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Published on: December 11, 2017
The impact of age and gender on cardiac resynchronization therapy outcome
Omeed Zardkoohi1, Veena Nandigam, Lorne Murray
1Cardiac Arrhythmia Service, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
Insights
Cardiac resynchronization therapy (CRT) outcomes are not significantly affected by patient age, gender, or heart failure cause. This study found no major differences in long-term results across these demographic and etiological groups.
Area of Science:
- Cardiology
- Heart Failure Management
- Medical Device Therapy
Background:
- Cardiac resynchronization therapy (CRT) is used for heart failure but outcomes vary.
- Factors like age, gender, and heart failure cause may influence CRT effectiveness.
- Understanding these influences is crucial for optimizing patient care.
Purpose of the Study:
- To investigate the impact of age, gender, and heart failure etiology on long-term CRT outcomes.
- To identify patient subgroups that may benefit differently from CRT.
Main Methods:
- A cohort of 117 patients with advanced heart failure receiving CRT were followed for one year.
- The primary endpoint combined heart failure hospitalization and all-cause mortality.
- Statistical analyses included Kaplan-Meier and Breslow-Wilcoxon tests, with Cox regression for covariate adjustment.
Main Results:
- No significant differences in CRT outcomes were observed based on age (>70 vs <70), gender (male vs female), or heart failure etiology (ischemic vs non-ischemic).
- A trend towards worse outcomes was noted in women with ischemic cardiomyopathy, but this did not reach statistical significance after adjustment.
- Overall, baseline characteristics were comparable across subgroups.
Conclusions:
- In this single-institution study, cardiac resynchronization therapy outcomes appear independent of age, gender, and heart failure etiology.
- Further research may be needed to explore potential subgroup variations in larger, multi-center studies.
Background:
Cardiac resynchronization therapy (CRT) outcome varies significantly among patients. We aimed to determine the impact of age, gender, and heart failure etiology on the long-term outcome of patients receiving CRT.
Methods:
A total of 117 patients with drug-refractory heart failure, New York Heart Association (NYHA) Class III or IV, and a wide QRS complex, who received CRT, were followed for one year. Long-term outcome was measured as a combined end point of hospitalization for heart failure and/or all cause mortality. Efficacy of CRT was compared between men and women, between older and younger patients, and between patients with ischemic and nonischemic heart disease. Time to the primary end point was estimated by the Kaplan-Meier method and comparisons were made using the Breslow-Wilcoxon test.
Results:
Baseline clinical characteristics were comparable between gender, age, and heart failure etiology subgroups. There was no significant difference in the combined end point between older versus younger (age >70, (n = 71), versus age < 70, (n = 46), P = 0.52); both genders (men, n = 91 vs women, n = 26, P = 0.46) and etiology of the cardiomyopathy (ischemic (n = 79) vs nonischemic (n = 38), P = 0.12). Substratification of the genders by the etiology of the cardiomyopathy, showed that women with ischemic cardiomyopathy (IW, n = 10) had a trend to a worse outcome compared to the other groups i.e., nonischemic women (NIW, n = 16), ischemic men (IM, n = 69), and nonischemic men (NIM, n = 22), P = 0.04. After adjusting for potential covariates, a Cox regression analysis showed no significant difference between the groups (P = 0.61).
Conclusions:
CRT outcome appears independent of age, gender, and heart failure etiology in this single institution study.
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