Abstract
Background: More and more heart failure (HF) patients aged ≥ 75 years undergo cardiac resynchronization therapy (CRT) device implantation, however the data regarding the outcomes and their predictors are scant. We investigated the mid- to long-term outcomes and their predictors in CRT patients aged ≥ 75 years. Methods: Patients in the Cardiac Resynchronization Therapy Modular (CRT MORE) Registry were divided into three age-groups: <65 (group A), 65–74 (group B) and ≥75 years (group C). Mortality, hospitalization, and composite event rate were evaluated at 1 year and during long-term follow-up. Results: Patients (n = 934) were distributed as follows: group A 242; group B 347; group C 345. On 12-month follow-up examination, 63% of patients ≥ 75 years displayed a positive clinical response. Mortality was significantly higher in patients ≥ 75 years than in the other two groups, although the rate of hospitalizations for HF worsening was similar to that of patients aged 65–74 (7 vs. 9.5%, respectively; p = 0.15). Independent predictors of death and of negative clinical response were age >80 years, chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD). Over long-term follow-up (1020 days (IQR 680-1362)) mortality was higher in patients ≥ 75 years than in the other two groups. Hospitalization and composite event rates were similar in patients ≥ 75 years and those aged 65–74 (9 vs. 11.8%; p = 0.26, and 26.7 vs. 20.5%; p = 0.06). Conclusion: Positive clinical response and hospitalization rates do not differ between CRT recipients ≥ 75 years and those aged 65–74. However, age > 80 years, COPD and CKD are predictors of worse outcomes.
Highlights
Cardiac resynchronization therapy (CRT) is a validated strategy for improving cardiac pump function through biventricular pacing in heart failure (HF) patients with interventricular conduction delay and mechanical dyssynchrony [1]
Increases with aging; a survey conducted by the European Society of Cardiology (ESC) revealed that, in current European practice, about 32% of cardiac resynchronization therapy (CRT) devices are implanted in patients aged ≥ 75 years [2]
The Cardiac Resynchronization Therapy Modular (CRT MORE) Registry was a prospective, single-arm, multi-center cohort study designed to evaluate the association between baseline and implantation variables and the outcomes of patients in whom a CRT device had been implanted in accordance with current guidelines [11]
Summary
Cardiac resynchronization therapy (CRT) is a validated strategy for improving cardiac pump function through biventricular pacing in heart failure (HF) patients with interventricular conduction delay and mechanical dyssynchrony [1]. We analyzed the large database of the CRT MORE registry in order to investigate the clinical response, the mortality and the hospitalization rates in elderly CRT recipients (≥75 years). More and more heart failure (HF) patients aged ≥ 75 years undergo cardiac resynchronization therapy (CRT) device implantation, the data regarding the outcomes and their predictors are scant. Hospitalization, and composite event rate were evaluated at 1 year and during long-term follow-up. Mortality was significantly higher in patients ≥ 75 years than in the other two groups, the rate of hospitalizations for HF worsening was similar to that of patients aged 65–74 (7 vs 9.5%, respectively; p = 0.15). Over long-term follow-up (1020 days (IQR 680-1362)) mortality was higher in patients ≥ 75 years than in the other two groups.
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