Julia Köbe1, Dietrich Andresen2, Sebastian Maier3, Christoph Stellbrink4, Thomas Kleemann5, Bernd-Dieter Gonska6, Sebastian Reif7, Matthias Hochadel8, Jochen Senges8, Lars Eckardt9. 1. Division of Electrophysiology, University Hospital of Muenster, Germany. Electronic address: koebeju@ukmuenster.de. 2. Department of Cardiology, Vivantes Klinikum am Urban, Berlin, Germany. 3. Department of Cardiology, Klinikum Straubing, Germany. 4. Department of Cardiology, Klinikum Bielefeld, Germany. 5. Department of Cardiology, Klinikum Ludwigshafen, Germany. 6. Department of Cardiology, St. Vincentius Kliniken Karlsruhe, Germany. 7. Department of Cardiology, Heart Center Munich-Bogenhausen, Germany. 8. Stiftung Institut für Herzinfarktforschung (IHF), Ludwigshafen, Germany. 9. Division of Electrophysiology, University Hospital of Muenster, Germany.
Abstract
OBJECTIVE: Evidence on cardiac resynchronization therapy (CRT) in older patients is scarce and conflicting. Nevertheless, CRT in the elderly is of major practical relevance as heart failure prevalence increases with age. METHODS: The German Device Registry (DEVICE) is a nationwide, prospective registry with a longitudinal follow-up design investigating device implantations in 60 German centres. The present analysis of DEVICE focussed on perioperative complication rates and 1-year outcome of patients ≥75years (n=320) compared to younger patients (n=879) receiving a CRT device. RESULTS: Comorbidities were more common in older patients (chronic kidney disease (CKD): 27.5% vs. 21.5%, p=0.029; atrial fibrillation (AF): 26.9% vs. 15.6%, p<0.001). Despite higher NYHA classes in the older age group, ejection fractions were comparable (27.2±7.1% ≥75years, 26.2±7.1% <75years, p=0.06). Perioperative complications and mortality rates did not show significant difference between groups. After new device implantation, absolute 1-year mortality was higher in older patients (11.0% ≥75years, 6.4% <75years, p=0.014), with a significantly lower proportion of cardiac deaths in the older group (p=0.05). Patients ≥75years being alive after 1year had lower response rates, with chronic kidney disease (OR 0.46, p<0.05) and smaller QRS complexes (OR 0.31, p<0.01) being particular risk factors for missing improvement of heart failure symptoms. As expected severe heart failure (NYHA IV) was a strong independent predictor of death (HR 1.95, p=0.01), whereas AF as underlying rhythm could be worked out as predictor for mortality especially in the younger patients (HR 2.31, p=0.002). CONCLUSIONS: Patients ≥75years of age receiving a CRT device do not have a higher perioperative mortality and complication rate although comorbidities (CKD and AF) occur more frequently. The absolute 1-year mortality is higher; nevertheless, the proportion of cardiac deaths is even lower in the older patients reflecting a benefit of CRT in this group.
OBJECTIVE: Evidence on cardiac resynchronization therapy (CRT) in older patients is scarce and conflicting. Nevertheless, CRT in the elderly is of major practical relevance as heart failure prevalence increases with age. METHODS: The German Device Registry (DEVICE) is a nationwide, prospective registry with a longitudinal follow-up design investigating device implantations in 60 German centres. The present analysis of DEVICE focussed on perioperative complication rates and 1-year outcome of patients ≥75years (n=320) compared to younger patients (n=879) receiving a CRT device. RESULTS: Comorbidities were more common in older patients (chronic kidney disease (CKD): 27.5% vs. 21.5%, p=0.029; atrial fibrillation (AF): 26.9% vs. 15.6%, p<0.001). Despite higher NYHA classes in the older age group, ejection fractions were comparable (27.2±7.1% ≥75years, 26.2±7.1% <75years, p=0.06). Perioperative complications and mortality rates did not show significant difference between groups. After new device implantation, absolute 1-year mortality was higher in older patients (11.0% ≥75years, 6.4% <75years, p=0.014), with a significantly lower proportion of cardiac deaths in the older group (p=0.05). Patients ≥75years being alive after 1year had lower response rates, with chronic kidney disease (OR 0.46, p<0.05) and smaller QRS complexes (OR 0.31, p<0.01) being particular risk factors for missing improvement of heart failure symptoms. As expected severe heart failure (NYHA IV) was a strong independent predictor of death (HR 1.95, p=0.01), whereas AF as underlying rhythm could be worked out as predictor for mortality especially in the younger patients (HR 2.31, p=0.002). CONCLUSIONS:Patients ≥75years of age receiving a CRT device do not have a higher perioperative mortality and complication rate although comorbidities (CKD and AF) occur more frequently. The absolute 1-year mortality is higher; nevertheless, the proportion of cardiac deaths is even lower in the older patients reflecting a benefit of CRT in this group.
Authors: Gerrit Frommeyer; Florian Reinke; Dietrich Andresen; Thomas Kleemann; Stefan G Spitzer; Joachim Jehle; Johannes Brachmann; Christoph Stellbrink; Matthias Hochadel; Jochen Senges; Lars Eckardt Journal: Clin Res Cardiol Date: 2019-07-31 Impact factor: 5.460
Authors: Elif Kaya; Jochen Senges; Matthias Hochadel; Lars Eckardt; Dietrich Andresen; Hüseyin Ince; Stefan G Spitzer; Thomas Kleemann; Sebastian S K Maier; Werner Jung; Christoph Stellbrink; Tienush Rassaf; Reza Wakili Journal: ESC Heart Fail Date: 2020-02-18
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