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Outcomes of Cardiac Resynchronization Therapy in the Elderly
Author(s) -
KILLU AMMAR M.,
WU JIAHUI,
FRIEDMAN PAUL A.,
SHEN WINKUANG,
WEBSTER TRACY L.,
BROOKE KELLY L.,
HODGE DAVID O.,
WISTE HEATHER J.,
CHA YONGMEI
Publication year - 2013
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.12048
Subject(s) - medicine , cardiac resynchronization therapy , hazard ratio , ejection fraction , cardiology , heart failure , mitral regurgitation , confidence interval
Background Octogenarians (>80 years) have been underrepresented in clinical trials of cardiac resynchronization therapy (CRT). Objective To determine the benefit of CRT with or without a defibrillator in older elderly patients. Methods We retrospectively studied consecutive patients who received CRT at our institution from 2002 through 2008. New York Heart Association (NYHA) class and echocardiographic parameters were assessed before and after CRT. Thirty‐day complications after device implant were collected. Survival data were obtained from the national death and location database. Data were compared between those 80 years and younger and those older than 80 years. Results Of 728 patients identified, 90 (12.4%) were older than 80 years. After CRT, older and younger patients had similar improvements in NHYA class (P = 0.41), ejection fraction (P = 0.48), and mitral valve regurgitation (MR) severity (P = 0.42). In the older patients, defibrillator implantation was associated with comparable improvement in NYHA class, ejection fraction, and MR grade severity (P > 0.05), as in those without a defibrillator. Overall survival was worse in octogenarians than in the younger patients by Kaplan‐Meier estimates (P = 0.001). Multivariate analysis showed similar survival between the younger and older subjects (hazard ratio, 1.23; 95% confidence interval, 0.83–1.84; P = 0.31). The observed complication rate in all study subjects was 12.2%, with no difference between the two age groups. Conclusion Octogenarian patients who received CRT with or without a defibrillator for advanced heart failure had similar clinical benefits as younger patients. CRT should not be withheld from octogenarians meeting current selection guidelines.