Author + information
- Paul A. Heidenreich,
- Vivian Tsai,
- Haikun Bao,
- Jeptha Curtis,
- Mary Goldstein,
- Lesley Curtis,
- Adrian Hernandez,
- Pamela Peterson and
- Frederick Masoudi
Many patients who receive cardiac resynchronization therapy (CRT-D) in practice are older than those included in the clinical trials. We sought to describe the use of CRT-D and impact on survival for older patients.
We identified patients undergoing ICD implantation in the National Cardiovascular Disease Registry (NCDR) ICD registry from 2006-2009 who also met clinical trial criteria for CRT including LVEF <=35%, QRS >=120msec, and NYHA class III or IV. NCDR registry data were linked to the social security death index to determine the primary outcome of time to death from any cause.
We identified 70,854 patients from 1187 facilities who met prior trial criteria for a CRT-D. The mean age was 69 years, and 69% were male. Patients receiving CRT-D (N=58,147) were slightly older (mean age 69.4) compared with those only receiving an ICD (12,707, mean age 68.9 years, p<0.0001). CRT use was most common in those aged 65-84 (Figure), and was 80% or higher among candidates in all age groups (Figure). Follow-up was available for 42,285 patients age 65 and older at 12 months. For those 65 and older, receipt of CRT-D was associated with better survival at one year (82.1% vs. 77.1%) and four years (54.0% vs. 46.2%) compared with those receiving only an ICD (p<0.001).
Over 80% of elderly patients undergoing ICD implantation who were candidates for a CRT-D received this device. Mortality in elderly patients undergoing ICD implantation was high but was lower for those receiving CRT-D.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Improving Heart Failure Outcomes
Abstract Category: 28. Quality of Care and Outcomes Assessment
Presentation Number: 1114-92
- 2013 American College of Cardiology Foundation