P821Long term outcomes of cardiac resynchronization therapy in the elderly

Abstract

Background/Introduction: An increasing number of elderly patients are subjected to Cardiac resynchronization therapy (CRT) to improve symptoms of heart failure (HF). Purpose(s): To evaluate clinical outcomes of CRT in elderly patients and to identify any clinical variable that may affect their prognosis. Method(s): We retrospectively studied 464 consecutive patients who received a CRT device at our institution from 2007 to 2015. Clinical and echocardiographic parameters were collected before and after CRT implantation. The follow-up was completed in December 2016. Result(s): Of 464 patients, 186 (40%) were older than 75 years. We divided population into 2 groups: under 75 and over 75. The groups were matched by sex, history of hypertension, diabetes mellitus and atrial fibrillation. Ischaemic aetiology for heart failure was slightly higher in older patient (53% vs 42%, p=0.025). During a mean follow up of 42 months, older patients had similar improvements in NYHA class and ejection fraction (p=ns) as younger patients. Overall mortality was higher in older patient (31% vs 11%, p<0.001), but cardiac mortality (75% vs 65%, p=0.12) and rate of re-hospitalization (22% vs 22%, p=ns) were similar among age groups. In the subgroup over 75, Kaplan-Meier survival curves showed a worse prognosis in patients affected by anemia (Hemoglobin < 9 gr/dl) or chronic renal failure, while there were no differences between ischaemic and not ischaemic cardiophaty. Conclusion(s): CRT improves symptoms and clinical outcomes in patients over 75 years as in younger group. However, the prevalence of coorbidities increases with age and in older patients chronic renal failure and anemia must be carefully evaluated.