title: Does Age Influence Cardiac Resynchronization Therapy Use and Outcome?
abstract: OBJECTIVE
  This study sought to describe the use of CRT-D and its association with survival for older patients.
  
  
  BACKGROUND
  Many patients who receive cardiac resynchronization therapy with defibrillator (CRT-D) in practice are older than those included in clinical trials.
  
  
  METHODS
  We identified patients undergoing ICD implantation in the National Cardiovascular Disease Registry (NCDR) ICD registry from 2006 to 2009, who also met clinical trial criteria for CRT, including left ventricular ejection fraction (LVEF) ≤35%, QRS ≥120 ms, and New York Heart Association (NYHA) functional class III or IV. NCDR registry data were linked to the social security death index to determine the primary outcome of time to death from any cause. We identified 70,854 patients from 1,187 facilities who met prior trial criteria for CRT-D. The mean age of the 58,147 patients receiving CRT-D was 69.4 years with 6.4% of patients age 85 or older. CRT use was 80% or higher among candidates in all age groups. Follow-up was available for 42,285 patients age ≥65 years at 12 months.
  
  
  RESULTS
  Receipt of CRT-D was associated with better survival at 1 year (82.1% vs. 77.1%, respectively) and 4 years (54.0% vs. 46.2% , respectively) than in those receiving only an ICD (p < 0.001). The CRT association with improved survival was not different for different age groups (p = 0.86 for interaction).
  
  
  CONCLUSIONS
  More than 80% of older patients undergoing ICD implantation who were candidates for a CRT-D received the combined device. Mortality in older patients undergoing ICD implantation was high but was lower for those receiving CRT-D.
authors.affiliation: Veterans Administration Palo Alto Healthcare System, Palo Alto, California. Electronic address: heiden@standford.edu.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Heidenreich
authors.affiliation: Palo Alto Medical Foundation, Palo Alto, California.
authors.forename: Vivian
authors.initials: V
authors.lastname: Tsai
authors.affiliation: Department of Medicine, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Haikun
authors.initials: H
authors.lastname: Bao
authors.affiliation: Department of Medicine, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Jeptha
authors.initials: J
authors.lastname: Curtis
authors.affiliation: Veterans Administration Palo Alto Healthcare System, Palo Alto, California.
authors.forename: Mary
authors.initials: M
authors.lastname: Goldstein
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Lesley
authors.initials: L
authors.lastname: Curtis
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Adrian
authors.initials: A
authors.lastname: Hernandez
authors.affiliation: University of Colorado Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Pamela
authors.initials: P
authors.lastname: Peterson
authors.affiliation: Veterans Administration Palo Alto Healthcare System, Palo Alto, California.
authors.forename: Mintu P
authors.initials: MP
authors.lastname: Turakhia
authors.affiliation: University of Colorado Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy / Q000401:mortality / Q000706:statistics & numerical data*; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000628:therapy; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D012042:Registries; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology
keywords: cardiac resynchronization therapy; elderly; heart failure