Long-term effects of cardiac resynchronization therapy in octogenarians: a comparative study with a younger population

Paul W. X. Foley, Shajil Chalil, Kayvan Khadjooi, Russell E. A. Smith, Michael Frenneaux, Francisco Leyva

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Aims Heart failure is a disease of octogenarians. The evidence base for cardiac resynchronization therapy (CRT) has emerged from trials of patients in their 60s. We compared the effectiveness of CRT in octogenerians with younger patients.

Methods and results Patients aged >= 80 years [n = 53, age 83.7 +/- 2.6 years (mean +/- SD)] and < 80 years (n = 277, age 66.9 +/- 9.5 years) with ischaemic or non-ischaemic cardiomyopathy (NYHA class III or IV heart failure, left ventricular ejection fraction < 35%, QRS >= 120 ms) underwent CRT. A clinical assessment, including a 6-min walk test, and a quality of life assessment (Minnesota Living with Heart Failure questionnaire) were undertaken at baseline and after CRT. In octogenarians, CRT was associated with similar changes in NYHA class [-1.28 vs. -1.22, P < 0.0001 (P-values refer to changes from baseline)], 6-min walking distance (77.2 vs. 78.6 m, P < 0.0001), and quality of life scores (-20.4 vs. -31.4, P = 0.0084) to < 80 year olds. A symptomatic response to CRT (improvement by >= 1 NYHA classes or >= 25% 6-min walking distance) was observed in 80% of < 80 year olds and in 81% of octogenarians (P = NS). Using a combined clinical score (CCS; survival for 1 year with no heart failure hospitalizations, and; improvement by >= 1 NYHA classes or >= 25% 6-min walking distance), a response was observed in 201 out of 277 (73%) patients < 80 years and in 36 out of 53 (68%) octogenarians (P = NS). After a maximum follow-up of 7.6 years (median 634 days), no group differences emerged with respect to the composite endpoints of cardiovascular death or hospitalization for major cardiovascular events, the composite endpoint of cardiovascular death or heart failure hospitalization, cardiovascular mortality, or total mortality.

Conclusion Octogenarians derive similar benefits from CRT to younger patients.

Original languageEnglish
Pages (from-to)1302-1307
Number of pages6
JournalEuropace
Volume10
Issue number11
Early online date30 Sep 2008
DOIs
Publication statusPublished - Nov 2008

Keywords

  • Cardiac resynchronization therapy
  • Heart failure
  • Age
  • Octogenarian
  • Mortality
  • Chronic heart-failure
  • Care-HF
  • Defibrillator
  • Prevalence
  • Phase
  • Delay

Cite this