Related Experiment Video

Updated: Jun 19, 2026

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
12:45

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

Published on: December 11, 2017

CRT upgrade improves frailty status in patients with HFrEF and RV pacing-a post hoc analysis of the BUDAPEST-CRT

Luca Kuthi1, Eperke Merkel1, Marianna Németh1

  • 1Heart and Vascular Center, Semmelweis University, Városmajor 68, 1122, Budapest, Hungary.

Geroscience
|June 18, 2026
PubMed

Insights

Cardiac resynchronization therapy (CRT) upgrade improved outcomes for heart failure patients, even those with frailty. This therapy also significantly reduced frailty scores compared to standard device therapy.

Area of Science:

  • Cardiology
  • Gerontology
  • Medical Devices

Background:

  • Heart failure (HF) and frailty are increasingly prevalent, negatively impacting patient prognosis.
  • Limited data exist on cardiac resynchronization therapy's (CRT) effect on frailty in HF patients.
  • Understanding frailty's influence on CRT outcomes is crucial for optimizing treatment.

Purpose of the Study:

  • To assess the impact of frailty on clinical outcomes in patients undergoing CRT upgrade.
  • To evaluate whether CRT provides benefits across different frailty levels.
  • To determine if CRT affects frailty status over time.

Main Methods:

  • Randomized trial comparing CRT-D upgrade versus ICD alone in heart failure with reduced ejection fraction (HFrEF) patients with high RV pacing burden.
  • Frailty assessed using a 31-item Frailty Index (FI) based on the Rockwood method.
  • Primary endpoint: composite of all-cause mortality, HF hospitalization, or LV end-systolic volume reduction at 12 months.

Main Results:

  • CRT-D upgrade significantly reduced the primary endpoint risk irrespective of baseline frailty status (interaction p=0.17).
  • CRT-D upgrade resulted in a significantly greater reduction in Frailty Index scores at 12 months compared to ICD alone (mean difference -0.03; p=0.005).
  • Frailty was common in this highly comorbid population but did not negate the clinical benefits of CRT-D upgrade.

Conclusions:

  • CRT-D upgrade is effective in reducing adverse clinical events in HFrEF patients, regardless of their frailty level.
  • CRT-D upgrade demonstrates a potential to improve frailty status in patients with heart failure.
  • Frailty should not be a barrier to considering CRT-D upgrade in eligible HFrEF patients.

Keywords:
CRT-D upgradeFrailtyHeart failure

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