Cardiac resynchronization therapy in the elderly. How much is it safe and beneficial?
Heart failure is a widespread disease in the western world whose incidence and prevalence are constantly increasing, mainly involving the more advanced age groups. Cardiac resynchronization therapy (CRT) has been shown able to reduce sudden cardiac death and all-cause mortality in patients with hear...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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PAGEPress Publications
2019-03-01
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| Series: | Monaldi Archives for Chest Disease |
| Subjects: | |
| Online Access: | https://www.monaldi-archives.org/index.php/macd/article/view/1025 |
| _version_ | 1818689995015192576 |
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| author | Francesco Vetta Giampaolo Vetta Sonia Bracchitta Maria Mignano Antonella Mattatelli |
| author_facet | Francesco Vetta Giampaolo Vetta Sonia Bracchitta Maria Mignano Antonella Mattatelli |
| author_sort | Francesco Vetta |
| collection | DOAJ |
| description | Heart failure is a widespread disease in the western world whose incidence and prevalence are constantly increasing, mainly involving the more advanced age groups. Cardiac resynchronization therapy (CRT) has been shown able to reduce sudden cardiac death and all-cause mortality in patients with heart failure and reduced ejection fraction. Elderly patients are generally under-represented in the clinical trials aimed to evaluate the efficacy of CRT and, chiefly, of implantable cardiac defibrillator (ICD). The simultaneous presence of confounding factors such as co-morbidities, polypharmacy, changes in cognitive status, frailty, are the most important causes for the exclusion of subjects of advanced age from RCTs on the ICD or CRT implant. Current guidelines do not suggest any upper age limit for ICD and CRT but recommend avoiding their use in frail older patients with a life expectancy of less than 1 year. Data from the literature show that CRT has equal dignity in both the elderly and the young, in fostering effective functional and morphological improvements, also suggesting that, in older patients, CRT-D may have little practical value compared to CRT-P given the low incidence of arrhythmic death. Nevertheless, it is necessary to develop RCTs that consider aspects of the elderly patient in relation to CRT such as functional, cognitive and nutritional status. |
| first_indexed | 2024-12-17T12:18:57Z |
| format | Article |
| id | doaj.art-d02dbb9895d6430dbead7a6953cab900 |
| institution | Directory Open Access Journal |
| issn | 1122-0643 2532-5264 |
| language | English |
| last_indexed | 2024-12-17T12:18:57Z |
| publishDate | 2019-03-01 |
| publisher | PAGEPress Publications |
| record_format | Article |
| series | Monaldi Archives for Chest Disease |
| spelling | doaj.art-d02dbb9895d6430dbead7a6953cab9002022-12-21T21:49:03ZengPAGEPress PublicationsMonaldi Archives for Chest Disease1122-06432532-52642019-03-0189110.4081/monaldi.2019.1025Cardiac resynchronization therapy in the elderly. How much is it safe and beneficial?Francesco Vetta0Giampaolo Vetta1Sonia Bracchitta2Maria Mignano3Antonella Mattatelli4Israelitico Hospital, Cardiology DepartmentIsraelitico Hospital, Cardiology DepartmentIsraelitico Hospital, Cardiology DepartmentIsraelitico Hospital, Cardiology DepartmentIsraelitico Hospital, Cardiology DepartmentHeart failure is a widespread disease in the western world whose incidence and prevalence are constantly increasing, mainly involving the more advanced age groups. Cardiac resynchronization therapy (CRT) has been shown able to reduce sudden cardiac death and all-cause mortality in patients with heart failure and reduced ejection fraction. Elderly patients are generally under-represented in the clinical trials aimed to evaluate the efficacy of CRT and, chiefly, of implantable cardiac defibrillator (ICD). The simultaneous presence of confounding factors such as co-morbidities, polypharmacy, changes in cognitive status, frailty, are the most important causes for the exclusion of subjects of advanced age from RCTs on the ICD or CRT implant. Current guidelines do not suggest any upper age limit for ICD and CRT but recommend avoiding their use in frail older patients with a life expectancy of less than 1 year. Data from the literature show that CRT has equal dignity in both the elderly and the young, in fostering effective functional and morphological improvements, also suggesting that, in older patients, CRT-D may have little practical value compared to CRT-P given the low incidence of arrhythmic death. Nevertheless, it is necessary to develop RCTs that consider aspects of the elderly patient in relation to CRT such as functional, cognitive and nutritional status.https://www.monaldi-archives.org/index.php/macd/article/view/1025Systolic heart failureagingcardiac resynchronization therapy |
| spellingShingle | Francesco Vetta Giampaolo Vetta Sonia Bracchitta Maria Mignano Antonella Mattatelli Cardiac resynchronization therapy in the elderly. How much is it safe and beneficial? Monaldi Archives for Chest Disease Systolic heart failure aging cardiac resynchronization therapy |
| title | Cardiac resynchronization therapy in the elderly. How much is it safe and beneficial? |
| title_full | Cardiac resynchronization therapy in the elderly. How much is it safe and beneficial? |
| title_fullStr | Cardiac resynchronization therapy in the elderly. How much is it safe and beneficial? |
| title_full_unstemmed | Cardiac resynchronization therapy in the elderly. How much is it safe and beneficial? |
| title_short | Cardiac resynchronization therapy in the elderly. How much is it safe and beneficial? |
| title_sort | cardiac resynchronization therapy in the elderly how much is it safe and beneficial |
| topic | Systolic heart failure aging cardiac resynchronization therapy |
| url | https://www.monaldi-archives.org/index.php/macd/article/view/1025 |
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