title: Complications and 1-year benefit of cardiac resynchronization therapy in patients over 75 years of age - Insights from the German Device Registry.
abstract: OBJECTIVE
  Evidence on cardiac resynchronization therapy (CRT) in older patients is scarce and conflicting. Nevertheless, CRT in the elderly is of major practical relevance as heart failure prevalence increases with age.
  
  
  METHODS
  The German Device Registry (DEVICE) is a nationwide, prospective registry with a longitudinal follow-up design investigating device implantations in 60 German centres. The present analysis of DEVICE focussed on perioperative complication rates and 1-year outcome of patients ≥75years (n=320) compared to younger patients (n=879) receiving a CRT device.
  
  
  RESULTS
  Comorbidities were more common in older patients (chronic kidney disease (CKD): 27.5% vs. 21.5%, p=0.029; atrial fibrillation (AF): 26.9% vs. 15.6%, p<0.001). Despite higher NYHA classes in the older age group, ejection fractions were comparable (27.2±7.1% ≥75years, 26.2±7.1% <75years, p=0.06). Perioperative complications and mortality rates did not show significant difference between groups. After new device implantation, absolute 1-year mortality was higher in older patients (11.0% ≥75years, 6.4% <75years, p=0.014), with a significantly lower proportion of cardiac deaths in the older group (p=0.05). Patients ≥75years being alive after 1year had lower response rates, with chronic kidney disease (OR 0.46, p<0.05) and smaller QRS complexes (OR 0.31, p<0.01) being particular risk factors for missing improvement of heart failure symptoms. As expected severe heart failure (NYHA IV) was a strong independent predictor of death (HR 1.95, p=0.01), whereas AF as underlying rhythm could be worked out as predictor for mortality especially in the younger patients (HR 2.31, p=0.002).
  
  
  CONCLUSIONS
  Patients ≥75years of age receiving a CRT device do not have a higher perioperative mortality and complication rate although comorbidities (CKD and AF) occur more frequently. The absolute 1-year mortality is higher; nevertheless, the proportion of cardiac deaths is even lower in the older patients reflecting a benefit of CRT in this group.
authors.affiliation: Division of Electrophysiology, University Hospital of Muenster, Germany. Electronic address: koebeju@ukmuenster.de.
authors.forename: Julia
authors.initials: J
authors.lastname: Köbe
authors.affiliation: Department of Cardiology, Vivantes Klinikum am Urban, Berlin, Germany.
authors.forename: Dietrich
authors.initials: D
authors.lastname: Andresen
authors.affiliation: Department of Cardiology, Klinikum Straubing, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Maier
authors.affiliation: Department of Cardiology, Klinikum Bielefeld, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Stellbrink
authors.affiliation: Department of Cardiology, Klinikum Ludwigshafen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kleemann
authors.affiliation: Department of Cardiology, St. Vincentius Kliniken Karlsruhe, Germany.
authors.forename: Bernd-Dieter
authors.initials: BD
authors.lastname: Gonska
authors.affiliation: Department of Cardiology, Heart Center Munich-Bogenhausen, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Reif
authors.affiliation: Stiftung Institut für Herzinfarktforschung (IHF), Ludwigshafen, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Hochadel
authors.affiliation: Stiftung Institut für Herzinfarktforschung (IHF), Ludwigshafen, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Senges
authors.affiliation: Division of Electrophysiology, University Hospital of Muenster, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Eckardt
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy; D058409:Cardiac Resynchronization Therapy Devices; D005260:Female; D005858:Germany / Q000453:epidemiology; D006333:Heart Failure / Q000150:complications / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D012042:Registries; D013997:Time Factors; D016896:Treatment Outcome
keywords: Age; Cardiac resynchronization therapy; Complications; Mortality; Registry