When Is Cardiac Resynchronization Therapy with a Defibrillator Indicated in Patients with Heart Failure, Especially
Hiroaki Mano1, Toshiko Nakai1, Yukitoshi Ikeya1
1Division of Cardiology, Department of Medicine, Nihon University School of Medicine.
Insights
In elderly heart failure patients, defibrillators did not significantly impact mortality. Device choice for cardiac resynchronization therapy should consider common comorbidities in older adults.
Area of Science:
- Cardiology
- Geriatric Medicine
- Medical Devices
Background:
- Implantable cardioverter-defibrillators prevent sudden cardiac death (SCD) and are recommended for low ejection fraction.
- The use of defibrillators within cardiac resynchronization therapy (CRT-D vs. CRT-P) in elderly patients remains controversial.
Purpose of the Study:
- To investigate the impact of defibrillators on mortality in elderly patients with heart failure.
- To inform device selection for cardiac resynchronization therapy in older populations.
Main Methods:
- Retrospective analysis of consecutive patients undergoing CRT implantation.
- Comparison of baseline characteristics, all-cause mortality, and cardiac death between elderly (>75 years) and younger (≤75 years) patients.
- Kaplan-Meier analysis to assess survival differences between age groups and device types (CRT-D vs. CRT-P).
Main Results:
- Elderly patients exhibited more comorbidities but less ventricular arrhythmia.
- Overall mortality was higher in elderly patients, but cardiac death rates did not differ significantly by age.
- No significant difference in mortality was observed between CRT-D and CRT-P groups.
Conclusions:
- Sudden cardiac death was infrequent, and defibrillators showed no significant impact on overall mortality in this cohort.
- Comorbidities are prevalent in elderly heart failure patients and are associated with mortality.
- Individualized selection of CRT-D versus CRT-P in elderly patients should carefully consider their comorbidity profile.
Abstract:
One benefit of an implantable cardioverter-defibrillator is the prevention of sudden cardiac death (SCD). It is recommended for patients with a low left ventricular ejection fraction (LVEF). However, the choice of cardiac resynchronization therapy (CRT) with or without a defibrillator (CRT-D and CRT-P) in elderly patients is controversial. To understand the current situation for proper device selection, we investigated the impact of defibrillators on mortality in elderly patients with heart failure.Consecutive patients who underwent CRT implantation were retrospectively recruited. Baseline characteristics, all-cause mortality, cardiac death, and defibrillator implantation rates were investigated in patients aged > 75 or ≤ 75 years.A total of 285 patients (79 patients aged > 75 years) were analyzed. Elderly patients had more comorbidities, but a lower proportion had ventricular arrhythmia. During the mean follow-up of 47 months, 109 patients died (67 due to cardiac death). Kaplan-Meier analysis showed higher mortality in elderly patients (P = 0.0428) but no significant difference in cardiac death by age group (P = 0.7472). There were no significant differences in mortality between patients with CRT-D versus CRT-P (P = 0.3386).SCD was rare. A defibrillator had no significant impact on mortality. In elderly patients, comorbidities are common and related to mortality. The selection of CRT-D versus CRT-P should take those factors into account.
More Related Videos
Related Concept Videos
01:22Heart Failure VI: Adjunct Therapies
01:30Cardiomyopathy II: Dilated Cardiomyopathy
01:23Cardiopulmonary Resuscitation III: AED Use
01:26Heart Failure Drugs: Inotropic Agents
01:30Heart Failure IV: Classification and Diagnostic Evaluation
01:26Heart Failure III: Clinical Manifestations