Cardiac Resynchronization With Defibrillator Has Favorable Outcomes in Older Patients

For older patients receiving an implantable cardioverter-defibrillator (ICD), cardiac resynchronization therapy (CRT) with defibrillator (CRT-D) was associated with decreased risk for hospitalization and mortality. The findings were published in JACC: Heart Failure.

Data for this study were sourced from Medicare fee-for-service beneficiaries. Older adults (aged ³65 years) who had a previous hospitalization for heart failure (HF) with reduced ejection fraction and who received ICD, CRT, or both between 2008 and August 2015 were assessed for outcomes on the basis of device (CRT-D vs ICD) and age (65-74 vs 75-84 vs ³85 years).

Patients aged 65-74 years, 75-84 years, and 85 years or older received CRT-D or ICD. At baseline, recipients of CRT-D were more likely to be women, White, older, to have renal failure, atrial fibrillation, and left bundle branch block (LBBB).

Using a weighted approach to balance baseline differences, overall device-related complications occurred among 14.3%-20% of patients. The highest complication rate occurred among the oldest patient group who received an ICD, and the lowest rate was observed among the youngest cohort who received a CRT-D. The most frequent complication was bleeding, occurring among 4.85%-8.11%.

Risk for HF hospitalization did not differ on the basis of implant for the patients aged 65-74 years (hazard ratio [HR], 0.95; 95% CI, 0.90-1.00; P=.052) or 75-84 years (HR, 1.00; 95% CI, 0.95-1.05; P=.937). Among the oldest cohort, CRT-D was associated with a reduced risk for HF hospitalization (HR, 0.82; 95% CI, 0.74-0.92; P<.001).

Mortality occurred at a rate of 18%-33% at 1 year, increasing with age. No significant device effect was observed for the youngest cohort (HR, 0.96; 95% CI, 0.90-1.02; P=.171). CRT-D was associated with decreased mortality risk among patients aged 75-84 years (HR, 0.90; 95% CI, 0.86-0.95; P<.001) and 85 years or older (HR, 0.81; 95% CI, 0.72-0.90; P<.001).

In a sensitivity analysis, no different patterns were observed among the subset of patients with LBBB.

This study may have been biased by residual cohort differences despite the weighting approach.

The findings in this study supported the use of CRT-D over ICD, as risk for HF hospitalization and mortality were significantly decreased. The study authors noted, “Overall mortality and complications attributable to device implantation are higher than previously reported, which, in part, likely reflects an evolving HF population that is increasingly older and comorbid.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Zeitler EP, Austin AM, Leggett CG, et al. Complications and mortality following CRT-D versus ICD implants in older Medicare beneficiaries with heart failure. J Am Coll Cardiol HF. Published online January 12, 2022. doi:10.1016/j.jchf.2021.10.012