Complications and 1-year benefit of cardiac resynchronization therapy in patients over 75 years of age — Insights from the German Device Registry. (1st February 2017)

• Record Type: Journal Article
• Authors: Köbe, Julia; Andresen, Dietrich; Maier, Sebastian; Stellbrink, Christoph; Kleemann, Thomas; Gonska, Bernd-Dieter; Reif, Sebastian; Hochadel, Matthias; Senges, Jochen; Eckardt, Lars
• Is Part Of: International journal of cardiology. Volume 228(2017)
• Page Start: 784
• Page End: 789
• Publication Date: 2017-02-01
• Subjects: Cardiac resynchronization therapy -- Registry -- Mortality -- Complications -- Age; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2016.11.212
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Objective: Evidence on cardiac resynchronization therapy (CRT) in older patients is scarce and conflicting. Nevertheless, CRT in the elderly is of major practical relevance as heart failure prevalence increases with age. Methods: The German Device Registry (DEVICE) is a nationwide, prospective registry with a longitudinal follow-up design investigating device implantations in 60 German centres. The present analysis of DEVICE focussed on perioperative complication rates and 1-year outcome of patients ≥ 75 years ( n = 320) compared to younger patients ( n = 879) receiving a CRT device. Results: Comorbidities were more common in older patients (chronic kidney disease (CKD): 27.5% vs. 21.5%, p = 0.029; atrial fibrillation (AF): 26.9% vs. 15.6%, p < 0.001). Despite higher NYHA classes in the older age group, ejection fractions were comparable (27.2 ± 7.1% ≥ 75 years, 26.2 ± 7.1% < 75 years, p = 0.06). Perioperative complications and mortality rates did not show significant difference between groups. After new device implantation, absolute 1-year mortality was higher in older patients (11.0% ≥ 75 years, 6.4% < 75 years, p = 0.014), with a significantly lower proportion of cardiac deaths in the older group ( p = 0.05). Patients ≥ 75 years being alive after 1 year had lower response rates, with chronic kidney disease (OR 0.46, p < 0.05) and smaller QRS complexes (OR 0.31, p < 0.01) being particular risk factors for missing improvement of heart failure symptoms. As expected severe heart failure (NYHA IV) was a strong independent predictor of death (HR 1.95, p = 0.01), whereas AF as underlying rhythm could be worked out as predictor for mortality especially in the younger patients (HR 2.31, p = 0.002). Conclusions: Patients ≥ 75 years of age receiving a CRT device do not have a higher perioperative mortality and complication rate although comorbidities (CKD and AF) occur more frequently. The absolute 1-year mortality is higher; nevertheless, the proportion of cardiac deaths is even lower in the older patients reflecting a benefit of CRT in this group.