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Improved Outcome with Preventive Cardiac Resynchronization Therapy in the Elderly: A MADIT‐CRT Substudy
Author(s) -
PENN JUSTIN,
GOLDENBERG ILAN,
MOSS ARTHUR J.,
McNITT SCOTT,
ZAREBA WOJCIECH,
KLEIN HELMUT U.,
CANNOM DAVID S.,
SOLOMON SCOTT D.,
BARSHESHET ALON,
HUANG DAVID T.
Publication year - 2011
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.2011.02011.x
Subject(s) - medicine , cardiac resynchronization therapy , heart failure , cardiology , adverse effect , population , ejection fraction , environmental health
Preventive Cardiac Resynchronization in the Elderly. Background: Elderly patients comprise a large portion of patients with heart failure (HF). Limited data exist on the effectiveness of cardiac resynchronization therapy with defibrillator (CRT‐D) in patients with mild HF symptoms in this population.Methods and Results: The benefit of CRT‐D compared with ICD‐only therapy in reducing HF or death was assessed by age categories (prespecified as <60 [n = 548], 60–74 [n = 941], and ≥75 [n = 331] years) among 1,820 patients in MADIT‐CRT. In patients with ICD‐only, there was a graded age‐related increase in the Kaplan–Meier cumulative probability of HF or death at 3‐year follow‐up (19%, 33%, and 36%, in patients aged <60, 60–74, and ≥75 years, respectively, P = 0.003). Multivariate analysis demonstrated that CRT‐D therapy was associated with a significant reduction in the risks of HF or death in patients aged 60–74, and ≥75 years (HR = 0.57, P = <0.001 and HR = 0.59, P = 0.017, respectively), and no significant benefit in patients aged <60 years (HR = 0.81, P = 0.3; P‐value for all treatment‐by‐age interactions >0.10). There was no significant difference in the rate of device‐related adverse events within 90 days following CRT‐D implantation among age‐subgroups (16.7%, 15.7%, and 11.7%, in patients <60, 60–74, and ≥75 years, respectively, P = 0.42) .Conclusion: CRT‐D was associated with a significant clinical benefit in older patients (≥60 years) during an average 2.4‐year follow‐up. These effects were preserved for the elderly patients ≥75 years of age but attenuated in patients <60 years. Elderly patients had no increase in device‐related adverse events compared with younger patients . (J Cardiovasc Electrophysiol, Vol. 22, pp. 892‐897, August 2011)