194 Cardiac resynchronization therapy in elderly patients

Abstract

Cardiac Resynchronization Therapy (CRT) improves morbidity and mortality in systolic heart failure. Elderly patients are under represented in large clinical trials although incidence of heart failure is high in this population. we considered 146 consecutive patients 75 years old with standard indication for CRT implanted between 2005 and 2007. Mean age was 79 yo, 72% males, EF = 27%, ischemic heart disease (IHD) 46%, Atrial Fibrillation 54%, CRT-D: 16%. Minimal follow-up was 12 months. Total mortality, clinical improvement (gain > 1 NYHA class without hospitalization for congestive heart failure) and combined criteria (mortality and clinical improvement) were retrospectively assessed. Mean follow-up is 25 +/-12 months. Data are complete for 137 patients (94.2%). Survival rate is 65%, clinical improvement is achieved in 51% and combined criteria in 45%. Independent factors of non response (p<0.10) are summarized in the table. Causes of deaths are: terminal heart failure: 35 pts, sudden cardiac death: 1 pt, non cardiac death: 13 pts and unknown: 2 pts. CRT is effective in elderly patients. Factors of non response are similar to those observed in younger population. CRT-P appears to be the most suitable device for this population. (Voir tableau ci-dessous) Multivariate analysis OR (IC 95%) Combined criteria Total Mortality Clinical improvement NYHA IV 4,1 (1.5–12.4) 3.1 (1.2–8.5) 2.5 (1–6.6) IHD 2,2 (1–4.8) 3.4 (1.5–7.9) NS CRT-D NS 3.2 (1.2–8.8) NS Atrial fibrillation 2,7 (1.3–5.8) 2.2 (1–5.1) NS No ACEI/ARB 2,7 (0.9–8.8) NS NS Renal failure (creatinine > 10μm/l) 1,1 (1–1.2) NS 1.2 (1.1–1.3) Doses of diuretics NS 1.03 (1–1.1) NS