Is cardiac resynchronisation therapy feasible, safe and beneficial in the very elderly

• Published in: Journal of geriatric cardiology : JGC Vol. 12; no. 5; pp. 497 - 501
• Main Authors: Olechowski, Bartosz, Sands, Rebecca, Zachariah, Donah, Andrews, Neil P, Balasubramaniam, Richard, Sopher, Mark, Paisey, John, Kalra, Paul R
• Format: Journal Article
• Language: English
• Published: China Science Press 01.09.2015
• Subjects: CRT; 同步化; 安全; 并发症; 心脏; 治疗; 老年人; 肾小球滤过率; Heart failure; Left ventricular dysfunction; Safety; Cardiac resynchronisation therapy; The elderly
• ISSN: 1671-5411
• DOI: 10.11909/j.issn.1671-5411.2015.05.003

Objective To evaluate whether cardiac resynchronisation therapy （CRT） implantation was feasible and safe in octogenarians and the asso- ciation with symptoms. Methods Consecutive patients undergoing CRT implantation were recruited from two UK centers. Patients grouped according to age： 〈 80 ＆ ≥ 80 years. Baseline demographics, complications and outcomes were compared between those groups. Results A total of 439 patients were included in this study, of whom 26% were aged ≥ 80 years. Octogenarians more often received cardiac resynchronization therapy pacemaker in comparison to cardiac resynchronisation therapy-defibrillator. Upgrade from pacemaker was common in both groups （16% 〈 80 years vs. 22% ≥ 80 years, P = NS）. Co-morbidities were similarly common in both groups （overall diabetes： 25%, atrial fibrillation： 23%, hypertension： 45%）. More patient age ≥ 80 years had significant chronic kidney disease （CKD, estimated glomerular filtration rate 〈 45 mL/min per 1.73 m^2, 44% vs. 22%, P 〈 0.01 ）. Overall complication rates （any） were similar in both groups （16% vs. 17%, P = NS）. Both groups demonstrated symptomatic benefit. One-year mortality rates were almost four fold greater in octogenarians as compared with the younger cohort （13.9% vs. 3.7%, P 〈 0.01）. Conclusions CRT appears to be safe in the very elderly despite extensive co-morbidity, and in particular frequent severe CKD. Symptomatic improvement appears to be meaningful. Strategies to increase the appropriate identification of elderly patients with CHF who are potential candidates for CRT are required.