Improved outcome with preventive cardiac resynchronization therapy in the elderly: a MADIT-CRT substudy

Area of Science:

• Cardiology
• Electrophysiology
• Geriatric Medicine

Background:

• Heart failure (HF) disproportionately affects the elderly.
• Limited data exist on cardiac resynchronization therapy with defibrillator (CRT-D) efficacy in elderly patients with mild HF symptoms.

Purpose of the Study:

• To evaluate the effectiveness of CRT-D versus ICD-only therapy in reducing HF or death across different age groups.
• To assess age-related differences in CRT-D benefits and device-related adverse events.

Main Methods:

• Analysis of 1,820 patients from the MADIT-CRT trial, stratified by age (<60, 60-74, ≥75 years).
• Comparison of Kaplan-Meier cumulative probability of HF or death at 3-year follow-up.
• Multivariate analysis to determine the association of CRT-D with HF or death risk and device-related adverse events.

Main Results:

• A graded age-related increase in HF or death probability was observed with ICD-only therapy.
• CRT-D significantly reduced HF or death risk in patients aged 60-74 and ≥75 years (HR=0.57, P<0.001; HR=0.59, P=0.017, respectively).
• No significant CRT-D benefit was found in patients <60 years (HR=0.81, P=0.3), with no significant increase in device-related adverse events across age groups.

Conclusions:

• CRT-D provides significant clinical benefit in older heart failure patients (≥60 years), including the very elderly (≥75 years).
• The benefits of CRT-D were attenuated in younger patients (<60 years).
• Elderly patients did not experience an increased rate of device-related adverse events compared to younger counterparts.