Clinical Response of Cardiac Resynchronization Therapy in the Elderly
Clinical Response of Cardiac Resynchronization Therapy in the Elderly
Background: Although prevalence of heart failure increases with age, in most clinical trials of cardiac resynchronization therapy (CRT), older patients are not included. Observational studies of effects of CRT in older patients had a small sample size. In the present study, the clinical and echocardiographic response to CRT in a larger group of elderly (age >75 years) patients was evaluated.
Methods: In this prospective observational study of 266 consecutive patients, CRT was performed in 107 elderly patients (40%) and 159 (60%) younger patients (age ≤75 years). Echocardiographic and clinical parameters were evaluated at baseline and at 3, 12, and 24 months.
Results: In the elderly group, mean age was 79 years compared with 67 years in patients aged ≤75 years. Clinical baseline characteristics between the 2 groups were comparable. During follow-up, there was a comparable and sustained improvement in both groups according to New York Heart Association (NYHA) class, quality of life score, and left ventricular (LV) ejection fraction. Clinical response, defined as survival with improvement (≥1 score) of NYHA class without hospital admittance for heart failure, was seen in 67% and 69% (group aged ≤75 years) versus 65% and 60% (group aged >75 years) after 3 months and 1 year, respectively. Reverse LV remodeling defined as LV end-systolic volume reduction ≥10% was seen in 79% and 87% (group aged ≤75 years) versus 71% and 79% (group aged >75 years) after 3 months and 1 year, respectively. Hospitalization for heart failure decreased significantly in both groups in the year after CRT. A subgroup analysis of 39 octogenarians (>80 years) also showed a significant improvement in NYHA class and LV ejection fraction in this subgroup. Also, LV reverse remodeling occurred in a similar extent (75% and 84%) after 3 months and 1 year, respectively.
Conclusions: This study shows a clinical and echocardiographic improvement of CRT in patients aged >75 years and even so in octogenarians.
Although cardiac resynchronization therapy (CRT) is very effective in reducing symptoms and decreasing mortality in heart failure, most results were demonstrated in selected patients. Whether the beneficial effects of CRT also apply to the elderly is unclear because these patients were not included in almost all randomized trials. Only one observational study suggested benefit of CRT in elderly patients, but this study had a small sample size and a short follow-up period. The prevalence of heart failure increases with age, and in daily practice, many patients with heart failure, LV dysfunction, and dyssynchrony are elderly.
Since 1999, CRT is performed in our hospital in patients with moderate or severe symptoms of heart failure, left ventricular (LV) dysfunction, and dyssynchrony as well as in patients with moderate LV dysfunction and a pacing-induced left bundle-branch block; and data for all implantations are collected prospectively. Older age at the time of the implantation is not a contraindication for CRT in our hospital. The purpose of our study is, in view of the limited knowledge of the mid- and long-term effects of CRT in elderly patients, to compare the clinical and echocardiographic results in elderly patients (aged >75 years) to younger patients (aged ≤75 years) undergoing CRT. Additional analyses were performed in octogenarians (≥80 years).
Abstract and Introduction
Abstract
Background: Although prevalence of heart failure increases with age, in most clinical trials of cardiac resynchronization therapy (CRT), older patients are not included. Observational studies of effects of CRT in older patients had a small sample size. In the present study, the clinical and echocardiographic response to CRT in a larger group of elderly (age >75 years) patients was evaluated.
Methods: In this prospective observational study of 266 consecutive patients, CRT was performed in 107 elderly patients (40%) and 159 (60%) younger patients (age ≤75 years). Echocardiographic and clinical parameters were evaluated at baseline and at 3, 12, and 24 months.
Results: In the elderly group, mean age was 79 years compared with 67 years in patients aged ≤75 years. Clinical baseline characteristics between the 2 groups were comparable. During follow-up, there was a comparable and sustained improvement in both groups according to New York Heart Association (NYHA) class, quality of life score, and left ventricular (LV) ejection fraction. Clinical response, defined as survival with improvement (≥1 score) of NYHA class without hospital admittance for heart failure, was seen in 67% and 69% (group aged ≤75 years) versus 65% and 60% (group aged >75 years) after 3 months and 1 year, respectively. Reverse LV remodeling defined as LV end-systolic volume reduction ≥10% was seen in 79% and 87% (group aged ≤75 years) versus 71% and 79% (group aged >75 years) after 3 months and 1 year, respectively. Hospitalization for heart failure decreased significantly in both groups in the year after CRT. A subgroup analysis of 39 octogenarians (>80 years) also showed a significant improvement in NYHA class and LV ejection fraction in this subgroup. Also, LV reverse remodeling occurred in a similar extent (75% and 84%) after 3 months and 1 year, respectively.
Conclusions: This study shows a clinical and echocardiographic improvement of CRT in patients aged >75 years and even so in octogenarians.
Introduction
Although cardiac resynchronization therapy (CRT) is very effective in reducing symptoms and decreasing mortality in heart failure, most results were demonstrated in selected patients. Whether the beneficial effects of CRT also apply to the elderly is unclear because these patients were not included in almost all randomized trials. Only one observational study suggested benefit of CRT in elderly patients, but this study had a small sample size and a short follow-up period. The prevalence of heart failure increases with age, and in daily practice, many patients with heart failure, LV dysfunction, and dyssynchrony are elderly.
Since 1999, CRT is performed in our hospital in patients with moderate or severe symptoms of heart failure, left ventricular (LV) dysfunction, and dyssynchrony as well as in patients with moderate LV dysfunction and a pacing-induced left bundle-branch block; and data for all implantations are collected prospectively. Older age at the time of the implantation is not a contraindication for CRT in our hospital. The purpose of our study is, in view of the limited knowledge of the mid- and long-term effects of CRT in elderly patients, to compare the clinical and echocardiographic results in elderly patients (aged >75 years) to younger patients (aged ≤75 years) undergoing CRT. Additional analyses were performed in octogenarians (≥80 years).
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