Disclosures: T.L. Webster is on an advisory board for Boston Scientific. Dr. Cha received a research grant from St. Jude Medical and Medtronic.
Outcomes of Cardiac Resynchronization Therapy in the Elderly
Version of Record online: 18 DEC 2012
©2012, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc.
Pacing and Clinical Electrophysiology
Volume 36, Issue 6, pages 664–672, June 2013
How to Cite
KILLU, A. M., WU, J.-H., FRIEDMAN, P. A., SHEN, W.-K., WEBSTER, T. L., BROOKE, K. L., HODGE, D. O., WISTE, H. J. and CHA, Y.-M. (2013), Outcomes of Cardiac Resynchronization Therapy in the Elderly. Pacing and Clinical Electrophysiology, 36: 664–672. doi: 10.1111/pace.12048
- Issue online: 4 JUN 2013
- Version of Record online: 18 DEC 2012
- Manuscript Accepted: 22 SEP 2012
- Manuscript Revised: 21 SEP 2012
- Manuscript Received: 22 FEB 2012
- electrophysiology – clinical;
- defibrillation – ICD;
Octogenarians (>80 years) have been underrepresented in clinical trials of cardiac resynchronization therapy (CRT).
To determine the benefit of CRT with or without a defibrillator in older elderly patients.
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.
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.
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.