Survival in octogenarians undergoing cardiac resynchronization therapy compared to the general population

Many patients eligible for cardiac resynchronization therapy (CRT) are over 80 years of age. Survival in this population and how it compares to the general octogenarian population has not been established.

We extracted clinical data on a cohort of 800 consecutive patients undergoing the new implantation of a CRT device between April 15, 2004 and August 6, 2007. Patients over age 80, with class III-IV New York Heart Association heart failure symptoms on optimal medical therapy undergoing initial CRT implantation, were included in the final cohort. Using the United States Social Security Period Life Table for 2006, fractional survival for octogenarians in the general population was calculated and matched to our cohort based on age and gender. A comparison was then made between octogenarians undergoing CRT compared to the general population.

A total of 95 octogenarians who met inclusion criteria were identified, of whom 86.3% received a biventricular defibrillator and the remainder a biventricular pacemaker. Over a mean follow-up of 3.6 ± 1.5 years, there were 47 deaths (47.4%). The mean survival time was 4.1 years (95% CI 3.7-4.5), and survival at 2 years was 78.9%. Compared to the general octogenarian population, octogenarians receiving CRT had only modestly worse survival over the duration of follow-up with the survival curves diverging at 2 years of follow-up (P = 0.03).

Octogenarians with advanced heart failure have a reasonable mean survival time following CRT. All-cause mortality in this patient population is only modestly worse compared to the general octogenarian population. Therefore, in octogenarians deemed to be reasonable candidates, CRT should not be withheld based on age alone.