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Long term clinical outcomes after cardiac resynchronization therapy implantation in elderly patients
Session:
Painel 5- Arritmologia 4
Speaker:
Alexandra Briosa
Congress:
CPC 2020
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.3 Cardiac Resynchronization Therapy
Session Type:
Posters
FP Number:
---
Authors:
Alexandra Briosa; Ana I. Marques; Ana Rita F. Pereira; Sofia Alegria; Daniel Sebaiti; João Grade Santos; Rita Miranda; Sofia Almeida; Luis Brandão; Helder Pereira
Abstract
<p><strong><em>Introduction: </em></strong>Cardiac Resynchronization Therapy (CRT) is a well-established treatment for symptomatic hear failure patients (pts) with reduced left ventricle ejection fraction (LVEF). Older pts have been underrepresented in randomized trials. </p> <p><strong><em>Aim:</em></strong> To characterize pts who were submitted to CRT implantation at the age of 80 or more vs younger pts and to analyze the differences in long term outcomes (response, mortality and hospitalizations) between both groups. </p> <p><strong><em>Methods: </em></strong>Retrospective study of a single center analyzing patients submitted to CRT implantation in the last 7 years (2012-2019). Clinical and imaging data were collected, as well as long term outcomes concerning hospitalization, mortality and response. Responders were defined as pts who improved >=1 NYHA class or/and > 10% LVEF.</p> <p><strong><em>Results: </em></strong>Total of 130 pts, 65% males with a mean age of 71±11 years, with optimized medical treatment. 25% were considered elderly pts (>/=85years). Non-ischemic cardiomyopathy was present in 77% of pts. 70% had QRS >150 and 79% had LBBB. The mean LVEF was 28±7,5% and mean left ventricular end-diastolic volume index (LVEDVI) was 125±116 ml/m2. By the time of CRT implantation, most pts were in NYHA class 3 and 51,5% implanted CRT-P. 68,8% were considered responders, subsequent hospitalizations occurred in 25,4%, and 20 pts died. </p> <p>When analyzing both groups, we found no differences in what concerns gender, HF etiology or previous medical history, except for the fact that elderly pts had more chronic kidney disease (CKD) (56,3% vs 36,6% p=0.049). They had higher rates of treatment with angiotensin receptors antagonist (25% vs 9,4% p=0,035) and diuretic (81,3% vs 59,4% p=0,025), although less betablocker therapy (53,1% vs 91,75% p< 0,001). Prior to implantation, elderly pts were more symptomatic (NYHA class – 2.9±0.6 vs 2.57±0,5, p=0.011) and had higher NT proBNP values (5850±8727 pg/mL vs 2706 ±3404 pg/mL, p=0,008). CRT-P was the most implanted device (87,5% vs 39,8% p< 0.001), most with bipolar electrodes (46,9% vs 24.5% p=0.016). After implantation, they maintained higher NYHA class (2,2 vs 1,9 p=0.034). </p> <p>Concerning long-term outcomes, although there was no difference in final response (p=0,883), they had more hospital admissions (43,8% vs 19,4% p=0,006), especially due to HF (34,4% vs 13,4% p=0.008). There were no differences regarding mortality and survival, although there was a tendency for higher rates of overall mortality (p=0.06). </p> <p><strong>Conclusion:</strong> Although there were no differences regarding CRT response or mortality in elderly patients, they were associated to higher morbidity rates with regard to hospitalization (especially for heart failure), probably due to a more advanced stage of the disease. Selection of elderly pts should be conscious and adjusted. </p>
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