title: Long-term effects of cardiac resynchronization therapy in octogenarians: a comparative study with a younger population.
abstract: OBJECTIVE
  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.
  
  
  RESULTS
  Patients aged >or=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 >or= 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 >or=1 NYHA classes or >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 >or=1 NYHA classes or >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.
  
  
  CONCLUSIONS
  Octogenarians derive similar benefits from CRT to younger patients.
authors.affiliation: Department of Cardiology, University of Birmingham, Good Hope Hospital, Sutton Coldfield, West Midlands, UK.
authors.forename: Paul W X
authors.initials: PW
authors.lastname: Foley
authors.forename: Shajil
authors.initials: S
authors.lastname: Chalil
authors.forename: Kayvan
authors.initials: K
authors.lastname: Khadjooi
authors.forename: Russell E A
authors.initials: RE
authors.lastname: Smith
authors.forename: Michael P
authors.initials: MP
authors.lastname: Frenneaux
authors.forename: Francisco
authors.initials: F
authors.lastname: Leyva
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002304:Cardiac Pacing, Artificial / Q000401:mortality* / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D011788:Quality of Life; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome