title: Comparison of pharmacological treatment alone versus treatment combined with cardiac resynchronization therapy in patients over 75 years.
abstract: BACKGROUND
  The role of cardiac resynchronization therapy (CRT) in patients aged ≥75 years is not well established.
  
  
  METHODS
  We identified 607 patients aged ≥75 years with left ventricular ejection fraction (LVEF) of ≤35 %, of whom 78 met the guidelines for indication of CRT. Based on the decision of the patients or attending cardiologists, 34 patients received a CRT defibrillator (CRT-D).
  
  
  RESULTS
  The age of patients with a CRT indication was 80 ± 4 years, and 73 % were males. As compared with patients on medical therapy, CRT-D patients were younger (79 ± 3 vs. 83 ± 4, P < 0.001), had lower LVEF (23 ± 7 vs. 27 ± 7 %, P = 0.008) and higher rate of decompensated heart failure episodes (77 vs. 55 %, P = 0.04), were more frequently New York Heart Association (NYHA) class III-IV (53 vs. 25 %, P = 0.01), and were more likely to be on beta-blockers (88 vs. 66 %, P = 0.023), anticoagulants (61 vs. 32 % P = 0.02), and anti-aldosterone drugs (82 vs. 50 %, P = 0.003). After a median follow-up of 26 months, seven patients in the CRT-D group (21 %) and 20 non-CRT patients (46 %) died (hazard ratio (HR) 0.16 [95 % confidence interval (CI) 0.06-0.46]). The end point of mortality or hospitalization was not reduced because of a similar rate of hospitalizations for heart failure of CRT-D patients. Four CRT-D patients (12 %) had received appropriate device therapy, and one had been inappropriately discharged. During follow-up, 44 % of CRT-D patients improved their LVEF by >40 %.
  
  
  CONCLUSIONS
  CRT-D is potentially of benefit in terms of mortality in our population; this effect persists after correction for use of beta-blockers. In patients ≥75 years, CRT indications should be similar to those accepted for younger subjects.
authors: Hospital Universitario Fundación Jiménez Díaz - idcsalud, Universidad Autónoma de Madrid, Madrid, Spain.
authors: Elena
authors: E
authors: de la Cruz
authors: Marcelino
authors: M
authors: Cortés
authors: Jerónimo
authors: J
authors: Farré
authors: Julia
authors: J
authors: Palfy
authors: Paloma
authors: P
authors: Ávila
authors: Ignacio
authors: I
authors: Hernández
authors: Angélica
authors: A
authors: Romero
authors: Juan
authors: J
authors: Benezet
authors: Juan Antonio
authors: JA
authors: Franco
authors: Miguel Angel
authors: MA
authors: Navas
authors: Jose Joel
authors: JJ
authors: Hernandez
authors: Sem
authors: S
authors: Briongos
authors: José M
authors: JM
authors: Rubio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy / Q000401:mortality* / Q000706:statistics & numerical data*; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy / Q000401:mortality / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000517:prevention & control*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D002316:Cardiotonic Agents