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

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