Outcomes of Cardiac Resynchronization Therapy in the Elderly. Issue 6 (18th December 2012)

• Record Type: Journal Article
• Authors: KILLU, AMMAR M.; WU, JIA‐HUI; FRIEDMAN, PAUL A.; SHEN, WIN‐KUANG; WEBSTER, TRACY L.; BROOKE, KELLY L.; HODGE, DAVID O.; WISTE, HEATHER J.; CHA, YONG‐MEI
• Is Part Of: Pacing and clinical electrophysiology. Volume 36:Issue 6(2013)
• Page Start: 664
• Page End: 672
• Publication Date: 2012-12-18
• Subjects: Cardiac pacing -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1111/pace.12048
• Languages: English
• ISSNs: 0147-8389

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="pace12048-sec-0010" sec-type="section"> <title>Background</title> <p>Octogenarians (>80 years) have been underrepresented in clinical trials of cardiac resynchronization therapy (CRT).</p> </sec> <sec id="pace12048-sec-0020" sec-type="section"> <title>Objective</title> <p>To determine the benefit of CRT with or without a defibrillator in older elderly patients.</p> </sec> <sec id="pace12048-sec-0030" sec-type="section"> <title>Methods</title> <p>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.</p> </sec> <sec id="pace12048-sec-0040" sec-type="section"> <title>Results</title> <p>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.</p> </sec> <sec id="pace12048-sec-0050" sec-type="section"> <title>Conclusion</title> <p>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.</p> </sec> </abstract>