Clinical outcomes of cardiac resynchronization therapy with and without a defibrillator in elderly patients with heart failure

Abstract

Background: Evidence regarding the incremental benefit of cardiac resynchronization therapy (CRT) with a defibrillator (CRT-D) versus without (CRT-P) in elderly patients with heart failure is limited. We compared mortality and cardiac hospitalisation between CRT-D and CRT-P in the elderly. Methods: A retrospective chart review identified all consecutive patients with age ≥75 with CRT implantation over the last 10 years at a Canadian tertiary care cardiac centre. Kaplan-Meier survival analyses and cumulative incidence curves were used to compare mortality and time to first cardiac hospitalisation, respectively, with CRT-D versus CRT-P over a 3 year period. Analyses were also repeated with propensity score matching based on age, sex, primary versus secondary prevention, date of implant, and Charlson Comorbidity Index. Results: One hundred and seventy CRT patients were identified. A total of 128 received CRT-D while 42 received CRT-P. Median age was 79 (IQR 77-81), and the majority were male (83%). CRT-P patients had a higher burden of comorbidities (Charlson score 7, IQR 6-8) than CRT-D patients (Charlson score 5, IQR 5-7; P < 0.001). There was no significant difference in survival between the two groups in an unmatched comparison (P = 0.69) and with a propensity score-matched cohort (P = 0.91). Secondary prevention CRT-D patients had a higher risk of hospitalisation compared to primary prevention CRT-D patients; however, there was no significant difference in hospitalisation between the CRT-D and CRT-P groups. Conclusion: This study suggests there is no significant difference in mortality or cardiac hospitalisation between CRT-D and CRT-P in elderly patients with heart failure.