Comparison of the Usefulness of Cardiac Resynchronization Therapy in Three Age-Groups (<65, 65-74 and ≥75 Years) (from the InSync/InSync ICD Italian Registry)

Abstract

Chronic heart failure is one of the most important geriatric syndromes, associated with disability, increased hospital admissions, and high mortality. The aim of this study was to evaluate the existence of age-related differences in clinical effectiveness and outcomes of cardiac resynchronization therapy (CRT), alone or in combination with an implantable cardioverter-defibrillator (CRT-D), in a large, real-world registry. A total of 1,787 patients admitted for CRT or CRT-D to the 117 centers participating in the InSync/InSync ICD Italian Registry from 1999 to 2005 were evaluated. Patients were divided into 3 age groups: <65 years (n ‫؍‬ 571), 65 to 74 years (n ‫؍‬ 740), and >75 years (n ‫؍‬ 476). The left ventricular ejection fraction did not differ in the 3 groups (26 ؎ 8% vs 26 ؎ 7% vs 27 ؎ 8%, p ‫؍‬ 0.123). Atrial fibrillation prevalence demonstrated an age-related increase. The use of recommended medical therapy for chronic heart failure decreased with age, as well as CRT-D implantation (p <0.001). The percentage of echocardiographic responders to CRT was similar in the 3 groups, and New York Heart Association class significantly improved independent of age. During the follow-up period (19 ؎ 13 months), all-cause mortality was higher in patients aged >75 years than in those aged <65 years (p ‫؍‬ 0.005). In the whole population, mortality was associated with the nonresponder condition, the presence of atrial fibrillation and the lack of prescription of recommended medical therapy. In conclusion, CRT improved left ventricular performance and functional capacity independent of age. The proportion of the responder condition to CRT was the same in all groups. Pharmacologic undertreatment is an important issue in a "real-world" geriatric population.

Left Ventricular Reverse Remodeling, Device-Related Adverse Events, and Long-Term Outcome After Cardiac Resynchronization Therapy in the Elderly

“…25 Similarly, the subanalysis of the InSync/InSync ICD Italian Registry demonstrated significant reductions in LV volumes at 6-and 12-month follow-up independent of age. 12 In line with these observations, subanalysis of the Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT) comparing the magnitude of LVESV change at 12-month follow-up among patients <60, 60 to 74, and ≥75 years reported no significant differences between age groups. 13 The present results provide more evidence on the beneficial effects of CRT on LV structure and function and would support the appropriateness of implanting CRT in old patients with heart failure.…”

“…An age-related increase in noncardiac mortality was also reported in the InSync ICD Italian Registry. 12 In addition, we evaluated 2 important end points for the elderly population. First, our study showed an equal proportional incidence of heart failure hospitalizations combined with all-cause mortality between the age groups, suggesting a comparable effect of CRT on clinical symptoms and quality of life.…”

“…[11][12][13] Patient data were prospectively collected in the departmental Cardiology Information System (EPD-Vision; Leiden University Medical Center, Leiden, The Netherlands) and were subsequently analyzed. For this retrospective analysis of clinically acquired data, the institutional review board waived the need of patient written informed consent.…”

“…Data from the InSync registry, MADIT-CRT, MIRACLE, and MIRACLE-ICD trial subanalyses demonstrated that the incidence of device-related adverse events was not influenced by age. 12,13,25 However, a recent study including 26 887 recipients of ICD or CRT devices has shown a significant higher frequency of acute device-related adverse event among elderly patients, women, and black race/ethnicity. 26 Similar to the results of the InSync, MADIT-CRT, MIR-ACLE, and MIRACLE-ICD studies, the present evaluation showed that the rates of early adverse events were not different between young and elderly patients.…”

Systolic heart failure in the elderly: optimizing medical management

“…Elderly patients respond just as well as younger patients do with CRT. A recently published article examining an Italian ICD registry divided patients into 3 age-groups (age\65, 65-75 and[75 years) and found no differences between the groups in terms of responding to CRT [77]. There was, however, an increase in all-cause mortality in the [75 group.…”