuals owing to a high prevalence of coronary heart disease, systolic dysfunction, and congestive heart failure (CHF). Although the incidence of SCD increases with age, the proportion of cardiac deaths that are sudden decreases owing to high numbers of other cardiac causes of death in elderly individuals. Implantable cardioverter-defibrillator (ICD) therapy has been demonstrated to improve survival and prevent SCD in selected patients with systolic dysfunction and CHF. However, ICD therapy in elderly patients might not be effective because of a greater rate of pulseless electrical activity underlying SCD and other competing nonarrhythmic causes of death in this population. Although under-represented in randomized trials of ICD use, elderly patients comprise a substantial proportion of the population that qualifies for and receives an ICD for primary prevention under current guidelines. Cardiac resynchronization therapy (CRT), which has been demonstrated to reduce mortality in selected populations with heart failure, is also more commonly used in this group of patients than in younger individuals. In this Review, we examine the causes of SCD in elderly individuals, and discuss the existing evidence for effectiveness of ICD therapy and CRT in this growing population.

Key Points

  • The incidence of sudden cardiac death (SCD) increases with age owing to increasing prevalence of coronary heart disease and congestive heart failure among elderly individuals

  • Elderly patients are more likely to have pulseless electrical activity or asystole at the time of SCD and are less likely to survive a cardiac arrest than younger individuals

  • The mortality benefit and cost-effectiveness of primary prevention implantable cardioverter-defibrillator (ICD) therapy in elderly patients is dependent on competing mortality risks and survival following device implantation

  • Cardiac resynchronization therapy (CRT) has demonstrated mortality and quality-of-life benefits across age groups

  • A substantial and growing proportion of primary prevention ICD and CRT devices are being implanted in elderly patients, and additional outcomes data in this growing population are needed

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Figure 1: The relationship between the risk of sudden cardiac death and age.
Figure 2: The relationship between the proportion of sudden cardiac deaths and age.

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  1. Division of Preventive Medicine, Brigham & Women's Hospital, 900 Commonwealth Avenue East, Boston, 02215, MA, USA

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P. Tung researched the data and wrote the article. C. M. Albert substantially contributed to reviewing and editing of the manuscript before submission.

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C. M. Albert declares that she has received a research grant from St Jude Medical to study markers of sudden cardiac death in patients with coronary artery disease. P. Tung declares no competing interests.

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Tung, P., Albert, C. Causes and prevention of sudden cardiac death in the elderly. Nat Rev Cardiol 10, 135–142 (2013). https://doi.org/10.1038/nrcardio.2012.201

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