Abstract 4850: Cardiac Resynchronisation Therapy in Elderly Patients: Outcome Data. A Secondary Analysis of CARE-HF
In elderly patients, the clinical impact of cardiac resynchronization therapy (CRT) is not clearly defined. Controlled data on clinical efficacy and safety of are very scarce. The CARE-HF study was the first multi-center randomized trial to demonstrate that CRT by atrio-biventricular pacing reduces all-cause mortality while decreasing major morbidity in NYHA Class III-IV HF patients with wide QRS. This post-hoc analysis reports outcome data in the sub-population of patients aged ≥70 yrs. The primary end point was time to death from any cause or unplanned hospitalization for a major cardiovascular event. Main secondary endpoints were death from any cause and composite of death from any cause and unplanned hospitalization with heart failure. 302 pts, mean age 75.1 yrs, were randomized to CRT (N=157) or medical treatment (MT:N=145) and followed for a mean of 28.9 months with a 6-mo additional period for mortality assessment (extension study). There were no significant differences between the two groups in baseline characteristics including HF pharmacological treatment. Overall, 91.7% pts received ACE-I or ARB and 64.8% a Beta-blocker. HF was of ischemic etiology in 51% pts and mean QRS width was 165 ms. Results: The primary endpoint was reached by 68 pts in the CRT group as compared with 85 in the MT group (43.3% vs 58.6%; HR, 0.67; 95% CI, 0.48 to 0.92; p=0.015). There were 36 deaths in CRT as compared with 57 in MT (22.9% vs 39.3%; HR, 0.55; 95% CI, 0.36 to 0.84; p<0.001. At the end of the extension period, the mortality rate was 30.6% and 48.3%, respectively (p=0.002). The secondary composite endpoint was reached by 51 pts in CRT and 79 in MT (32.5% vs 54.5%, HR, 0.51; 95% CI, 0.36 to 0.73, p=0.0001).
Conclusion: In elderly patients with HF and wide QRS, CRT has a major impact on severe HF morbidity and all-cause mortality, similar to what was previously observed in the overall CARE-HF population.