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The impact of age on clinical outcomes following cardiac resynchronisation therapy

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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Abbreviations

NYHA:

New York Heart Association

EF:

Ejection fraction

CRT-P/D:

Cardiac resynchronization therapy-pacemaker/defibrillator

LBBB/non-LBBB:

Left bundle branch block/non-left bundle branch block

GFR:

Glomerular filtration rate

DM:

Diabetes mellitus

HTN:

Hypertension

AF:

Atrial fibrillation

ACEi/ARB:

Angiotensin converting enzyme inhibitor/angiotensin receptor blocker

BB:

Beta blocker

MRA:

Mineralocorticosteroid receptor antagonist

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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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Authors and Affiliations

  1. Department of Cardiology, Royal Brompton Hospital, Sydney Street, SW3 6NP, London, UK

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

  2. National Heart & Lung Institute, Imperial College London, Dovehouse Street, SW3 6LY, London, UK

    K. Guha, B. Chandrasekaran & R. Sharma

Authors
  1. K. Guha
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  2. D. Konstantinou
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  3. L. Mantziari
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  4. B. N. Modi
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  5. B. Chandrasekaran
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  6. Z. Khalique
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  7. T. McDonagh
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  8. R. Sharma
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Correspondence to D. Konstantinou.

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Guha, K., Konstantinou, D., Mantziari, L. et al. The impact of age on clinical outcomes following cardiac resynchronisation therapy. J Interv Card Electrophysiol 39, 95–102 (2014). https://doi.org/10.1007/s10840-013-9844-0

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  • DOI: https://doi.org/10.1007/s10840-013-9844-0

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