Elsevier

JACC: Heart Failure

Volume 3, Issue 6, June 2015, Pages 497-504
JACC: Heart Failure

Clinical Research
Does Age Influence Cardiac Resynchronization Therapy Use and Outcome?

https://doi.org/10.1016/j.jchf.2015.01.012Get rights and content
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Abstract

Objectives

This study sought to describe the use of CRT-D and its association with survival for older patients.

Background

Many patients who receive cardiac resynchronization therapy with defibrillator (CRT-D) in practice are older than those included in clinical trials.

Methods

We identified patients undergoing ICD implantation in the National Cardiovascular Disease Registry (NCDR) ICD registry from 2006 to 2009, who also met clinical trial criteria for CRT, including left ventricular ejection fraction (LVEF) ≤35%, QRS ≥120 ms, and New York Heart Association (NYHA) functional class III or IV. NCDR registry data were linked to the social security death index to determine the primary outcome of time to death from any cause. We identified 70,854 patients from 1,187 facilities who met prior trial criteria for CRT-D. The mean age of the 58,147 patients receiving CRT-D was 69.4 years with 6.4% of patients age 85 or older. CRT use was 80% or higher among candidates in all age groups. Follow-up was available for 42,285 patients age ≥65 years at 12 months.

Results

Receipt of CRT-D was associated with better survival at 1 year (82.1% vs. 77.1%, respectively) and 4 years (54.0% vs. 46.2% , respectively) than in those receiving only an ICD (p < 0.001). The CRT association with improved survival was not different for different age groups (p = 0.86 for interaction).

Conclusions

More than 80% of older patients undergoing ICD implantation who were candidates for a CRT-D received the combined device. Mortality in older patients undergoing ICD implantation was high but was lower for those receiving CRT-D.

Key Words

cardiac resynchronization therapy
elderly
heart failure

Abbreviations and Acronyms

CRT
cardiac resynchronization therapy
CRT-D
cardiac resynchronization therapy with defibrillator
CRT-P
cardiac resynchronization therapy with pacing and no defibrillator
ICD
implantable cardioverter-defibrillator
LVEF
left ventricular ejection fraction
NCDR
National Cardiovascular Disease Registry
NYHA
New York Heart Association

Cited by (0)

Dr. Heidenreich is supported by a grant from Veterans Administration Quality Enhancement and Research Initiative 04-326. Dr. Turakhia is supported by Veterans Health Services Research and Development Career Development Award CDA09027-1. Dr. Peterson is supported by Agency for Healthcare Research and Quality grant K08 HS019814-01. Dr. Curtis owns stock in Medtronics; and has received grant support from Boston Scientific through her institution. Dr. Hernandez has received grant support from Medtronics-Research. Dr. Turakhia has received grant support from Medtronics, iRhythm, Gilead Sciences; is an employee of U.S. Department of Veterans Affairs; has consulted for Medtronic, St. Jude Medical, and Precision Health Economics; and has received lecture honoraria from Biotronik. Dr. Masoudi is senior medical officer for American College of Cardiology. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.