Paul A Heidenreich1, Vivian Tsai2, Haikun Bao3, Jeptha Curtis3, Mary Goldstein4, Lesley Curtis5, Adrian Hernandez5, Pamela Peterson6, Mintu P Turakhia4, Frederick A Masoudi6. 1. Veterans Administration Palo Alto Healthcare System, Palo Alto, California. Electronic address: heiden@standford.edu. 2. Palo Alto Medical Foundation, Palo Alto, California. 3. Department of Medicine, Yale School of Medicine, New Haven, Connecticut. 4. Veterans Administration Palo Alto Healthcare System, Palo Alto, California. 5. Duke Clinical Research Institute, Durham, North Carolina. 6. University of Colorado Anschutz Medical Campus, Aurora, Colorado.
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.
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.
Authors: Bradley McKay; Nicholas W H Tseng; Hassan I Sheikh; Mohammad K Syed; Maureen Pakosh; Jessica E Caterini; Abhinav Sharma; Tracey J F Colella; Kaja M Konieczny; Kim A Connelly; Michelle M Graham; Michael McDonald; Laura Banks; Varinder Kaur Randhawa Journal: CJC Open Date: 2021-09-15
Authors: Laura A Hatfield; Daniel B Kramer; Rita Volya; Matthew R Reynolds; Sharon-Lise T Normand Journal: J Am Heart Assoc Date: 2016-07-28 Impact factor: 5.501