Ulas Höke1, Hein Putter1, Enno T Van Der Velde1, Martin J Schalij1, Victoria Delgado1, Jeroen J Bax1, Nina Ajmone Marsan2. 1. From the Departments of Cardiology (U.H., E.T.V.D.V., M.J.S., V.D., J.J.B., N.A.M.) and Medical Statistics and Bioinformatics (H.P.), Leiden University Medical Center, Leiden, The Netherlands; and Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands (U.H.). 2. From the Departments of Cardiology (U.H., E.T.V.D.V., M.J.S., V.D., J.J.B., N.A.M.) and Medical Statistics and Bioinformatics (H.P.), Leiden University Medical Center, Leiden, The Netherlands; and Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands (U.H.). N.Ajmone@lumc.nl.
Abstract
BACKGROUND: Limited data are available on efficacy, safety, and long-term prognosis after cardiac resynchronization therapy (CRT) in elderly patients. We aimed at evaluating the effect of CRT, device-related adverse events, and long-term outcome after CRT among elderly patients. METHODS AND RESULTS: A total of 798 CRT recipients (208 elderly: age, ≥75 years; 590 nonelderly: age, <75 years) underwent clinical and echocardiographic evaluation at baseline and 6-month follow-up. Elderly patients had similar improvements in clinical symptoms, left ventricular function, and left ventricular reverse remodeling as their counterparts. Similar rates of device-related in-hospital (within 24 hours; P=0.552), early (within 30 days; P=0.984), and long-term adverse events (entire follow-up; hazard ratio, 0.90; P=0.620) were observed between groups. During long-term follow-up (median, 38.6 months; interquartile range, 22.5-61.8 months), all-cause mortality rate was significantly higher among the elderly patients. However, the differences in cumulative event rates started after 4 years of follow-up (P=0.013), and the cause of death was mainly noncardiac (29% in the elderly versus 19% in nonelderly; P<0.001). Diabetes mellitus (hazard ratio, 2.322; P=0.019), impaired renal function (hazard ratio, 0.975; P=0.006), and reduced 6-minute walk distance (hazard ratio, 0.996; P<0.019) were independently associated with all-cause mortality in elderly patients. CONCLUSIONS: CRT efficacy and device-related adverse events in elderly patients were comparable with that of nonelderly patients. However, after 4 years of follow-up, elderly patients showed worse survival and the cause of death was mainly noncardiac. Diabetes mellitus, impaired renal function, and reduced 6-minute walk distance were independently associated with all-cause mortality of elderly patients.
BACKGROUND: Limited data are available on efficacy, safety, and long-term prognosis after cardiac resynchronization therapy (CRT) in elderly patients. We aimed at evaluating the effect of CRT, device-related adverse events, and long-term outcome after CRT among elderly patients. METHODS AND RESULTS: A total of 798 CRT recipients (208 elderly: age, ≥75 years; 590 nonelderly: age, <75 years) underwent clinical and echocardiographic evaluation at baseline and 6-month follow-up. Elderly patients had similar improvements in clinical symptoms, left ventricular function, and left ventricular reverse remodeling as their counterparts. Similar rates of device-related in-hospital (within 24 hours; P=0.552), early (within 30 days; P=0.984), and long-term adverse events (entire follow-up; hazard ratio, 0.90; P=0.620) were observed between groups. During long-term follow-up (median, 38.6 months; interquartile range, 22.5-61.8 months), all-cause mortality rate was significantly higher among the elderly patients. However, the differences in cumulative event rates started after 4 years of follow-up (P=0.013), and the cause of death was mainly noncardiac (29% in the elderly versus 19% in nonelderly; P<0.001). Diabetes mellitus (hazard ratio, 2.322; P=0.019), impaired renal function (hazard ratio, 0.975; P=0.006), and reduced 6-minute walk distance (hazard ratio, 0.996; P<0.019) were independently associated with all-cause mortality in elderly patients. CONCLUSIONS: CRT efficacy and device-related adverse events in elderly patients were comparable with that of nonelderly patients. However, after 4 years of follow-up, elderly patients showed worse survival and the cause of death was mainly noncardiac. Diabetes mellitus, impaired renal function, and reduced 6-minute walk distance were independently associated with all-cause mortality of elderly patients.
Authors: Daniel B Kramer; Daniel D Matlock; Alfred E Buxton; Nathan E Goldstein; Carol Goodwin; Ariel R Green; James N Kirkpatrick; Christopher Knoepke; Rachel Lampert; Paul S Mueller; Matthew R Reynolds; John A Spertus; Lynne W Stevenson; Susan L Mitchell Journal: Circ Cardiovasc Qual Outcomes Date: 2015-06-02
Authors: G Bazoukis; K P Letsas; P Korantzopoulos; C Thomopoulos; K Vlachos; S Georgopoulos; N Karamichalakis; A Saplaouras; M Efremidis; A Sideris Journal: J Arrhythm Date: 2017-05-01
Authors: Luiz Eduardo Montenegro Camanho; Eduardo Benchimol Saad; Charles Slater; Luiz Antonio Oliveira Inacio Junior; Gustavo Vignoli; Lucas Carvalho Dias; Pedro Pimenta de Mello Spineti; Ricardo Mourilhe-Rocha Journal: PLoS One Date: 2019-12-02 Impact factor: 3.240