Does the Age Affect the Outcomes of Cardiac Resynchronization Therapy in Elderly Patients?
Teresa Strisciuglio1, Giuseppe Stabile2, Domenico Pecora3
1Department of Advanced Biomedical Sciences, Federico II University of Naples, 80138 Naples, Italy.
Insights
Older heart failure patients (≥75 years) receiving cardiac resynchronization therapy (CRT) show similar response and hospitalization rates to younger groups. However, advanced age (>80), COPD, and CKD predict poorer outcomes in elderly CRT recipients.
Area of Science:
- Cardiology
- Geriatric Medicine
- Medical Devices
Background:
- Increasing number of elderly patients (≥75 years) are undergoing cardiac resynchronization therapy (CRT).
- Limited data exists on the outcomes and predictors of CRT in this specific demographic.
- This study addresses the need for more information on mid- to long-term outcomes in elderly CRT recipients.
Purpose of the Study:
- To evaluate the mid- to long-term clinical outcomes of cardiac resynchronization therapy (CRT) in patients aged 75 years and older.
- To identify predictors of mortality and clinical response in elderly CRT recipients.
- To compare outcomes in patients ≥75 years with younger age groups (65-74 and <65 years).
Main Methods:
- Analysis of patients from the Cardiac Resynchronization Therapy Modular (CRT MORE) Registry.
- Stratification of patients into three age groups: <65, 65-74, and ≥75 years.
- Evaluation of mortality, hospitalization rates, and composite events at 1 year and during long-term follow-up.
Main Results:
- 63% of patients ≥75 years showed a positive clinical response at 12 months.
- Mortality was significantly higher in the ≥75 years group compared to younger groups.
- Hospitalizations for heart failure worsening were similar between patients ≥75 and 65-74 years.
- Age >80 years, COPD, and CKD were independent predictors of death and negative clinical response.
- Long-term follow-up showed higher mortality in the ≥75 years group, with similar hospitalization and composite event rates compared to the 65-74 years group.
Conclusions:
- Cardiac resynchronization therapy (CRT) recipients aged ≥75 years demonstrate comparable positive clinical response and hospitalization rates to those aged 65-74 years.
- Age over 80 years, chronic obstructive pulmonary disease (COPD), and chronic kidney disease (CKD) are significant predictors of adverse outcomes in elderly CRT patients.
- These findings highlight the importance of considering comorbidities and advanced age when assessing prognosis for CRT in older adults.
Background:
More and more heart failure (HF) patients aged ≥ 75 years undergo cardiac resynchronization therapy (CRT) device implantation, however the data regarding the outcomes and their predictors are scant. We investigated the mid- to long-term outcomes and their predictors in CRT patients aged ≥ 75 years.
Methods:
Patients in the Cardiac Resynchronization Therapy Modular (CRT MORE) Registry were divided into three age-groups: <65 (group A), 65-74 (group B) and ≥75 years (group C). Mortality, hospitalization, and composite event rate were evaluated at 1 year and during long-term follow-up.
Results:
Patients (n = 934) were distributed as follows: group A 242; group B 347; group C 345. On 12-month follow-up examination, 63% of patients ≥ 75 years displayed a positive clinical response. Mortality was significantly higher in patients ≥ 75 years than in the other two groups, although the rate of hospitalizations for HF worsening was similar to that of patients aged 65-74 (7 vs. 9.5%, respectively; p = 0.15). Independent predictors of death and of negative clinical response were age >80 years, chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD). Over long-term follow-up (1020 days (IQR 680-1362)) mortality was higher in patients ≥ 75 years than in the other two groups. Hospitalization and composite event rates were similar in patients ≥ 75 years and those aged 65-74 (9 vs. 11.8%; p = 0.26, and 26.7 vs. 20.5%; p = 0.06).
Conclusion:
Positive clinical response and hospitalization rates do not differ between CRT recipients ≥ 75 years and those aged 65-74. However, age > 80 years, COPD and CKD are predictors of worse outcomes.
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