Predictors of clinical outcomes after cardiac resynchronization therapy in patients ≥75 years of age: a retrospective cohort study

Abstract Background: Cardiac resynchronization therapy has been shown to benefit selected patients with heart failure and reduced ejection fraction. Older patients have been underrepresented in randomized trials. This study was conducted to determine whether predictive factors for cardiac resynchronization therapy outcomes differ in patients older and younger than 75 years of age. Methods: Consecutive patients who received a cardiac resynchronization device cardiac resynchronization therapy between 2013 and 2016 in our center were retrospectively included in this cohort study. The primary endpoint was cardiac resynchronization therapy effectiveness, which was defined as survival for one year with both no heart failure hospitalization and improvement by one or more NYHA class. The secondary endpoints were mortality, complications, and device therapies. Results: Among the 243 patients included, 102 were ≥75 years old. Cardiac resynchronization therapy effectiveness was observed in 70 patients (50%) <75 years old and in 48 patients (47%) ≥75 years old (p=0.69). NYHA class ≥III (OR=6.02; CI95% [1.33-18.77], p=0.002) was a predictive factor for cardiac resynchronization therapy effectiveness only in the ≥75-year-old group, while atrial fibrillation was independently negatively associated with the primary endpoint in the <75-year-old group (OR=0.28; CI95% [0.13-0.62], p=0.001). The one-year mortality rate was 14%, with no difference between age groups. Rescue cardiac resynchronization therapy and atrial fibrillation were independent predictive factors for mortality in both age groups. Eighty-two complications occurred in 45 patients (19%), with no difference between groups. Defibrillator use and QRS duration were independent predictive factors for complications in both age groups. There was no difference between groups considering device therapies. Conclusion: At one year, cardiac resynchronization therapy response is not compromised by patient age. In older patients, highly symptomatic individuals with NYHA class ≥III have better outcomes after cardiac resynchronization therapy.

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Predictors of clinical outcomes after cardiac resynchronization therapy in patients ≥75 years of age: a retrospective cohort study

BMC Geriatrics ◽

10.1186/s12877-019-1351-4 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Laure Champ-Rigot ◽

Anne-Laure Cornille ◽

Pierre Ollitrault ◽

Arnaud Pellissier ◽

Mathieu Chequel ◽

...

Keyword(s):

Cardiac Resynchronization Therapy ◽

Predictive Factors ◽

Older Patients ◽

Nyha Class ◽

Age Groups ◽

Cardiac Resynchronization ◽

Class Iii ◽

Resynchronization Therapy ◽

Therapy Effectiveness ◽

One Year

Abstract Background Cardiac resynchronization therapy has been shown to benefit selected patients with heart failure and reduced ejection fraction. Older patients have been underrepresented in randomized trials. This study was conducted to determine whether predictive factors for cardiac resynchronization therapy outcomes differ in patients older and younger than 75 years of age. Methods Consecutive patients who received a cardiac resynchronization device cardiac resynchronization therapy between 2013 and 2016 in our center were retrospectively included in this cohort study. The primary endpoint was cardiac resynchronization therapy effectiveness, which was defined as survival for one year with both no heart failure hospitalization and improvement by one or more NYHA class. The secondary endpoints were mortality, complications, and device therapies. Results Among the 243 patients included, 102 were ≥ 75 years old. Cardiac resynchronization therapy effectiveness was observed in 70 patients (50%) < 75 years old and in 48 patients (47%) ≥75 years old (p = 0.69). NYHA class ≥III (OR = 6.02; CI95% [1.33–18.77], p = 0.002) was a predictive factor for cardiac resynchronization therapy effectiveness only in the ≥75-year-old group, while atrial fibrillation was independently negatively associated with the primary endpoint in the < 75-year-old group (OR = 0.28; CI95% [0.13–0.62], p = 0.001). The one-year mortality rate was 14%, with no difference between age groups. Rescue cardiac resynchronization therapy and atrial fibrillation were independent predictive factors for mortality in both age groups. Eighty-two complications occurred in 45 patients (19%), with no difference between groups. Defibrillator use and QRS duration were independent predictive factors for complications in both age groups. There was no difference between groups considering device therapies. Conclusion At one year, cardiac resynchronization therapy response is not compromised by patient age. In older patients, highly symptomatic individuals with NYHA class ≥III have better outcomes after cardiac resynchronization therapy.

