Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT) was supported by a research grant from Guidant, Inc., St. Paul, MN, to the University of Rochester School of Medicine and Dentistry. The study sponsor, Boston Scientific, Inc., had no role in data collection, data management, statistical analysis, or manuscript preparation. The sponsor is aware of this substudy and its data.
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Improved Outcome with Preventive Cardiac Resynchronization Therapy in the Elderly: A MADIT-CRT Substudy
Article first published online: 10 AUG 2011
DOI: 10.1111/j.1540-8167.2011.02011.x
© 2011 Wiley Periodicals, Inc.
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How to Cite
PENN, J., GOLDENBERG, I., MOSS, A. J., McNITT, S., ZAREBA, W., KLEIN, H. U., CANNOM, D. S., SOLOMON, S. D., BARSHESHET, A., HUANG, D. T. and for the MADIT-CRT Trial investigators (2011), Improved Outcome with Preventive Cardiac Resynchronization Therapy in the Elderly: A MADIT-CRT Substudy. Journal of Cardiovascular Electrophysiology, 22: 892–897. doi: 10.1111/j.1540-8167.2011.02011.x
Dr. Solomon reports a research grant supported by Boston Scientific to Brigham and Women's Hospital. Dr. Huang reports participation in research grants supported by Boston Scientific, Medtronic, St. Jude Medical, and Biotronik. Other authors: No disclosures.
Publication History
- Issue published online: 10 AUG 2011
- Article first published online: 10 AUG 2011
- Received 24 September 2010; Revised manuscript received 26 December 2010; Accepted for publication 28 December 2010.
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Keywords:
- cardiac resynchronization therapy;
- cardiomyopathy;
- coronary artery disease;
- congestive heart failure;
- elderly;
- implantable cardioverter defibrillator
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)