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Heart failure hospitalization and survival after cardiac resynchronization therapy in elderly population
Session:
CO 23 - Dispositivos
Speaker:
Ricardo Costa
Congress:
CPC 2021
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.3 Cardiac Resynchronization Therapy
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Ricardo Costa; André Frias; Andreia Campinas; Maria João Sousa; Vítor Lagarto; Mário Santos; Hipólito Reis; Severo Torres
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Introduction: The benefits of cardiac resynchronization therapy (CRT) in patients with heart failure (HF) with reduced ejection fraction are well known. However, the elderly population was not well represented in previous studies. We aimed to compare the clinical improvement, incidence of HF hospitalization and survival of patients with ≥75 years submitted to CRT with those with <75 years. </span></span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Methods: We retrospectively studied consecutive patients with HF, left ventricular ejection fraction (LVEF) ≤35%, New York Heart Association (NYHA) functional class ≥II and QRS ≥130 milliseconds submitted to CRT at a tertiary hospital between January 2002 and March 2016. Clinical and outcome data were retrieved by review of the patient’s records.</span></span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Results: Of 264 patients (69±10 years, 67% male), 33% had ≥75 years at the time of CRT procedure. Aetiology was ischaemic in 43% of individuals. Median LVEF before CRT was 28% (23-29). Patients with ≥75 years had higher prevalence of hypertension </span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">(78% versus 65%, p=0.03) and they are more frequently in NYHA class ≥III before CRT (89% versus 78%, p=0.02). They were also less likely to be on betablocker (67% versus 82%, p=0.03). Implantation of CRT-defibrillator was lower in the older group (32% versus 71%, p<0.001). During a median follow-up of 36 (16-74) months, all-cause death was 34%, higher in patients with </span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">≥75 years</span></span> <span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">(44% versus 28%, p=0.008). Incidence of worsening HF requiring hospitalization was 19%. Comparing to baseline, improvement of NYHA class after CRT </span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">was more common </span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">in the older group (</span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">85% versus 66%, p=0.001) and NYHA class ≥III was less frequent (10% versus 22%, p=0.01). Mean LVEF during follow-up was 35% (11), a mean improvement of 8% (11) comparing to the baseline, without significant difference between groups. Improvement of quality life after CRT was referred in 78% of patients, similar in both groups. Biventricular pacing percentage was 99% (97-100). In multivariate analysis, age ≥75 years</span></span> <span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">was not an </span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">independent predictor of all-cause death (HR 1.7, 95% CI 0.9-3.3, p=0.08) nor HF hospitalization (HR 0.9, 95% CI 0.4-2.0, p=0.88).</span></span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Conclusions: In our cohort, despite patients with ≥75 years had higher mortality rate, it was not identified as an independent predictor of death nor HF hospitalization. In fact, LVEF increased as younger patients and their functional class improved even more.</span></span></span></span></p>
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