title: Intermediate-term mortality and incidence of ICD therapy in octogenarians after cardiac resynchronization therapy.
abstract: BACKGROUND
  Clinical outcomes of cardiac resynchronization therapy (CRT) in patients over the age of 80 have not been well described.
  
  
  METHODS
  We retrospectively identified 96 consecutive patients ≥ 80 years old who underwent an initial implant or an upgrade to CRT, with or without defibrillator (CRT-D vs. CRT-P), at our institution between January 2003 and July 2008. The control cohort consisted of 177 randomly selected patients < 80 years old undergoing CRT implant during the same time period. The primary efficacy endpoint was all-cause mortality at 36 months, assessed by Kaplan-Meier time to first event curves.
  
  
  RESULTS
  In the octogenarian cohort, mean age at CRT implant was 83.1 ± 2.9 years vs. 60.1 ± 8.8 years among controls (P < 0.001). Across both groups, 70% were male, mean left ventricular ejection fraction (LVEF) was 24.8% ± 14.1% and QRS duration was 154 ± 24.8 ms, without significant differences between groups. Octogenarians were more likely to have ischemic cardiomyopathy (74% vs. 37%, P < 0.001) and more likely to undergo upgrade to CRT instead of an initial implant (42% vs. 19%, P < 0.001). The rate of appropriate defibrillator shocks was lower among octogenarians (14% vs. 27%, P = 0.02) whereas the rate of inappropriate shocks was similar (3% vs. 6%, P = 0.55). At 36 months, there was no significant difference in the rate of all-cause mortality between octogenarians (11%) and controls (8%, P = 0.381).
  
  
  CONCLUSIONS
  Appropriately selected octogenarians who are candidates for CRT have similar intermediate-term mortality compared to younger patients receiving CRT.
authors.affiliation: Department of Medicine, Emory University School of Medicine, 1364 Clifton Road Atlanta, GA 30322, USA.
authors.forename: Heval Mohamed
authors.initials: HM
authors.lastname: Kelli
authors.affiliation: Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Medical Office Tower, 550 Peachtree Street, Atlanta, GA 30308, USA.
authors.forename: Faisal M
authors.initials: FM
authors.lastname: Merchant
authors.affiliation: Cardiology Clinical Databases, Emory Healthcare, 1364 Clifton Road F402, Atlanta, GA 30322, USA.
authors.forename: Andenet
authors.initials: A
authors.lastname: Mengistu
authors.affiliation: Cardiology Clinical Databases, Emory Healthcare, 1364 Clifton Road F402, Atlanta, GA 30322, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Casey
authors.affiliation: Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 1364 Clifton Road, Atlanta, GA 30322, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Hoskins
authors.affiliation: Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Medical Office Tower, 550 Peachtree Street, Atlanta, GA 30308, USA.
authors.forename: Mikhael F
authors.initials: MF
authors.lastname: El-Chami
keywords: Cardiac resynchronization therapy; Implantable cardioverter-defibrillator; Octogenarians