Clinical outcomes in cardiac resynchronization therapy-defibrillator recipients 80 years of age and older.
OBJECTIVE
Very elderly patients have not been well-represented in the randomized trials that established the benefits of cardiac resynchronization therapy (CRT) in heart failure (HF) patients. We therefore compared clinical outcomes in CRT-defibrillator (CRT-D) recipients ≥80 and <80 years old.


RESULTS
We compared mortality and time to first appropriate shock in 258 consecutive CRT-D patients ≥80 years old with New York Heart Association II-IV HF, left ventricular ejection fraction ≤35%, QRS duration ≥120 ms, and no prior sustained ventricular tachyarrhythmias to 1058 patients <80 years old implanted with CRT-D during the same timeframe. Comorbidities and medical therapy differed significantly between the groups. During 52 ± 36 months, 123 (48%) patients ≥80 and 474 (45%) patients <80 died; mortality was significantly higher among patients ≥80 [corrected hazard ratio (HR) 1.39, 95% confidence interval (CI) 1.12-1.72; P = 0.003]. Among 258 patients ≥80 with device follow-up, only 20 (8%) received an appropriate shock compared with 172 (17%) shocks in 1053 patients <80 years old. Time to first appropriate shock was significantly shorter in patients <80 (corrected HR 0.51, 95% CI 0.30-0.87, P = 0.013). Older patients experienced 14 inappropriate shocks, and while life-threatening device complications were rare, complications related to the high-power components of the CRT-D system were not infrequent (n = 11).


CONCLUSIONS
Mortality among CRT-D recipients ≥80 years old is higher than in younger patients but is not excessive. The risk of appropriate device shocks in older patients is relatively low and significantly less than in younger patients. These observations suggest that CRT-pacemakers should be given due consideration in elderly HF patients.
Heart and Vascular Institute, University of Pittsburgh, 200 Lothrop Street, PUH B535, Pittsburgh, PA 15213, USA adelsteinec@upmc.edu.
Evan C
EC
Adelstein
Heart and Vascular Institute, University of Pittsburgh, 200 Lothrop Street, PUH B535, Pittsburgh, PA 15213, USA.
Jeffrey
J
Liu
Heart and Vascular Institute, University of Pittsburgh, 200 Lothrop Street, PUH B535, Pittsburgh, PA 15213, USA.
Sandeep
S
Jain
Heart and Vascular Institute, University of Pittsburgh, 200 Lothrop Street, PUH B535, Pittsburgh, PA 15213, USA.
David
D
Schwartzman
Heart and Vascular Institute, University of Pittsburgh, 200 Lothrop Street, PUH B535, Pittsburgh, PA 15213, USA.
Andrew D
AD
Althouse
Heart and Vascular Institute, University of Pittsburgh, 200 Lothrop Street, PUH B535, Pittsburgh, PA 15213, USA.
Norman C
NC
Wang
Heart and Vascular Institute, University of Pittsburgh, 200 Lothrop Street, PUH B535, Pittsburgh, PA 15213, USA.
John
J
Gorcsan
Heart and Vascular Institute, University of Pittsburgh, 200 Lothrop Street, PUH B535, Pittsburgh, PA 15213, USA.
Samir
S
Saba
D000200:Action Potentials; D000367:Age Factors; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects / Q000401:mortality; D058409:Cardiac Resynchronization Therapy Devices / Q000009:adverse effects; D017147:Defibrillators, Implantable / Q000009:adverse effects; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D018579:Patient Selection; D011475:Prosthesis Failure; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
Cardiac resynchronization therapy; Elderly; Heart failure; Implantable cardioverter-defibrillator; Survival