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Predictors of clinical outcomes after cardiac resynchronization therapy in patients ≥75 years

10.21203/rs.2.11022/v1 ◽

2019 ◽

Author(s):

Laure Champ-Rigot ◽

Anne-Laure Cornille ◽

Pierre Ollitrault ◽

Arnaud Pellissier ◽

Mathieu Chequel ◽

...

Keyword(s):

Heart Failure ◽

Cardiac Resynchronization Therapy ◽

Predictive Factors ◽

Nyha Class ◽

Age Groups ◽

Cardiac Resynchronization ◽

Class Iii ◽

Resynchronization Therapy ◽

Therapy Effectiveness ◽

One Year

Abstract Background: Cardiac resynchronization therapy benefit has been proved in selected patients with heart failure and reduced ejection fraction. Older patients have been underrepresented in CRT trials. This study was conducted to determine whether predictive factors of cardiac resynchronization therapy outcomes may differ in patients older and younger than 75 years. Methods: Consecutive patients who received cardiac resynchronization therapy device between 2013 and 2016 in our center were retrospectively included. The primary endpoint was cardiac resynchronization therapy effectiveness defined as combination of survival for one year with no heart failure hospitalization and improvement by one or more NYHA classes. Secondary endpoints were mortality, complications, and device therapies. Results: Among the 243 patients included, 102 were ≥75 years. Cardiac resynchronization therapy effectiveness was observed in 70 patients (50%) <75 years and in 48 patients (47%) ≥75 years (p=0.69). NYHA class ≥III (OR=6.02; CI95% [1.33-18.77], p=0.002) was a predictive factor of cardiac resynchronization therapy effectiveness only in ≥75 years group, while in <75 years group atrial fibrillation was independently negatively associated with primary endpoint (OR=0.28; CI95% [0.13-0.62], p=0.001). One-year mortality rate was 14% with no difference between age groups. Rescue cardiac resynchronization therapy and atrial fibrillation were independent predictive factors for mortality in both age groups. Eighty-two complications occurred in 45 patients (19%) with no difference between groups. Defibrillator use and QRS duration were independent predictive factors for complications in both age groups. There was no difference considering device therapies. Conclusion: At one-year, cardiac resynchronization therapy response is not compromised by patients age. In older patients, highly symptomatic individuals with NYHA class ≥III have better outcomes after cardiac resynchronization therapy. KEY WORDS: Resynchronization therapy; heart failure; aged; treatment outcome

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Predictors of clinical outcomes after cardiac resynchronization therapy in patients ≥75 years of age: a retrospective cohort study

10.21203/rs.2.11022/v3 ◽

2019 ◽

Author(s):

Laure Champ-Rigot ◽

Anne-Laure Cornille ◽

Pierre Ollitrault ◽

Arnaud Pellissier ◽

Mathieu Chequel ◽

...

Keyword(s):

Heart Failure ◽

Cardiac Resynchronization Therapy ◽

Predictive Factors ◽

Nyha Class ◽

Age Groups ◽

Cardiac Resynchronization ◽

Class Iii ◽

Resynchronization Therapy ◽

Therapy Effectiveness ◽

One Year

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NISAR-F SCORE: a simple risk stratification tool for patients implanted with cardiac resynchronization therapy

EP Europace ◽

10.1093/europace/euab116.457 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

J Correia ◽

L Goncalves ◽

I Pires ◽

J Santos ◽

V Neto ◽

...

Keyword(s):

Ejection Fraction ◽

Cardiac Resynchronization Therapy ◽

Cox Regression ◽

Nyha Class ◽

Prognostic Score ◽

Roc Curves ◽

Cardiac Resynchronization ◽

Class Iii ◽

Resynchronization Therapy

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Individualized estimation of prognosis after cardiac resynchronization therapy (CRT) remains challenging. Outcomes in this group of patients are influenced by multiple factors and a comprehensive and customized approach to estimate prognosis after CRT is lacking Aims To develop and validate a simple prognostic score for patients implanted with CRT (NISAR-F score), based on readily available clinical and echocardiographic variables to predict the combined endpoints of death or hospitalization in 24 months. Methods A single-centre retrospective study was conducted with inclusion of all consecutive patients who underwent CRT implantation between 2012 and 2019. Follow-up started after CRT implantation and ended upon death, hospitalization or 24 months after study entry. Survival analysis was performed using a multivariate Cox regression model, in order to analyze the effect on survival /hospitalization in 24 months of the following factors: age, gender, NYHA Class III-IV, ischemic heart failure, type 2 diabetes, arterial hypertension, dyslipidemia and ejection fraction < 21%. According to the analysis, points were attributed to each factor. Afterwards, the NISAR-F score was calculated for each patient, summing the points of each variable. The authors finally created ROC curves for the NISAR-F score to predict the occurrence of the combined endpoint in 2 groups of patients: CRT responders (ejection fraction increase of at least 10% after CRT implantation) and CRT non-responders. The statistical analysis was performed in SPSS. Results 102 patients were included in the study (75.4% male, mean age 68 ± 10.46 years). 10(9.8%) of the patients were re-hospitalized and 8 (7.8%) died during the 24-month follow-up. After calculating NISAR-F score for each patient, area under ROC curves were obtained. The analysis of the ROC curves allows us to confirm the good performance of the score created [responders group (AUC 0.812) vs non-responders (AUC 0.721)]. Conclusion The NISAR-F score is a useful tool to predict the combined endpoint (mortality and hospitalization in 24 months) after CRT implantation, in both responders and non-responders, revealing good performance of this new and simple score based only on clinical and echocardiographic variables.

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2177Cardiac resynchronization therapy in patients greater than 75 years of age - results from the European Society of Cardiology Survey II with 11 088 patients

European Heart Journal ◽

10.1093/eurheartj/ehz748.0096 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

C Normand ◽

K Dickstein ◽

C Linde

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Adverse Events ◽

Cardiac Resynchronization Therapy ◽

European Society ◽

Nyha Class ◽

Cardiac Resynchronization ◽

Class Iii ◽

Resynchronization Therapy ◽

European Society Of Cardiology

Abstract Background Cardiac Resynchronization Therapy (CRT) reduces morbidity and mortality in selected patients with heart failure (HF) and electrical dyssynchrony. The median age for patients included in the CRT landmark trials ranged from 62–68 years, therefore limited trial evidence exists on CRT in patients ≥75 years of age. Purpose To assess similarities and differences in patient demographics and implantation practice in different age groups implanted with a CRT device. Methods Between 2015 and 2017, two European Society of Cardiology (ESC) associations, European Heath Rhythm Society and the Heart Failure Association, conducted the CRT Survey II, a survey of CRT implantations in 11,088 patients in 42 ESC member states. Results In our survey 32% of patients included were ≥75 years of age. These patients were more frequently in NYHA Class III or IV, had more comorbidity (including hypertension, atrial fibrillation, anaemia and renal dysfunction) and had significantly higher NT-pro BNP levels than younger patients. Slightly fewer patients ≥75 years of age had LBBB but all groups had the same median QRS duration. Despite substantially more patients ≥75 years of age having HF of ischaemic aetiology compared with those <65 year of age, far fewer patients in oldest age group category were implanted with a CRT-defibrillator (CRT-D) compared with those in the youngest group. CRT Survey II Patients by Age Categories Demographics Age <65 years Age 65–74 years Age ≥75 years N 3478 (32%) 4025 (36%) 3536 (32%) NYHA class III & IV 52% 59% 66%* Ischaemic HF aetiology 33% 49% 50%* Atrial fibrillation 17% 27% 33* NT proBNP (pg/ml, median, IQR) 1651 (670, 3811) 2319 (1070, 5169) 3510 (1647, 7631)* CRT-D 81% 76% 52%* Peri-procedural complications 5% 6% 6% Adverse Events during hospitalization 4% 5% 5% CRT-D, Cardiac resynchronization therapy – defibrillator; HF, heart failure; IQR, interquartile range. *Differences between groups is significant with p<0.001. Conclusions Patients ≥75 years of age had greater comorbidity and experienced more symptoms from their heart failure. However, they did not suffer more complications or adverse events during the index hospitalization, suggesting that CRT may safely be offered to elderly patients. Acknowledgement/Funding The work was supported by EHRA, the HFA, Biotronik, Boston Scientific, Medtronic, Sorin, St. Jude, Abbott, Bayer, Bristol-Myers Squibb and Servier

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Faculty Opinions recommendation of Comparison of the usefulness of cardiac resynchronization therapy in three age-groups (<65, 65-74 and ≥75 Years) (from the InSync/InSync ICD Italian Registry).

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.11393956.12408055 ◽

2011 ◽

Author(s):

Wilbert Aronow

Keyword(s):

Cardiac Resynchronization Therapy ◽

Age Groups ◽

Cardiac Resynchronization ◽

Resynchronization Therapy

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Abstract 3778: Racial and Ethnic Differences in Cardiac Resynchronization Therapy Outside of Published Guidelines

Circulation ◽

10.1161/circ.116.suppl_16.ii_859-b ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Steven A Farmer ◽

James N Kirkpatrick ◽

Paul A Heidenreich ◽

Jeptha P Curtis ◽

Yongfei Wang ◽

...

Keyword(s):

Cardiac Resynchronization Therapy ◽

Ethnic Differences ◽

Coronary Revascularization ◽

Cardiac Resynchronization ◽

Implantable Cardioverter Defibrillators ◽

Class Iii ◽

Resynchronization Therapy ◽

Racial And Ethnic Differences ◽

Qrs Duration ◽

White Patients

Objective Ethnic and racial disparities in cardiac care may partially result from over-provision of care among white patients. We hypothesized that whites were more likely than blacks and Hispanics to receive cardiac resynchronization therapy with defibrillator (CRT-D) devices outside of ACC/AHA/HRS guidelines. Methods We analyzed 01/2005– 04/2007 data from the ACC-National Cardiovascular Data Registry for implantable cardioverter-defibrillators (ICDs). We identified white, black and Hispanic patients who received CRT-D. We then fit a multivariable hierarchical logistic regression model with full ACC/AHA/HRS guideline concordance (QRS duration >=0.12 ms, LVEF <<26>35%, and class III or IV CHF) as a binary outcome. Independent variables included race/ethnicity, age, gender, cardiomyopathy etiology, duration of CHF, LVEF, blood pressure, QRS duration/morphology, prior coronary revascularization, atrial fibrillation, cerebrovascular disease, hypertension, diabetes, renal failure, and pulmonary disease. Results Of 108,341 registry patients, 39,088 CRT-D recipients were selected, including 33,310 (85%) non-Hispanic whites, 3,963 (10%) non-Hispanic blacks, and 1,815 (5%) Hispanics. Among all CRT-D recipients, univariate analyses indicated 9,430 (24%) patients lacked 1 CRT-D criterion, 1,840 (5%) patients lacked 2 criteria, and 217 (1%) patients lacked all 3 criteria. Specifically, 2,271 (6%) had an LVEF >35%, 6,758 (17%) had class I/II CHF, and 4,732 (12%) had a QRS duration <0.12 ms. In multivariate analyses, blacks (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.04 –1.23; p=0.004) and Hispanics (OR 1.10, 95% CI 0.97–1.24; p=0.13) were more likely to meet all 3 CRT-D eligibility criteria than non-Hispanic whites. Conclusions After multivariate adjustment, we observed greater guideline-concordant use of CRT-D among blacks and Hispanics than among non-Hispanic whites. Although it is possible that patients receiving CRT-D outside of published guidelines had other compelling clinical findings unrecorded in the registry, such as echocardiographic evidence of dyssynchrony, our findings suggest that racial and ethnic differences in CRT-D partially may be due to over-provision of this technology among white patients.

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Efficacy of Cardiac Resynchronization Therapy in Patients with a Narrow QRS Complex

Journal of Interventional Cardiology ◽

10.1155/2021/8858836 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Toshiko Nakai ◽

Yukitoshi Ikeya ◽

Hiroaki Mano ◽

Rikitake Kogawa ◽

Ryuta Watanabe ◽

...

Keyword(s):

