Clinical outcomes of cardiac resynchronization therapy with and without a defibrillator in elderly patients with heart failure
Abstract Background Evidence regarding the incremental benefit of cardiac resynchronization therapy (CRT) with a defibrillator (CRT‐D) versus without (CRT‐P) in elderly patients with heart failure is limited. We compared mortality and cardiac hospitalisation between CRT‐D and CRT‐P in the elderly. M...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2019-02-01
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| Series: | Journal of Arrhythmia |
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| Online Access: | https://doi.org/10.1002/joa3.12131 |
| _version_ | 1819124093058809856 |
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| author | Simon Christie Brett Hiebert Colette M. Seifer Clarence Khoo |
| author_facet | Simon Christie Brett Hiebert Colette M. Seifer Clarence Khoo |
| author_sort | Simon Christie |
| collection | DOAJ |
| description | Abstract Background Evidence regarding the incremental benefit of cardiac resynchronization therapy (CRT) with a defibrillator (CRT‐D) versus without (CRT‐P) in elderly patients with heart failure is limited. We compared mortality and cardiac hospitalisation between CRT‐D and CRT‐P in the elderly. Methods A retrospective chart review identified all consecutive patients with age ≥75 with CRT implantation over the last 10 years at a Canadian tertiary care cardiac centre. Kaplan‐Meier survival analyses and cumulative incidence curves were used to compare mortality and time to first cardiac hospitalisation, respectively, with CRT‐D versus CRT‐P over a 3 year period. Analyses were also repeated with propensity score matching based on age, sex, primary versus secondary prevention, date of implant, and Charlson Comorbidity Index. Results One hundred and seventy CRT patients were identified. A total of 128 received CRT‐D while 42 received CRT‐P. Median age was 79 (IQR 77‐81), and the majority were male (83%). CRT‐P patients had a higher burden of comorbidities (Charlson score 7, IQR 6‐8) than CRT‐D patients (Charlson score 5, IQR 5‐7; P < 0.001). There was no significant difference in survival between the two groups in an unmatched comparison (P = 0.69) and with a propensity score‐matched cohort (P = 0.91). Secondary prevention CRT‐D patients had a higher risk of hospitalisation compared to primary prevention CRT‐D patients; however, there was no significant difference in hospitalisation between the CRT‐D and CRT‐P groups. Conclusion This study suggests there is no significant difference in mortality or cardiac hospitalisation between CRT‐D and CRT‐P in elderly patients with heart failure. |
| first_indexed | 2024-12-22T07:18:45Z |
| format | Article |
| id | doaj.art-24df9fe86e484a6c8b1fe40c3da6fc39 |
| institution | Directory Open Access Journal |
| issn | 1880-4276 1883-2148 |
| language | English |
| last_indexed | 2024-12-22T07:18:45Z |
| publishDate | 2019-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Arrhythmia |
| spelling | doaj.art-24df9fe86e484a6c8b1fe40c3da6fc392022-12-21T18:34:20ZengWileyJournal of Arrhythmia1880-42761883-21482019-02-01351616910.1002/joa3.12131Clinical outcomes of cardiac resynchronization therapy with and without a defibrillator in elderly patients with heart failureSimon Christie0Brett Hiebert1Colette M. Seifer2Clarence Khoo3Max Rady College of Medicine University of Manitoba Winnipeg Manitoba CanadaCardiac Sciences Program Winnipeg Regional Health Authority Winnipeg Manitoba CanadaSection of Cardiology University of Manitoba Winnipeg Manitoba CanadaSection of Cardiology University of Manitoba Winnipeg Manitoba CanadaAbstract Background Evidence regarding the incremental benefit of cardiac resynchronization therapy (CRT) with a defibrillator (CRT‐D) versus without (CRT‐P) in elderly patients with heart failure is limited. We compared mortality and cardiac hospitalisation between CRT‐D and CRT‐P in the elderly. Methods A retrospective chart review identified all consecutive patients with age ≥75 with CRT implantation over the last 10 years at a Canadian tertiary care cardiac centre. Kaplan‐Meier survival analyses and cumulative incidence curves were used to compare mortality and time to first cardiac hospitalisation, respectively, with CRT‐D versus CRT‐P over a 3 year period. Analyses were also repeated with propensity score matching based on age, sex, primary versus secondary prevention, date of implant, and Charlson Comorbidity Index. Results One hundred and seventy CRT patients were identified. A total of 128 received CRT‐D while 42 received CRT‐P. Median age was 79 (IQR 77‐81), and the majority were male (83%). CRT‐P patients had a higher burden of comorbidities (Charlson score 7, IQR 6‐8) than CRT‐D patients (Charlson score 5, IQR 5‐7; P < 0.001). There was no significant difference in survival between the two groups in an unmatched comparison (P = 0.69) and with a propensity score‐matched cohort (P = 0.91). Secondary prevention CRT‐D patients had a higher risk of hospitalisation compared to primary prevention CRT‐D patients; however, there was no significant difference in hospitalisation between the CRT‐D and CRT‐P groups. Conclusion This study suggests there is no significant difference in mortality or cardiac hospitalisation between CRT‐D and CRT‐P in elderly patients with heart failure.https://doi.org/10.1002/joa3.12131cardiac resynchronization therapydefibrillatordeviceelderlyheart failure |
| spellingShingle | Simon Christie Brett Hiebert Colette M. Seifer Clarence Khoo Clinical outcomes of cardiac resynchronization therapy with and without a defibrillator in elderly patients with heart failure Journal of Arrhythmia cardiac resynchronization therapy defibrillator device elderly heart failure |
| title | Clinical outcomes of cardiac resynchronization therapy with and without a defibrillator in elderly patients with heart failure |
| title_full | Clinical outcomes of cardiac resynchronization therapy with and without a defibrillator in elderly patients with heart failure |
| title_fullStr | Clinical outcomes of cardiac resynchronization therapy with and without a defibrillator in elderly patients with heart failure |
| title_full_unstemmed | Clinical outcomes of cardiac resynchronization therapy with and without a defibrillator in elderly patients with heart failure |
| title_short | Clinical outcomes of cardiac resynchronization therapy with and without a defibrillator in elderly patients with heart failure |
| title_sort | clinical outcomes of cardiac resynchronization therapy with and without a defibrillator in elderly patients with heart failure |
| topic | cardiac resynchronization therapy defibrillator device elderly heart failure |
| url | https://doi.org/10.1002/joa3.12131 |
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