title: Outcomes of cardiac resynchronization therapy in the elderly.
abstract: BACKGROUND
  Octogenarians (>80 years) have been underrepresented in clinical trials of cardiac resynchronization therapy (CRT).
  
  
  OBJECTIVE
  To determine the benefit of CRT with or without a defibrillator in older elderly patients.
  
  
  METHODS
  We retrospectively studied consecutive patients who received CRT at our institution from 2002 through 2008. New York Heart Association (NYHA) class and echocardiographic parameters were assessed before and after CRT. Thirty-day complications after device implant were collected. Survival data were obtained from the national death and location database. Data were compared between those 80 years and younger and those older than 80 years.
  
  
  RESULTS
  Of 728 patients identified, 90 (12.4%) were older than 80 years. After CRT, older and younger patients had similar improvements in NHYA class (P = 0.41), ejection fraction (P = 0.48), and mitral valve regurgitation (MR) severity (P = 0.42). In the older patients, defibrillator implantation was associated with comparable improvement in NYHA class, ejection fraction, and MR grade severity (P > 0.05), as in those without a defibrillator. Overall survival was worse in octogenarians than in the younger patients by Kaplan-Meier estimates (P = 0.001). Multivariate analysis showed similar survival between the younger and older subjects (hazard ratio, 1.23; 95% confidence interval, 0.83-1.84; P = 0.31). The observed complication rate in all study subjects was 12.2%, with no difference between the two age groups.
  
  
  CONCLUSIONS
  Octogenarian patients who received CRT with or without a defibrillator for advanced heart failure had similar clinical benefits as younger patients. CRT should not be withheld from octogenarians meeting current selection guidelines.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Ammar M
authors.initials: AM
authors.lastname: Killu
authors.forename: Jia-Hui
authors.initials: JH
authors.lastname: Wu
authors.forename: Paul A
authors.initials: PA
authors.lastname: Friedman
authors.forename: Win-Kuang
authors.initials: WK
authors.lastname: Shen
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Webster
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Brooke
authors.forename: David O
authors.initials: DO
authors.lastname: Hodge
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Wiste
authors.forename: Yong-Mei
authors.initials: YM
authors.lastname: Cha
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy / Q000401:mortality* / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome