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Comparison of pharmacological treatment alone versus treatment combined with cardiac resynchronization therapy in patients over 75 years

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Abstract

Background

The role of cardiac resynchronization therapy (CRT) in patients aged ≥75 years is not well established.

Methods

We identified 607 patients aged ≥75 years with left ventricular ejection fraction (LVEF) of ≤35 %, of whom 78 met the guidelines for indication of CRT. Based on the decision of the patients or attending cardiologists, 34 patients received a CRT defibrillator (CRT-D).

Results

The age of patients with a CRT indication was 80 ± 4 years, and 73 % were males. As compared with patients on medical therapy, CRT-D patients were younger (79 ± 3 vs. 83 ± 4, P < 0.001), had lower LVEF (23 ± 7 vs. 27 ± 7 %, P = 0.008) and higher rate of decompensated heart failure episodes (77 vs. 55 %, P = 0.04), were more frequently New York Heart Association (NYHA) class III–IV (53 vs. 25 %, P = 0.01), and were more likely to be on beta-blockers (88 vs. 66 %, P = 0.023), anticoagulants (61 vs. 32 % P = 0.02), and anti-aldosterone drugs (82 vs. 50 %, P = 0.003). After a median follow-up of 26 months, seven patients in the CRT-D group (21 %) and 20 non-CRT patients (46 %) died (hazard ratio (HR) 0.16 [95 % confidence interval (CI) 0.06–0.46]). The end point of mortality or hospitalization was not reduced because of a similar rate of hospitalizations for heart failure of CRT-D patients. Four CRT-D patients (12 %) had received appropriate device therapy, and one had been inappropriately discharged. During follow-up, 44 % of CRT-D patients improved their LVEF by >40 %.

Conclusion

CRT-D is potentially of benefit in terms of mortality in our population; this effect persists after correction for use of beta-blockers. In patients ≥75 years, CRT indications should be similar to those accepted for younger subjects.

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References

  1. Mosterd, A., & Hoes, A. W. (2007). Clinical epidemiology of heart failure. Heart, 93, 1137–1146.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Bristow, M. R., Saxon, L. A., Boehmer, J., Krueger, S., Kass, D. A., De Marco, T., Carson, P., DiCarlo, L., DeMets, D., White, B. G., DeVries, D. W., & Feldman, A. M. (2004). Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. New England Journal of Medicine, 350, 2140–2150.

    Article  CAS  PubMed  Google Scholar 

  3. Cesario, D. A., Turner, J. W., & Dec, G. W. (2007). Biventricular pacing and defibrillator use in chronic heart failure. Cardiology Clinics, 25, 595–603.

    Article  PubMed  Google Scholar 

  4. Silverman, M. E., Pressel, M. D., Brackett, J. C., Lauria, S. S., Gold, M. R., & Gottlieb, S. S. (1995). Prognostic value of the signal-averaged electrocardiogram and a prolonged QRS in ischemic and nonischemic cardiomyopathy. American Journal of Cardiology, 75, 460–464. 180.

    Article  CAS  PubMed  Google Scholar 

  5. Fried, A. G., Parker, A. B., Newton, G. E., & Parker, J. D. (1999). Electrical and hemodynamic correlates of the maximal rate of pressure increase in the human left ventricle. Journal of Cardiac Failure, 5, 8–16. 181.

    Article  CAS  PubMed  Google Scholar 

  6. Wilensky, R. L., Yudelman, P., Cohen, A. I., Fletcher, R. D., Atkinson, J., Virmani, R., & Roberts, W. C. (1988). Serial electrocardiographic changes in idiopathic dilated cardiomyopathy confirmed at necropsy. American Journal of Cardiology, 62, 276–283.

    Article  CAS  PubMed  Google Scholar 

  7. Sogaard, P., Kim, W. Y., Jensen, H. K., Mortensen, P., Pedersen, A. K., Kristensen, B. Ø., & Egeblad, H. (2001). Impact of acute biventricular pacing on left ventricular performance and volumes in patients with severe heart failure: a tissue Doppler and three-dimensional echocardiographic study. Cardiology, 95, 173–182.

    Article  CAS  PubMed  Google Scholar 

  8. Young, J. B., Abraham, W. T., Smith, A. L., Leon, A. R., Lieberman, R., Wilkoff, B., Canby, R. C., Schroeder, J. S., Liem, L. B., Hall, S., & Wheelan, K. (2003). Combined cardiac resynchronization and implantable cardioversion defibrillation in advanced chronic heart failure: the MIRACLE ICD Trial. Journal of the American Medical Association, 289, 2685–2694.

