89IS CARDIAC RESYNCHRONISATION THERAPY (CRT) FEASIBLE, SAFE AND BENEFICIAL IN OCTOGENARIANS?

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Abstract

Purpose: Chronic heart failure(CHF) predominantly affects the elderly. In the UK the mean age of patients hospitalised with CHF is 78 yrs. Despite proven benefit of CRT, the mean age of UK patients undergoing CRT-P is 71 yrs. We evaluated whether CRT is feasible/safe and associated with improved symptoms in octogenarians.

Methods: Consecutive patients undergoing CRT implantation at 2 UK centres(2009-11). Patients grouped according to age: < 80 & ≥80 yrs. Baseline demographics, complications and outcomes were compared between groups.

Results: 439 patients were evaluated of whom 26% were aged ≥80 yrs. See table. Octogenarians more often received CRT-P. Upgrade from pacemaker was common in both groups (16% <80yrs vs 22%, p = ns). Major co-morbidities were similarly common in both groups (diabetes 25%, AF 49%, hypertension 45%). More patients age ≥80 yrs had significant chronic kidney disease(CKD, eGFR < 45 ml/min/1.73m2, 44% vs 22%, p < 0.01). Overall complication rates(any) were similar in both groups(17% ≥80 yrs vs 21%, p = ns). Both groups demonstrated significant symptomatic benefit. One year mortality rates were almost 4 fold greater in the very elderly(13.9% vs 3.7%, p < 0.01).

Conclusions: CRT appears to be safe in octogenarians despite extensive co-morbidity, and in particular frequent severe CKD. Symptomatic improvement is meaningful and similar to a younger population(mean age 14 yrs lower). Mortality at 1 year was higher in those aged ≥80 yrs. Strategies to increase the appropriate identification of elderly patients with CHF for CRT are required.

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