Clinical outcomes and mortality in old and very old patients undergoing cardiac resynchronization therapy
Luiz Eduardo Montenegro Camanho1,2, Eduardo Benchimol Saad2, Charles Slater2
1Serviço e Disciplina de Cardiologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil.
Insights
Cardiac resynchronization therapy (CRT) is effective in elderly heart failure patients. While advanced age did not impact clinical response or cardiovascular mortality, very old patients showed increased total mortality.
Area of Science:
- Cardiology
- Geriatrics
- Heart Failure Management
Background:
- Cardiac resynchronization therapy (CRT) is a key treatment for heart failure (HF).
- Guidelines have historically underrepresented the elderly population in CRT studies.
- Understanding CRT's impact on older adults is crucial for equitable care.
Purpose of the Study:
- To evaluate the effect of advanced age on CRT outcomes in heart failure patients.
- To assess clinical response, cardiovascular mortality, and total mortality in different age groups undergoing CRT.
- To determine the safety of CRT in the elderly by analyzing acute complication rates.
Main Methods:
- A study of 249 heart failure patients undergoing CRT, categorized into three age groups: <65, 65-75, and ≥75 years.
- Responsiveness defined by improvement in functional class, ejection fraction, or left ventricular end-systolic diameter.
- Comparison of clinical response, mortality rates, and acute complications across age groups.
Main Results:
- Clinical response and cardiovascular mortality were similar across all age groups.
- Patients aged ≥75 years experienced a significant increase in total mortality.
- The rate of acute complications following CRT was comparable among the age groups.
Conclusions:
- Advanced age does not negatively affect CRT response or cardiovascular survival and should not be an exclusion criterion.
- CRT is a safe procedure for elderly heart failure patients, evidenced by low acute complication rates.
- While CRT is safe and effective, increased total mortality in the very old warrants further investigation.
Aim:
Cardiac resynchronization therapy (CRT) is a valid therapeutic option for patients with heart failure (HF). However, the elderly population was not well represented in the guidelines. The primary end point was to evaluate the impact of advanced age on clinical response and cardiovascular and total mortality of patients undergoing CRT. The secondary end point was to assess the rate of acute complications related to the procedure.
Methods And Results:
A total of 249 consecutive patients with HF and optimized treatment, QRS ≥ 120 ms, ejection fraction (EF) ≤ 35% and functional class (FC) III/ IV (NYHA) underwent CRT and divided into 3 groups: Group I-< 65 years-88/ 249 (35%); Group II- 65 to 75 years (old)- 72/ 249 (29%); Group III-≥ 75 years (very old)- 89/ 249 (36%). The improvement in FC and increase in EF (>10%) and/ or decrease in the left ventricular end systolic diameter (LVESD) >15% were the criteria of responsiveness. The favorable clinical response (p = ns) and cardiovascular mortality (p = 0.737) was similar in the 3 groups. In the group of very old patients, a significant increase in total mortality was observed (p = 0.03). The rate of acute complications related to the procedure did not differ between the groups (p = ns).
Conclusion:
The response to CRT and cardiovascular mortality were not affected by the advanced age and should not be an exclusion factor of this therapy. The procedure has been shown to be safe in elderly patients due to low rate of acute complications.
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