  9. Cleland, J. G., Daubert, J. C., Erdmann, E., Freemantle, N., Gras, D., Kappenberger, L., & Tavazzi, L. (2005). The effect of cardiac resynchronization on morbidity and mortality in heart failure. New England Journal of Medicine, 352, 1539–1549.

    Article  CAS  PubMed  Google Scholar 

  10. Moss, A. J., Hall, W. J., Cannom, D. S., Klein, H., Brown, M. W., Daubert, J. P., Estes, N. A., 3rd, Foster, E., Greenberg, H., Higgins, S. L., Pfeffer, M. A., Solomon, S. D., Wilber, D., & Zareba, W. (2009). Cardiac resynchronization therapy for the prevention of heart-failure events. New England Journal of Medicine, 361, 1329–1338.

    Article  PubMed  Google Scholar 

  11. Abraham, W. T., Fisher, W. G., Smith, A. L., Delurgio, D. B., Leon, A. R., Loh, E., Kocovic, D. Z., Packer, M., Clavell, A. L., Hayes, D. L., Ellestad, M., Trupp, R. J., Underwood, J., Pickering, F., Truex, C., McAtee, P., & Messenger, J. (2002). Cardiac resynchronization in chronic heart failure. New England Journal of Medicine, 346, 1845–1853.

    Article  PubMed  Google Scholar 

  12. Gold, M. R., Thebault, C., Linde, C., Abraham, W. T., Gerritse, B., Ghio, S., St John Sutton, M., & Daubert, J. C. (2012). Effect of QRS duration and morphology on cardiac resynchronization therapy outcomes in mild heart failure: results from the Resynchronization Reverses Remodelling in Systolic Left Ventricular Dysfunction (REVERSE) study. Circulation, 126, 822–829.

    Article  PubMed  Google Scholar 

  13. Auricchio, A., Stellbrink, C., Butter, C., Sack, S., Vogt, J., Misier, A. R., Bocker, D., Block, M., Kirkels, J. H., Kramer, A., & Huvelle, E. (2003). Clinical efficacy of cardiac resynchronization therapy using left ventricular pacing in heart failure patients stratified by severity of ventricular conduction delay. Journal of the American College of Cardiology, 42, 2109–2116.

    Article  PubMed  Google Scholar 

  14. Cazeau, S., Leclercq, C., Lavergne, T., Walker, S., Varma, C., Linde, C., Garrigue, S., Kappenberger, L., Haywood, G. A., Santini, M., Bailleul, C., & Daubert, J. C. (2001). Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. New England Journal of Medicine, 344, 873–880.

    Article  CAS  PubMed  Google Scholar 

  15. Higgins, S. L., Hummel, J. D., Niazi, I. K., Giudici, M. C., Worley, S. J., Saxon, L. A., Boehmer, J. P., Higginbotham, M. B., De Marco, T., Foster, E., & Yong, P. G. (2003). Cardiac resynchronization therapy for the treatment of heart failure in patients with intraventricular conduction delay and malignant ventricular tachyarrhythmias. Journal of the American College of Cardiology, 42, 1454–1459.

    Article  PubMed  Google Scholar 

  16. Abraham, W. T., Young, J. B., Leon, A. R., Adler, S., Bank, A. J., Hall, S. A., Lieberman, R., Liem, L. B., O’Connell, J. B., Schroeder, J. S., & Wheelan, K. R. (2004). Effects of cardiac resynchronization on disease progression in patients with left ventricular systolic dysfunction, an indication for an implantable cardioverter-defibrillator, and mildly symptomatic chronic heart failure. Circulation, 110, 2864–2868.

    Article  PubMed  Google Scholar 

  17. Linde, C., Abraham, W. T., Gold, M. R., St John Sutton, M., Ghio, S., & Daubert, C. (2008). Randomized trial of cardiac resynchronization in mildly symptomatic heart failure patients and in asymptomatic patients with left ventricular dysfunction and previous heart failure symptoms. Journal of the American College of Cardiology, 52, 1834–1843.

    Article  PubMed  Google Scholar 

  18. Tang, A. S., Wells, G. A., Talajic, M., Arnold, M. O., Sheldon, R., Connolly, S., Hohnloser, S. H., Nichol, G., Birnie, D. H., Sapp, J. L., Yee, R., Healey, J. S., & Rouleau, J. L. (2010). Cardiac-resynchronization therapy for mild-to-moderate heart failure. New England Journal of Medicine, 363, 2385–2395.

    Article  CAS  PubMed  Google Scholar 

  19. Penn, J., Goldenberg, I., Moss, A. J., McNitt, S., Zareba, W., Klein, H. U., Cannom, D. S., Solomon, S. D., Barsheshet, A., & Huang, D. T. (2011). Improved outcome with preventive cardiac resynchronization therapy in the elderly: a MADIT-CRT substudy; MADIT-CRT Trial investigators. Journal of Cardiovascular Electrophysiology, 22(8), 892–897.

