The impact of age on clinical outcomes following cardiac resynchronisation therapy

• Published in: Journal of interventional cardiac electrophysiology Vol. 39; no. 1; pp. 95 - 102
• Main Authors: Guha, K., Konstantinou, D., Mantziari, L., Modi, B. N., Chandrasekaran, B., Khalique, Z., McDonagh, T., Sharma, R.
• Format: Journal Article
• Language: English
• Published: Boston Springer US 2014; Springer Nature B.V
• Subjects: Adult; Age Distribution; Age Factors; Aged; Aged, 80 and over; Cardiac Resynchronization Therapy - mortality; Cardiology; Clinical outcomes; Comorbidity; Female; Heart Failure - diagnosis; Heart Failure - mortality; Heart Failure - prevention & control; Hospital Mortality; Humans; Length of Stay - statistics & numerical data; Male; Medicine; Medicine & Public Health; Middle Aged; Outcome Assessment (Health Care) - methods; Prevalence; Prognosis; Reproducibility of Results; Risk Factors; Sensitivity and Specificity; Survival Rate; Treatment Outcome; United Kingdom - epidemiology; Heart failure; Cardiac resynchronisation therapy; Elderly
• ISSN: 1383-875X; 1572-8595
• DOI: 10.1007/s10840-013-9844-0

Background
Cardiac resynchronisation therapy (CRT) is an established treatment for selected patients with symptomatic left ventricular (LV) systolic dysfunction. Heart failure (HF) is primarily a disease of the elderly; however, these patients are underrepresented in CRT trials. Our aim was to evaluate the impact of age on clinical outcomes following CRT.
Methods
A consecutive series of 177 patients was identified and divided into those aged ≤75 years (
n
 = 131, mean ± SD 62.1 ± 11.2 years) and those aged >75 years (
n
 = 46, mean ± SD 80.7 ± 4.1 years). The primary end point was a composite of all-cause mortality or HF hospitalisation.
Results
During a median ± IQR follow up of 28.5 ± 33.7 months, the event rate for the primary end point was significantly higher in the elderly compared to younger patients (20.1 vs. 11.1 %, respectively, logrank
p
 = 0.020). This was mainly driven by an excess mortality rate among those aged >75 years (10 vs. 4.7 %, respectively, logrank
p
 = 0.018) whereas HF hospitalisation rates were similar between groups (10 vs. 6.4 %, respectively, logrank
p
 = 0.301). After adjusting for comorbidities and ICD status, the difference in the composite end point rates was attenuated and no longer significant (HR 1.580, 95 % CI 0.899–2.778;
p
 = 0.112 for >75 vs. ≤75 years). Notably, both groups demonstrated similar response rates to CRT in terms of symptomatic improvement, reverse LV remodelling and neurohormonal activation.
Conclusions
CRT is equally effective in the elderly as in younger patients to reduce adverse clinical outcomes. For those who fulfil the prerequisite selection criteria, it should be considered as a valid therapeutic option.