Cardiac resynchronization therapy in the elderly: Systematic Review
Behon Anett, Merkel Eperke Dóra, Schwertner Walter Richard, Kuthi Luca Katalin, Veres Boglárka, Masszi Richard, Kosztin Annamária*, Merkely Béla*
Semmelweis Egyetem, Városmajori Szív- és Érgyógyászati Klinika, Budapest
Prof. Dr. Merkely Béla, Semmelweis Egyetem, Városmajori Szív- és Érgyógyászati Klinika, 1122 Budapest, Városmajor u. 68.
*Egyenlő részt vállaltak a közlemény elkészítésében.
Heart failure (HF) is a leading cause of morbidity, mortality, and hospitalization in the elderly. However, in most of the randomized clinical trials (RCT), the elderly were not included, therefore cardiac resynchronization therapy (CRT) response and outcome cannot be characterised in this population. As the population ages and the life expectancy of HF patients increases due to advanced therapy options, the number of elderly patients (>70–75 years old) with HF is increasing. Therefore, it is an important question, whether age negatively affects response to CRT. We aimed to assess the efficacy, the rate of peri- and postprocedural complications, and long-term outcome after CRT implantation by age, collecting the most recent literature data, published after 2000. Based on the findings of previous studies after device implantation left ventricular ejection fraction showed a significant improvement and the percentage of responders was comparable across the whole age spectrum. They found no statistical difference in peri- or postprocedural complications among the different age groups. Regarding the long-term outcome, there was an increase in all-cause mortality in the older subgroups, which can be explained by the increased prevalence of comorbidities and related non-cardiovascular mortality. However, they found no age-related difference in the risk of the composite endpoint of all-cause mortality or hospitalization for HF and HF hospitalization alone. The available data suggest that patients with appropriate indications benefit from CRT regardless of age. The rate of positive response, the risk of HF hospitalization, and complications are comparable between elderly patients over 70–75 years of age and non-elderly patients. However, due to the higher incidence of comorbidities in the elderly, their all-cause mortality is significantly higher, mainly driven by non-cardiovascular causes.