Related Experiment Video

Updated: May 12, 2026

Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
06:10

Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock

Published on: June 12, 2021

[Use of devices in elderly patients with chronic heart failure]

Stefano Fumagalli, Debbie Gabbai, Samuele Baldasseroni

    Giornale Italiano Di Cardiologia (2006)
    |April 25, 2013
    PubMed

    Insights

    Cardiac resynchronization therapy (CRT) and implantable cardioverter-defibrillators (ICD) improve survival in elderly patients with chronic heart failure (CHF). More research is needed to confirm benefits and guide age-specific recommendations.

    Area of Science:

    • Cardiology
    • Geriatrics
    • Medical Devices

    Background:

    • Chronic heart failure (CHF) significantly impacts elderly patients, with persistently high mortality despite medical advancements.
    • Cardiac resynchronization therapy (CRT) and implantable cardioverter-defibrillators (ICD) have improved survival rates in CHF patients.
    • Evidence on the effectiveness of CRT and ICD specifically in the elderly population remains limited, primarily from observational studies.

    Purpose of the Study:

    • To evaluate the effectiveness and safety of CRT and ICD in elderly patients with CHF.
    • To identify potential age-related differences in response to CRT and ICD therapy.
    • To highlight the need for controlled clinical trials addressing quality of life, disability, and cognitive function in elderly CHF patients receiving these devices.

    Main Methods:

    • Analysis of data from observational studies, including the InSync/InSync ICD study (1787 patients) and the Italian Clinical Service Project (6311 patients).
    • Examination of responder rates and procedural complication rates for CRT.
    • Assessment of excess mortality causes in older subjects receiving ICD therapy.

    Main Results:

    • The InSync/InSync ICD study indicated no significant age-related differences in CRT responder rates (approx. 60%) or procedural complications (11%).
    • In the Italian Clinical Service Project, comorbid conditions accounted for 22.6% of excess mortality in older subjects receiving ICDs.
    • Existing data suggest CRT and ICD are generally safe and effective across age groups, but specific benefits in the elderly require further investigation.

    Conclusions:

    • CRT and ICD offer survival benefits for elderly CHF patients, with comparable response and complication rates to younger populations.
    • Comorbidities significantly contribute to mortality risk in older CHF patients treated with ICDs.
    • Further controlled clinical trials are essential to fully understand the impact of CRT and ICD on quality of life, disability, and cognitive function in the elderly, informing age-oriented guidelines.

    Related Concept Videos

    Heart Failure VI: Adjunct Therapies01:22

    Heart Failure VI: Adjunct Therapies

    Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
    Heart Failure V: Medical Management01:30

    Heart Failure V: Medical Management

    Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
    Heart Failure VII: Nursing Interventions01:30

    Heart Failure VII: Nursing Interventions

    The first step in nursing management of a patient with heart failure involves thoroughly assessing the patient's medical history.Subjective Data: Obtain the patient's medical history of coronary artery disease, hypertension, myocardial infarction, and symptoms like dyspnea, orthopnea, and paroxysmal nocturnal dyspnea.Objective Data: Conduct a physical examination to identify findings such as jugular vein distention, pulmonary crackles, tachycardia, murmurs, peripheral edema, and vital signs,...
    Heart Failure Drugs: Inotropic Agents01:26

    Heart Failure Drugs: Inotropic Agents

    Positive inotropic agents are commonly used as the first line of treatment for heart failure. One such agent is digoxin, derived from the genus Digitalis, which has been known for centuries but effectively utilized since 1785. However, these cardiac glycosides can have potentially toxic effects due to their mechanism of action, which involves inhibiting Na+/K+-ATPase and increasing contractility. Digoxin is absorbed orally and distributed in various tissues, including the CNS. It has a long...
    Heart Failure III: Clinical Manifestations01:26

    Heart Failure III: Clinical Manifestations

    Heart failure (HF) manifests primarily as dyspnea, fatigue, and fluid retention, resulting in peripheral and pulmonary edema. Symptoms may vary depending on which ventricle is more affected, left or right.Left-Sided Heart FailureAlso known as left ventricular failure, this condition results from the left ventricle's inability to fill or eject sufficient blood into the systemic circulation. It leads to pulmonary congestion, which occurs when the left ventricle fails to eject blood effectively...
    Heart Failure Drugs: β-Blockers01:22

    Heart Failure Drugs: β-Blockers

    β-adrenergic antagonists, commonly known as β-blockers, block the effects of sympathetic neurotransmitters such as noradrenaline (NA) and adrenaline (ADR). They have several beneficial effects in heart failure treatment. They reduce heart rate, the force of contraction, and cardiac muscle relaxation. They also slow the atrial-ventricular conduction rate and raise the threshold for arrhythmias. The concentration of β-blockers determines their effects on bronchodilation, vasodilation, and...