74 * Impact on clinical outcomes of age at implant in cardiac resynchronization therapy: a four year retrospective study

Abstract

Purpose: Cardiac resynchronization therapy (CRT) is effective treatment for selected patients with Heart Failure (HF). However, elderly patients are under-represented in CRT trials. We examined the impact of age on CRT. Method: Retrospective study of consecutive CRT implants (Jan 2009-April 2013). Data collected on baseline demographics, co-morbidities, indications and procedure details. Comparison was made between 2 age groups (≥80yrs vs 2mths) response (defined as >1 NYHA class improvement), all-cause mortality, first hospital admission. Survival assessment and multivariate logistic regression analysis was performed. Results: 322 implants were performed (table). There were no significant differences between the groups (including NYHA class, LVEF and QRS duration) except dilated cardiomyopathy aetiology (commoner in <80 group) and bradycardia pacing indication (commoner in the ≥80). Long-term CRT response was significantly worse for ≥80yrs. There was a trend towards increased mortality and first hospital admissions in those ≥80yrs. No independent predictors of long-term response were found. Conclusion: Patients ≥80yrs have reduced long-term CRT response and increased acute HF admissions at follow up. CRT therapy should be considered carefully in this age group. | Selected Pre-implantation data + Outcome | |:----------------------------------------:| ------------------------------------------ | | | | Total (N= 322) | <80 yrs (N=246) | ≥80yrs (N=76) | P value | | Demographics: | Age±SD (years) | 71.9±10.6 | 68.2±9.3 | 83.9±3.0 | N/A | | | Men (n, %) | 244 (76) | 187 (76.0) | 57 (75.0) | 0.879 | | Aetiology | Ischaemic Cardiomyopathy (n, %) | 181(59) | 134(56.8) | 47(66.2) | 0.157 | | | Dilated Cardiomyopathy (n, %) | 107(37.8) | 91(42.1) | 16(23.9) | 0.009 | | Implant Data: | CRT-D (n, %) | 166(51.6) | 137(55.7) | 29(38.2) | 0.009 | | Outcome measures: | Acute CRT Response (%) | 61.9 | 62.0 | 61.5 | 0.958 | | | Long term CRT Response (%) | 48.2 | 52.3 | 33.3 | 0.036 | | | HF Admissions (%, median days±IQR) | 10.85 (103±52-275) | 9.8 (88±51-185) | (213±65-362) | 0.125 | | | All Cause Admissions (%, median days±IQR) | 35.7 (128±47-455) | 44.7 (139±41-465) | 31.3 (128±47-469) | 0.051 | | | All Cause Mortality (%, median months±IQR) | 21.4 (14.0± 5.0-28.0) | 19.9 (15.0±6.0-28.0) | 26.3 (11.5±5.8-28.8) | 0.108 |