Does Age Influence Cardiac Resynchronization Therapy Use and Outcome?
Paul A Heidenreich1, Vivian Tsai2, Haikun Bao3
1Veterans Administration Palo Alto Healthcare System, Palo Alto, California.
Insights
Older patients receiving cardiac resynchronization therapy with defibrillator (CRT-D) showed improved survival rates compared to those with an implantable cardioverter-defibrillator (ICD) alone. This benefit was consistent across all age groups, highlighting CRT-D
Area of Science:
- Cardiology
- Medical Devices
- Geriatric Medicine
Background:
- Many patients receiving cardiac resynchronization therapy with defibrillator (CRT-D) are older than those in clinical trials.
- Real-world CRT-D patient populations differ from trial populations, necessitating studies on older adults.
Purpose of the Study:
- To describe the utilization of CRT-D in older patients.
- To evaluate the association between CRT-D implantation and survival outcomes in elderly individuals.
Main Methods:
- Utilized the National Cardiovascular Disease Registry (NCDR) ICD registry (2006-2009).
- Identified patients meeting clinical trial criteria for CRT (LVEF ≤35%, QRS ≥120 ms, NYHA class III-IV).
- Linked NCDR data with the Social Security Death Index to determine all-cause mortality.
Main Results:
- CRT-D receipt was associated with significantly better 1-year (82.1% vs. 77.1%) and 4-year (54.0% vs. 46.2%) survival compared to ICD alone (p < 0.001).
- The survival benefit of CRT-D was consistent across different age groups (p=0.86 for interaction).
- Over 80% of eligible older patients received CRT-D, with 6.4% aged 85+.
Conclusions:
- CRT-D is widely used in older patients meeting trial criteria for implantation.
- Older patients undergoing ICD implantation have high mortality, but CRT-D is associated with lower mortality.
- The survival advantage of CRT-D in older populations supports its use in this demographic.
Objectives:
This study sought to describe the use of CRT-D and its association with survival for older patients.
Background:
Many patients who receive cardiac resynchronization therapy with defibrillator (CRT-D) in practice are older than those included in clinical trials.
Methods:
We identified patients undergoing ICD implantation in the National Cardiovascular Disease Registry (NCDR) ICD registry from 2006 to 2009, who also met clinical trial criteria for CRT, including left ventricular ejection fraction (LVEF) ≤35%, QRS ≥120 ms, and New York Heart Association (NYHA) functional class III or IV. NCDR registry data were linked to the social security death index to determine the primary outcome of time to death from any cause. We identified 70,854 patients from 1,187 facilities who met prior trial criteria for CRT-D. The mean age of the 58,147 patients receiving CRT-D was 69.4 years with 6.4% of patients age 85 or older. CRT use was 80% or higher among candidates in all age groups. Follow-up was available for 42,285 patients age ≥65 years at 12 months.
Results:
Receipt of CRT-D was associated with better survival at 1 year (82.1% vs. 77.1%, respectively) and 4 years (54.0% vs. 46.2% , respectively) than in those receiving only an ICD (p < 0.001). The CRT association with improved survival was not different for different age groups (p = 0.86 for interaction).
Conclusions:
More than 80% of older patients undergoing ICD implantation who were candidates for a CRT-D received the combined device. Mortality in older patients undergoing ICD implantation was high but was lower for those receiving CRT-D.
Related Concept Videos
01:29Cardiomyopathy V: Interprofessional Care
01:30Cardiomyopathy II: Dilated Cardiomyopathy
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:23Cardiopulmonary Resuscitation III: AED Use
01:22Heart Failure VI: Adjunct Therapies
01:26Heart Failure Drugs: Inotropic Agents