Left ventricular reverse remodeling, device-related adverse events, and long-term outcome after cardiac resynchronization therapy in the elderly.
BACKGROUND
Limited data are available on efficacy, safety, and long-term prognosis after cardiac resynchronization therapy (CRT) in elderly patients. We aimed at evaluating the effect of CRT, device-related adverse events, and long-term outcome after CRT among elderly patients.


RESULTS
A total of 798 CRT recipients (208 elderly: age, ≥75 years; 590 nonelderly: age, <75 years) underwent clinical and echocardiographic evaluation at baseline and 6-month follow-up. Elderly patients had similar improvements in clinical symptoms, left ventricular function, and left ventricular reverse remodeling as their counterparts. Similar rates of device-related in-hospital (within 24 hours; P=0.552), early (within 30 days; P=0.984), and long-term adverse events (entire follow-up; hazard ratio, 0.90; P=0.620) were observed between groups. During long-term follow-up (median, 38.6 months; interquartile range, 22.5-61.8 months), all-cause mortality rate was significantly higher among the elderly patients. However, the differences in cumulative event rates started after 4 years of follow-up (P=0.013), and the cause of death was mainly noncardiac (29% in the elderly versus 19% in nonelderly; P<0.001). Diabetes mellitus (hazard ratio, 2.322; P=0.019), impaired renal function (hazard ratio, 0.975; P=0.006), and reduced 6-minute walk distance (hazard ratio, 0.996; P<0.019) were independently associated with all-cause mortality in elderly patients.


CONCLUSIONS
CRT efficacy and device-related adverse events in elderly patients were comparable with that of nonelderly patients. However, after 4 years of follow-up, elderly patients showed worse survival and the cause of death was mainly noncardiac. Diabetes mellitus, impaired renal function, and reduced 6-minute walk distance were independently associated with all-cause mortality of elderly patients.
From the Departments of Cardiology (U.H., E.T.V.D.V., M.J.S., V.D., J.J.B., N.A.M.) and Medical Statistics and Bioinformatics (H.P.), Leiden University Medical Center, Leiden, The Netherlands; and Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands (U.H.).
Ulas
U
Höke
From the Departments of Cardiology (U.H., E.T.V.D.V., M.J.S., V.D., J.J.B., N.A.M.) and Medical Statistics and Bioinformatics (H.P.), Leiden University Medical Center, Leiden, The Netherlands; and Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands (U.H.).
Hein
H
Putter
From the Departments of Cardiology (U.H., E.T.V.D.V., M.J.S., V.D., J.J.B., N.A.M.) and Medical Statistics and Bioinformatics (H.P.), Leiden University Medical Center, Leiden, The Netherlands; and Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands (U.H.).
Enno T
ET
Van Der Velde
From the Departments of Cardiology (U.H., E.T.V.D.V., M.J.S., V.D., J.J.B., N.A.M.) and Medical Statistics and Bioinformatics (H.P.), Leiden University Medical Center, Leiden, The Netherlands; and Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands (U.H.).
Martin J
MJ
Schalij
From the Departments of Cardiology (U.H., E.T.V.D.V., M.J.S., V.D., J.J.B., N.A.M.) and Medical Statistics and Bioinformatics (H.P.), Leiden University Medical Center, Leiden, The Netherlands; and Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands (U.H.).
Victoria
V
Delgado
From the Departments of Cardiology (U.H., E.T.V.D.V., M.J.S., V.D., J.J.B., N.A.M.) and Medical Statistics and Bioinformatics (H.P.), Leiden University Medical Center, Leiden, The Netherlands; and Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands (U.H.).
Jeroen J
JJ
Bax
From the Departments of Cardiology (U.H., E.T.V.D.V., M.J.S., V.D., J.J.B., N.A.M.) and Medical Statistics and Bioinformatics (H.P.), Leiden University Medical Center, Leiden, The Netherlands; and Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands (U.H.). N.Ajmone@lumc.nl.
Nina Ajmone
NA
Marsan
D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000473:pathology / Q000601:surgery*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000628:therapy*; D020257:Ventricular Remodeling
aged; cardiac resynchronization therapy; heart failure; prognosis