Abstract 14866: Comparison of Optimal Pharmacological Treatment and Cardiac Resynchronization Therapy in Patients over 75 Years
INTRODUCTION: Cardiac Resynchronization Therapy (CRT) for heart failure (HF) improves clinical outcomes and may reduce mortality in selected patients. Its role in very elderly patients (> 75 years) is not well established.
METHODS: From January 2008 to March 2011 we have recruited prospectively 472 patients aged > 75 years that had a left ventricular ejection fraction (LVEF) ≤ 35%. From this group we identified 66 patients with a potential indication for according to current recommendations. The clinical characteristics of the patients at baseline and during a minimal follow-up of one year were collected. The final indication of a CRT device was based on the decision of the patient and/or the attending cardiologist.
RESULTS: The mean age of the 66 patients with a potential profile for a CRT device implant was 80.1±4.16 years and 72.7% were males. During follow up a CRT-ICD was implanted in 26 cases (39.4%). This group was significantly younger (78.5 vs. 81.1, p 0.01), and with a lower LVEF (22.5% vs 26.4%, p 0.03) than those on medical therapy alone. There were not significant differences in relation with the etiology and additional comorbidities . CRT patients received beta blockers more frequently that medically treated patients (92.0% vs 72.5%, p 0.04), but treatment was otherwise similar in both groups. After a follow up of 27.6±11.62 months, 12 patients (18.2%) died (4 (15,4%) in CRT group, vs 8 (20.0%), p NS) and 31 (47%) had an event (death or hospitalization) (14 (53.8%) in CRT group, vs 17 (43.6%), p NS). Eleven patients with CRT (47.8%) improved their ejection fraction more than 10% (vs 7.5%, p 0.001), and 8 (34.8%) improved their functional class (vs 13.9%, p 0.05). Survival analysis by Cox regression did not show a significant benefit with the CRT in mortality or hospitalizations for HF.
CONCLUSION: In our population of patients aged >75 years), CRT improved functional class and LVEF in more than one third of the patients but this change did not result in a significant significant reduction of mortality of hospitalization for HF. A specific controlled trial to determine the role of CRT in these patients is warranted.
- © 2012 by American Heart Association, Inc.