The impact of age on clinical outcomes following cardiac resynchronisation therapy

  • K. Guha
  • D. Konstantinou
  • L. Mantziari
  • B. N. Modi
  • B. Chandrasekaran
  • Z. Khalique
  • T. McDonagh
  • R. Sharma



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.


Cardiac resynchronisation therapy Elderly Heart failure 



New York Heart Association


Ejection fraction


Cardiac resynchronization therapy-pacemaker/defibrillator


Left bundle branch block/non-left bundle branch block


Glomerular filtration rate


Diabetes mellitus




Atrial fibrillation


Angiotensin converting enzyme inhibitor/angiotensin receptor blocker


Beta 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.


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • K. Guha
    • 1
    • 2
  • D. Konstantinou
    • 1
  • L. Mantziari
    • 1
  • B. N. Modi
    • 1
  • B. Chandrasekaran
    • 1
    • 2
  • Z. Khalique
    • 1
  • T. McDonagh
    • 1
  • R. Sharma
    • 1
    • 2
  1. 1.Department of CardiologyRoyal Brompton HospitalLondonUK
  2. 2.National Heart & Lung InstituteImperial College LondonLondonUK

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