The impact of age on clinical outcomes following cardiac resynchronisation therapy
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Cardiac resynchronisation therapy (CRT) is an established treatment for selected patients with symptomatic left ventricular (LV) systolic dysfunction. Heart failure (HF) is primarily a disease of the elderly; however, these patients are underrepresented in CRT trials. Our aim was to evaluate the impact of age on clinical outcomes following CRT.
A consecutive series of 177 patients was identified and divided into those aged ≤75 years (n = 131, mean ± SD 62.1 ± 11.2 years) and those aged >75 years (n = 46, mean ± SD 80.7 ± 4.1 years). The primary end point was a composite of all-cause mortality or HF hospitalisation.
During a median ± IQR follow up of 28.5 ± 33.7 months, the event rate for the primary end point was significantly higher in the elderly compared to younger patients (20.1 vs. 11.1 %, respectively, logrank p = 0.020). This was mainly driven by an excess mortality rate among those aged >75 years (10 vs. 4.7 %, respectively, logrank p = 0.018) whereas HF hospitalisation rates were similar between groups (10 vs. 6.4 %, respectively, logrank p = 0.301). After adjusting for comorbidities and ICD status, the difference in the composite end point rates was attenuated and no longer significant (HR 1.580, 95 % CI 0.899–2.778; p = 0.112 for >75 vs. ≤75 years). Notably, both groups demonstrated similar response rates to CRT in terms of symptomatic improvement, reverse LV remodelling and neurohormonal activation.
CRT is equally effective in the elderly as in younger patients to reduce adverse clinical outcomes. For those who fulfil the prerequisite selection criteria, it should be considered as a valid therapeutic option.
KeywordsCardiac resynchronisation therapy Elderly Heart failure
New York Heart Association
Cardiac resynchronization therapy-pacemaker/defibrillator
Left bundle branch block/non-left bundle branch block
Glomerular filtration rate
Angiotensin converting enzyme inhibitor/angiotensin receptor blocker
Mineralocorticosteroid receptor antagonist
Conflict of interests
There is no conflict of interest between any of the authors and an institutional or commercial establishment. No funding was received for the present study.
- 1.Dickstein, K., Cohen-Solal, A., Filippatos, G., McMurray, J. J., Ponikowski, P., Poole-Wilson, P. A., et al. (2008). ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). European Journal of Heart Failure, 10, 933–989.PubMedCrossRefGoogle Scholar
- 10.Jansen, A. H., Bracke, F. A., van Dantzig, J. M., Meijer, A., van der Voort, P. H., Aarnoudse, W., et al. (2006). Correlation of echo-Doppler optimization of atrioventricular delay in cardiac resynchronization therapy with invasive hemodynamics in patients with heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. American Journal of Cardiology, 97, 552–557.PubMedCrossRefGoogle Scholar
- 16.Fonarow, G. C., Abraham, W. T., Albert, N. M., Stough, W. G., Gheorghiade, M., Greenberg, B. H., et al. (2009). Age- and gender-related differences in quality of care and outcomes of patients hospitalised with heart failure (from OPTIMIZE-HF). American Journal of Cardiology, 104, 107–115.PubMedCrossRefGoogle Scholar