title: Response to cardiac resynchronization therapy in elderly patients (≥70 years) and octogenarians.
abstract: OBJECTIVE
  Cardiac resynchronization therapy (CRT) leads to reverse ventricular remodelling, improved functional capacity, and better clinical outcome in patients with advanced chronic heart failure, reduced ejection fraction, and evidence of ventricular conduction delay, who are under optimal medical therapy. This study investigated whether these benefits can be extrapolated to older patients, typically not included in randomized clinical trials.
  
  
  RESULTS
  Consecutive patients who received a CRT device between October 2008 and June 2011, including optimization afterwards in a dedicated clinic, were stratified into 3 pre-specified groups, according to age: <70 years (n = 76); 70-79 years (n = 95); and ≥80 years (n = 49). Left ventricular remodelling, functional capacity, heart failure hospitalization, and mortality data were assessed during follow-up. Reverse left ventricular remodelling and improvement in New York Heart Association functional class were similar in all groups at 6 months after implantation. During mean follow-up of 20 months, 32 patients died and 66 were admitted for heart failure. Annualized mortality rates were significantly higher in elderly patients (6% vs. 8% vs. 15% in all groups, respectively; P < 0.001), but time to death or first heart failure admission was similar among age groups (P = 0.531). Progressive pump failure was the major cause of death (50%), with co-morbidity-related deaths also being frequent (41%).
  
  
  CONCLUSIONS
  Reverse left ventricular remodelling and functional capacity improvement after CRT are sustained at advanced age. Moreover, time to all-cause mortality or heart failure admission was similar, irrespective of age, in a context of maximized optimization including optimal medical therapy.
authors.affiliation: Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
authors.forename: Frederik H
authors.initials: FH
authors.lastname: Verbrugge
authors.forename: Matthias
authors.initials: M
authors.lastname: Dupont
authors.forename: Philippe
authors.initials: P
authors.lastname: De Vusser
authors.forename: Maximo
authors.initials: M
authors.lastname: Rivero-Ayerza
authors.forename: Hugo
authors.initials: H
authors.lastname: Van Herendael
authors.forename: Jan
authors.initials: J
authors.lastname: Vercammen
authors.forename: Linda
authors.initials: L
authors.lastname: Jacobs
authors.forename: David
authors.initials: D
authors.lastname: Verhaert
authors.forename: Pieter
authors.initials: P
authors.lastname: Vandervoort
authors.forename: W H Wilson
authors.initials: WH
authors.lastname: Tang
authors.forename: Wilfried
authors.initials: W
authors.lastname: Mullens
mesh_terms: D000203:Activities of Daily Living / Q000145:classification; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D058406:Cardiac Resynchronization Therapy; D055424:Cardiac-Gated Imaging Techniques; D002423:Cause of Death; D017147:Defibrillators, Implantable; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D010359:Patient Readmission; D015996:Survival Rate; D016896:Treatment Outcome; D020257:Ventricular Remodeling / Q000502:physiology