Response to cardiac resynchronization therapy in elderly patients (≥70 years) and octogenarians

Abstract

AimsCardiac resynchronization therapy (CRT) leads to reverse ventricular remodelling, improved functional capacity, and better clinical outcome in patients with advanced chronic heart failure, reduced ejection fraction, and evidence of ventricular conduction delay, who are under optimal medical therapy. This study investigated whether these benefits can be extrapolated to older patients, typically not included in randomized clinical trials. Methods and resultsConsecutive patients who received a CRT device between October 2008 and June 2011, including optimization afterwards in a dedicated clinic, were stratified into 3 pre-specified groups, according to age: ,70 years (n ¼ 76); 70 -79 years (n ¼ 95); and ≥80 years (n ¼ 49). Left ventricular remodelling, functional capacity, heart failure hospitalization, and mortality data were assessed during follow-up. Reverse left ventricular remodelling and improvement in New York Heart Association functional class were similar in all groups at 6 months after implantation. During mean follow-up of 20 months, 32 patients died and 66 were admitted for heart failure. Annualized mortality rates were significantly higher in elderly patients (6% vs. 8% vs. 15% in all groups, respectively; P , 0.001), but time to death or first heart failure admission was similar among age groups (P ¼ 0.531). Progressive pump failure was the major cause of death (50%), with co-morbidity-related deaths also being frequent (41%). ConclusionReverse left ventricular remodelling and functional capacity improvement after CRT are sustained at advanced age. Moreover, time to all-cause mortality or heart failure admission was similar, irrespective of age, in a context of maximized optimization including optimal medical therapy.--

Cause-of-death analysis in patients with cardiac resynchronization therapy with or without a defibrillator: a systematic review and proportional meta-analysis

“…Two-hundred and thirtyseven were retrieved for analysis of titles and abstracts and 49 of these were selected for further analysis of the full-length article. Eighteen were considered eligible for inclusion 3,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] .…”

Heart Failure in Non-Caucasians, Women, and Older Adults: A White Paper on Special Populations From the Heart Failure Society of America Guideline Committee

“…46 In addition, although very few older adult patients were enrolled in the major trials evaluating CRT, several small observational studies have demonstrated that appropriately selected octogenarians experience reduced symptoms, reverse ventricular remodeling, and improved exercise tolerance and quality of life following CRT implantation. 201 Therefore, based on currently available evidence, CRT is a reasonable option in selected patients with persistent HF symptoms despite medical therapy who meet criteria for implantation.…”

Does Age Influence Cardiac Resynchronization Therapy Use and Outcome?

“…Nonrandomized studies have found similar reversals of left ventricular remodeling for old and young patients after CRT placement (11)(12)(13)(14).…”