Abstract and Introduction
Abstract
Background: Many patients eligible for cardiac resynchronization therapy (CRT) are over 80 years of age. Survival in this population and how it compares to the general octogenarian population has not been established.
Methods: We extracted clinical data on a cohort of 800 consecutive patients undergoing the new implantation of a CRT device between April 15, 2004 and August 6, 2007. Patients over age 80, with class III-IV New York Heart Association heart failure symptoms on optimal medical therapy undergoing initial CRT implantation, were included in the final cohort. Using the United States Social Security Period Life Table for 2006, fractional survival for octogenarians in the general population was calculated and matched to our cohort based on age and gender. A comparison was then made between octogenarians undergoing CRT compared to the general population.
Results: A total of 95 octogenarians who met inclusion criteria were identified, of whom 86.3% received a biventricular defibrillator and the remainder a biventricular pacemaker. Over a mean follow-up of 3.6 ± 1.5 years, there were 47 deaths (47.4%). The mean survival time was 4.1 years (95% CI 3.7–4.5), and survival at 2 years was 78.9%. Compared to the general octogenarian population, octogenarians receiving CRT had only modestly worse survival over the duration of follow-up with the survival curves diverging at 2 years of follow-up (P = 0.03).
Conclusions: Octogenarians with advanced heart failure have a reasonable mean survival time following CRT. All-cause mortality in this patient population is only modestly worse compared to the general octogenarian population. Therefore, in octogenarians deemed to be reasonable candidates, CRT should not be withheld based on age alone.
Introduction
Heart failure remains the fastest growing cardiovascular disease and carries a poor prognosis even in those fully optimized from a medical therapy standpoint.[1] The elderly population remains at highest risk for developing heart failure with a prevalence between 10% and 20%.[2] In patients with heart failure and a wide QRS complex, the beneficial effects of cardiac resynchronization therapy (CRT) have been well established.[3–7] Despite their high prevalence of heart failure, octogenarians were either excluded or significantly under-represented in the vast majority of clinical trials of CRT. Although roughly 20% of cardiac implantable electronic devices are implanted in patients ≥80 years of age, the data pertaining to outcomes in this group following CRT are sparse and conflicted.[8] The large majority of studies that do exist have compared outcomes in octogenarians receiving CRT to those in younger age groups. This comparison, however, does not provide a true means of gauging long-term survival in this population given certain selection biases, which are sure to exist. Survival among octogenarians with advanced heart failure receiving CRT compared to other octogenarians is unknown. The primary goal of this study was to compare survival among octogenarians undergoing CRT to an age- and gender-matched general octogenarian cohort.
Pacing Clin Electrophysiol. 2014;37(6):740-744. © 2014 Blackwell Publishing
