title: Morbidity and mortality with cardiac resynchronization therapy with pacing vs. with defibrillation in octogenarian patients in a real-world setting.
abstract: OBJECTIVE
  Cardiac resynchronization therapy (CRT) with a defibrillator (CRT-D) has downsides of high cost and inappropriate shocks compared to CRT without a defibrillator (CRT-P). Recent data suggest that the survival benefit of implantable cardioverter defibrillator (ICD) therapy is attenuated in the older age group. We hypothesized that, among octogenarians eligible for cardiac resynchronization therapy, CRT-P confers similar morbidity and mortality benefits as CRT-D.
  
  
  RESULTS
  We compared morbidity and mortality outcomes between consecutive octogenarian patients eligible for CRT therapy who underwent CRT-P implantation at Barzilai MC (n = 142) vs. those implanted with CRT-D for primary prevention indication who were prospectively enrolled in the Israeli ICD Registry (n = 104). Among the 246 study patients, mean age was 84 ± 3 years, 74% were males, and 66% had ischaemic cardiomyopathy. Kaplan-Meier survival analysis showed that at 5 years of follow-up the rate of all-cause mortality was 43% in CRT-P vs. 57% in the CRT-D group [log-rank P = 0.13; adjusted hazard ratio (HR) = 0.79, 95% CI 0.46-1.35, P = 0.37]. Kaplan-Meier analysis also showed no significant difference in the rates of the combined endpoint of heart failure or death (46 vs. 60%, respectively, log-rank P = 0.36; adjusted HR was 0.85, 95% CI 0.51-1.44, P = 0.55). A Cox proportional hazard with competing risk model showed that re-hospitalizations for cardiac cause were not different for the two groups (adjusted HR 1.35, 95% CI 0.7-2.6, P = 0.37).
  
  
  CONCLUSIONS
  Our data suggest that, in octogenarians with systolic heart failure, CRT-P therapy is associated with similar morbidity and mortality outcomes as CRT-D therapy.
authors.affiliation: Electrophysiology and Pacing Unit, Department of Cardiology, Barzilai University Medical Center, Ashkelon and Faculty of Health Sciences, Ben-Gurion University of the Negev, 2 Hahistadrut Street, Ashkelon 78278, Israel.
authors.forename: Avishag
authors.initials: A
authors.lastname: Laish-Farkash
authors.affiliation: Electrophysiology and Pacing Unit, Department of Cardiology, Barzilai University Medical Center, Ashkelon and Faculty of Health Sciences, Ben-Gurion University of the Negev, 2 Hahistadrut Street, Ashkelon 78278, Israel.
authors.forename: Sharon
authors.initials: S
authors.lastname: Bruoha
authors.affiliation: Electrophysiology and Pacing Unit, Department of Cardiology, Barzilai University Medical Center, Ashkelon and Faculty of Health Sciences, Ben-Gurion University of the Negev, 2 Hahistadrut Street, Ashkelon 78278, Israel.
authors.forename: Amos
authors.initials: A
authors.lastname: Katz
authors.affiliation: The Israeli Association for Cardiovascular Trials, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.affiliation: Department of Cardiology, Rambam Medical Center, Haifa, Israel.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Suleiman
authors.affiliation: Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors.forename: Yoav
authors.initials: Y
authors.lastname: Michowitz
authors.affiliation: The Israeli Association for Cardiovascular Trials, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Nir
authors.initials: N
authors.lastname: Shlomo
authors.affiliation: The Israeli Association for Cardiovascular Trials, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Michal
authors.initials: M
authors.lastname: Einhorn-Cohen
authors.affiliation: Electrophysiology and Pacing Unit, Department of Cardiology, Barzilai University Medical Center, Ashkelon and Faculty of Health Sciences, Ben-Gurion University of the Negev, 2 Hahistadrut Street, Ashkelon 78278, Israel.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Khalameizer
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects / Q000401:mortality*; D058409:Cardiac Resynchronization Therapy Devices; D002423:Cause of Death; D016009:Chi-Square Distribution; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007557:Israel; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D010359:Patient Readmission; D011322:Primary Prevention / Q000295:instrumentation*; D057216:Propensity Score; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cardiac resynchronization therapy; Morbidity; Mortality; Octogenarians