Cardiac Resynchronization Therapy ◽

Response Rate ◽

Nyha Class ◽

Heart Association ◽

Cardiac Resynchronization ◽

Qrs Complex ◽

Resynchronization Therapy ◽

Narrow Qrs ◽

Narrow Qrs Complex ◽

Crt Response

Aims. In the guidelines for cardiac resynchronization therapy (CRT), there is a gap between the Japanese Circulation Society (JCS) criteria, which specify a QRS duration of ≥120 ms, and other countries, with a QRS ≥ 130 ms. The efficacy of CRT remains controversial in patients with a narrow QRS <130 ms. The aims of this study are to evaluate the response to CRT in patients with a narrow QRS and to identify predictors of mortality. Methods. We retrospectively studied 212 patients who received CRT. They were divided into narrow QRS (<130 ms) and wide QRS (≥130 ms) groups. We compared CRT response rates and investigated whether age, gender, baseline New York Heart Association (NYHA) class, ischemic etiology, atrial fibrillation, and ventricular arrhythmias are associated with response and also predictive of mortality. Results. The CRT response rate was not significantly different between the wide QRS group and the narrow QRS group (74.6% versus 77.2%, p = 0.6876), and the response rate in the narrow QRS group was as good as that reported worldwide. NYHA class IV was shown to be a predictor of mortality (HR 9.38, 95% CI 5.35–16.3, p < 0.0001). Conclusions. The present study demonstrated that patients with a narrow QRS complex responded well to CRT. Even with QRS <130 ms, CRT should be tried if no other effective treatment is available.

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Cardiac Resynchronization Therapy in Older Patients: Age Is Just a Number, and Yet …

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2016.10.006 ◽

2016 ◽

Vol 22 (12) ◽

pp. 978-980 ◽

Cited By ~ 2

Author(s):

Daniel B. Kramer ◽

Daniel A. Steinhaus

Keyword(s):

Cardiac Resynchronization Therapy ◽

Older Patients ◽

Cardiac Resynchronization ◽

Resynchronization Therapy

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P5680One-year outcomes of heart failure patients undergoing cardiac resynchronization therapy using adaptivCRT algorithm

European Heart Journal ◽

10.1093/eurheartj/ehz746.0622 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S Briongos Figuero ◽

A Estevez ◽

M L Perez ◽

J B Martinez-Ferrer ◽

L Alvarez-Costa ◽

...

Keyword(s):

Heart Failure ◽

Cardiac Resynchronization Therapy ◽

Real Life ◽

Left Ventricular ◽

Cardiac Resynchronization ◽

Ventricular Pacing ◽

Class Iii ◽

Resynchronization Therapy ◽

Risk Of Death

Abstract Background Adaptive cardiac resynchronization therapy (aCRT) algorithm provides synchronized left ventricular (LV) only pacing and ambulatory optimization of the intrinsic atrioventricular and interventricular conduction intervals. Studies reporting morbidity and mortality outcomes of aCRT carriers in daily clinical practice are lacking. Purpose To determine in a real-life setting, whether 1-year outcomes were different among CRT carriers undergoing aCRT pacing and those under conventional biventricular (biV) pacing. Methods Symptomatic heart failure (HF) patients with sinus rhythm undergoing first CRT-defibrillator implant were selected from the UMBRELLA nationwide registry (2012–2017). The primary endpoint was the composite of all-cause mortality or HF hospitalization at 12-month follow-up. HF admission was defined as hospitalization due to symptoms requiring intravenous diuretic treatment. Primary healthcare records were used to prospectively collect all data. Results Two hundred and six patients were collected (66.1±8.7 years; 73.3% male). Eighty-seven out of 206 patients were implanted with an aCRT capable device, but this algorithm was activated at implant and remained enabled at 1-year in 59 patients (aCRT group). The other 147 patients composed the non-aCRT group. At implant left bundle branch block was present in 93% of patients, 69.6% of population was in functional class III or IV and mean left ventricle ejection fraction was of 26.5±5.6%. Non-ischemic cardiomyopathy was present in 63.1% of patients and optimal medical treatment was achieved in majority of population (92% of patients with beta-blockers; angiotensin-converting enzyme inhibitorsor angiotensin II receptor blockersin 89%). The percentage of ventricular pacing through 12 months was 96.1±9.4% in non-aCRT patients and 97.5±2.7% in aCRT patients (p=0.261). In aCRT patients, LV-only pacing accounted for a mean of 53.3±37.6% of all ventricular pacing. After 12-month follow-up period, 25 patients (12.1%) met the primary composite endpoint of death or HF hospitalization. Nine patients died and nineteen patients were admitted due to worsening HF. There was no difference in the risk of all-cause death or HF hospitalization between aCRT and non-aCRT patients (10.2% vs. 12.9% respectively; OR=0.76, CI: 0.29–2.01, p=0.585) Conclusions In this contemporary cohort of HF patients undergoing CRT with high percentages of ventricular pacing, clinical performance of aCRT algorithm was adequate. The risk of death or HF hospitalization was low and no differences were observed at one-year follow-up. Future randomized studies will clarify the role of this algorithm in CRT carriers. Acknowledgement/Funding None

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