    Article  PubMed  Google Scholar 

  20. Kron, J., Aranda, J. M., Miles, W. M., Burkart, T. A., Woo, G. W., Saxonhouse, S. J., Sears, S. F., Jr., & Conti, J. B. (2009). Benefit of cardiac resynchronization in elderly patients: results from the Multicenter InSync Randomized Clinical Evaluation (MIRACLE) and Multicenter InSync ICD Randomized Clinical Evaluation (MIRACLE-ICD) trials. Journal of Interventional Cardiac Electrophysiology, 25, 91–96.

    Article  PubMed  Google Scholar 

  21. Dickstein, K., Vardas, P. E., Auricchio, A., Daubert, J. C., Linde, C., McMurray, J., Ponikowski, P., Priori, S. G., Sutton, R., & van Veldhuisen, D. J. (2010). Focused Update of ESC Guidelines on device therapy in heart failure. Europace, 12, 1526–1536.

    Article  PubMed  Google Scholar 

  22. Bleeker, G. B., Schalij, M. J., Molhoek, S. G., Boersma, E., Steendijk, P., van der Wall, E. E., & Bax, J. J. (2005). Comparison of cardiac resynchronization therapy in patients 70 versus >70 years of age. American Journal of Cardiology, 96, 420–422.

    Article  PubMed  Google Scholar 

  23. Delnoy, P. P., Ottervanger, J. P., Luttikhuis, H. O., Elvan, A., Misier, A. R., Beukema, W. P., & van Hemel, N. M. (2008). Clinical response of cardiac resynchronization therapy in the elderly. American Heart Journal, 155, 746–751.

    Article  PubMed  Google Scholar 

  24. Killu, A. M., Jia-Hui, W., Friedman, P. A., Webster, T. L., Brooker, K. L., Hodge, D. O., Wiste, H. J., & Yong-Mei, C. (2013). Outcomes of cardiac resynchronization therapy in the elderly. Pacing and Clinical Electrophysiology, 36, 664–672.

  25. António, N., Lourenço, C., Teixeira, R., Saraiva, F., Coelho, L., Ventura, M., Cristóvão, J., Elvas, L., Gonçalves, L., & Providência, L. A. (2010). Cardiac resynchronization therapy is effective even in elderly patients with comorbidities. Journal of Interventional Cardiac Electrophysiology, 27, 61–68.

    Article  PubMed  Google Scholar 

  26. Verbrugge, F. H., Dupont, M., De Vusser, P., Rivero-Ayerza, M., Van Herendael, H., Vercammen, J., Jacobs, L., Verhaert, D., Vandervoort, P., Tang, W. H., & Mullens, W. (2013). Response to cardiac resynchronization therapy in elderly patients (≥70 years) and octogenarians. European Journal of Heart Failure, 15, 203–210.

    Article  PubMed  Google Scholar 

  27. Suleiman, M., Goldenberg, I., Haim, M., Schliamser, J. E., Boulos, M., Ilan, M., Swissa, M., Gavrielov-Yusim, N., Fuchs, T., Amit, G., & Glikson, M. (2014). Clinical characteristics and outcomes of elderly patients treated with an implantable cardioverter-defibrillator or cardiac resynchronization therapy in a real-world setting: data from the Israeli ICD Registry. Heart Rhythm, 11, 435–441.

    Article  PubMed  Google Scholar 

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Acknowledgments

Acknowledgment is given to Oliver Shaw.

Conflict of interest

The authors report no relationships that could be construed as a conflict of interest.

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Authors and Affiliations

  1. Hospital Universitario Fundación Jiménez Díaz – idcsalud, Universidad Autónoma de Madrid, Madrid, Spain

    Elena de la Cruz, Marcelino Cortés, Jerónimo Farré, Julia Palfy, Paloma Ávila, Ignacio Hernández, Angélica Romero, Juan Benezet, Juan Antonio Franco, Miguel Angel Navas, Jose Joel Hernandez, Sem Briongos & José M. Rubio

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  1. Elena de la Cruz
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  2. Marcelino Cortés
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  3. Jerónimo Farré
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Correspondence to Marcelino Cortés.

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de la Cruz, E., Cortés, M., Farré, J. et al. Comparison of pharmacological treatment alone versus treatment combined with cardiac resynchronization therapy in patients over 75 years. J Interv Card Electrophysiol 43, 13–20 (2015). https://doi.org/10.1007/s10840-015-9979-2

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  • DOI: https://doi.org/10.1007/s10840-015-9979-2

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