Implantable cardiac defibrillators in octogenarians.

OBJECTIVE: Implantable cardiac defibrillators (ICD) implantation in the very elderly remains controversial. We aimed to describe the experience and outcome of patients over 80 years old implanted with an ICD in Belgium. METHODS: Data were extracted from the national QERMID-ICD registry. All implantations performed in octogenarians between February 2010 and March 2019 were analysed. Data on baseline patient characteristics, type of prevention, device configuration and all-cause mortality were available. To determine predictors of mortality, multivariable Cox proportional hazard regression modelling was performed. RESULTS: Nationwide, 704 primo ICD implantations were performed in octogenarians (median age 82, IQR 81-83 years; 83% male and 45% secondary prevention). During a mean follow-up of 3.1 ± 2.3 years, 249 (35%) patients died, of which 76 (11%) within the first year after implantation. In multivariable Cox regression analysis age (HR = 1.15, P = 0.004), oncological history (HR = 2.43, P = 0.027) and secondary prevention (HR = 2.23, P = 0.001) were independently associated with 1-year mortality. A better preserved left ventricular ejection fraction (LVEF) was associated with a better outcome (HR = 0.97, P = 0.002). Regarding overall mortality multivariable analysis withheld age, history of atrial fibrillation, centre volume and oncological history as significant predictors. Higher LVEF was again protective (HR = 0.99, P = 0.008). CONCLUSIONS: Primary ICD implantation in octogenarians is not often performed in Belgium. Among this population, 11% died within the first year after ICD implantation. Advanced age, oncological history, secondary prevention and a lower LVEF were associated with an increased one-year mortality. Age, low LVEF, atrial fibrillation, centre volume and oncological history were indicative of higher overall mortality.

Inequality between women and men in ICD implantation.

Background: The impact of sex on ICD implantation practice and survival remain a topic of controversy. To assess sex-specific differences in ICD implantation practice we compared clinical characteristics and survival in women and men. Methods: From a nationwide registry, all new ICD implantations performed between 01/02/2010 and 31/01/2019 in Belgian patients were analyzed retrospectively. Baseline characteristics and survival rates were compared between sexes. To identify predictors of mortality, multivariable Cox regression was performed. Results: Only 3096 (20.9%) of 14,787 ICD implantations were performed in women. Within each type of underlying cardiomyopathy, the proportion women were lower than men. The main indication in men was ischemic vs dilated cardiomyopathy in women. Women were overall younger (59.1 ± 15.1 vs 62.6 ± 13.1 years; p < 0.001) and had less comorbidities except for oncological disease. More women functioned in NYHA-class III (33.6% vs 27.9%; p < 0.001) and had a QRS > 150 ms (29.4% vs 24.3%; p < 0.001), consistent with a higher use of CRT-D devices (31.7% vs 25.1%; p < 0.001). Women had more complications, reflected by the need to more re-interventions within 1 year (4.3% vs 2.7%, p < 0.001). After correction for covariates, sex-category was not a significant predictor of mortality (p = 0.055). Conclusion: There is a significant sex-disparity in ICD implantation rates, not fully explained by epidemiological differences in the prevalence of cardiomyopathies, which could imply an undertreatment of women. Women differ from men in baseline characteristics at implantation suggesting a selection bias. Further research is necessary to evaluate if women receive equal sudden cardiac death prevention.

Investing in climate change adaptation and mitigation: A methodological review of real-options studies.

Uncertain future payoffs and irreversible costs characterize investment in climate change adaptation and mitigation. Under these conditions, it is relevant to analyze investment decisions in a real options framework, as this approach takes into account the economic value associated with investment time flexibility. In this paper, we provide an overview of the literature adopting a real option approach to analyze investment in climate change adaptation and mitigation, and examine how the uncertain impacts of climate change on the condition of the human environment, risk preferences, and strategic interactions among decisions-makers have been modeled. We found that the complex nature of uncertainties associated with climate change is typically only partially taken into account and that the analysis is usually limited to decisions taken by individual risk neutral profit maximizers. Our findings call for further research to fill the identified gaps.

An empirical examination of the conceptualization of companion animals.

BACKGROUND: The extensive keeping of companion animals and the substantial monetary amount we spend on these animals indicate that they are highly valued. Although the benefits humans derive from keeping cats and dogs have been extensively studied, how we conceptualize these animals has received limited attention. How people conceptualize cats and dogs is important as it influences human behavior and the well-being of humans as well as animals. The objective of this paper was to examine the conceptual meaning of dogs and cats and the relative importance of meanings assigned to these species. METHODS: Based on a Swedish on-line survey (n = 2028) the free-elicitation method was used to measure the salience of conceptualizations for dogs and cats as this method measures the accessibility of the focal object in people's memory. An R-index approach was used to analyze the importance and dominance of attributes on the premise that the order in which attributes were listed by respondents reflects their relative importance. The sum of the choice probability was used to evaluate the stochastic rank order of attributes and Somers' D was used to examine difference in rankings between groups of respondents. RESULTS: For dogs, human well-being in terms of emotional and social support, and emotional attachment (friendship, love, companionship, joy and loyalty) were found to be most important while elements related to the animals themselves (e.g. personality of the animal) were found to be less important. For cats, personality of the animal was along with love found to be most important. The results were largely consistent across different types of households. CONCLUSIONS: The results provide information on the relative importance of salient attributes and thus indicate which attributes that are important to consider, for example, when analyzing human-animal interaction, animal welfare, human health and subjective-well-being, or the economic value of cats and dogs.