56-67: Morbidity and Mortality with Cardiac Resynchronization Therapy with Pacing (CRT-P) versus with Defibrillation (CRT-D) in Octogenarian Patients in a Real-World Setting Academic Article uri icon

abstract

  • Background: Cardiac resynchronization therapy with a defibrillator (CRT-D) has the downsides of high cost and inappropriate shocks compared to CRT without a defibrillator (CRT-P). Recent studies suggest that aging is associated with a significant reduction in the incidence of ventricular tachy-arrhythmias and of appropriate ICD shocks. We hypothesized that among octogenarians, CRT-P therapy may confer similar morbidity and mortality benefits as CRT-D. Methods: We compared two groups of consecutive patients aged ≥80 years: those who underwent CRT-P implantation and follow-up at Barzilai MC (n = 142) versus octogenarians implanted with CRT-D for primary prevention indication who were enrolled and followed-up in the Israeli ICD Registry (n = 104). Results: Among the total 246 study patients, mean age was 83.5 ± 3 years. 74% were males and 66% had ischemic heart disease. Kaplan-Meier survival analysis showed that at 5 years of follow-up the cumulative probability of all-cause mortality was 40% in the CRT-P group versus 55% in the CRT-D group (log-rank p = 0.126). Consistently, the adjusted hazard ratio (HR) of mortality between the two groups was 1.27 (95% CI 0.74-2.16, p = 0.37). Kaplan-Meier analysis also showed no statistical difference for the combination of death and first hospitalization for heart failure (HF) (p = 0.359) and the adjusted HR was 1.17 (95% CI 0.69-1.97, p = 0.55). A Cox proportional hazard with competing risk model showed that re-hospitalizations for cardiac cause were not different for the two groups (adjusted HR 1.35, 95% CI 0.7-2.6, p = 0.37). Conclusion: In octogenarians with systolic HF enrolled in a real-world scenario, CRT-P therapy is associated with similar morbidity and mortality outcomes as CRT-D therapy. These findings suggest that, in older patients, implantation of CRT-P alone, without defibrillator therapy, may be considered as an alternative to CRT-D. View largeDownload slide View largeDownload slide

publication date

  • January 1, 2016