Benefit of cardiac resynchronization therapy among older patients: A patient-level meta-analysis

Emily P Zeitler*, Frederik Dalgaard, William T Abraham, John G F Cleland, Anne B Curtis, Daniel J Friedman, Michael R Gold, Valentina Kutyifa, Cecilia Linde, Anthony S Tang, Antonio Olivas-Martinez, Lurdes Y T Inoue, Gillian D Sanders, Sana M Al-Khatib

*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskriftArtikelForskningpeer review


BACKGROUND: Cardiac resynchronization therapy (CRT) reduces heart failure hospitalizations (HFH) and mortality for guideline-indicated patients with heart failure (HF). Most patients with HF are aged ≥70 years but such patients are often under-represented in randomized trials.

METHODS: Patient-level data were combined from 8 randomized trials published 2002-2013 comparing CRT to no CRT (n = 6,369). The effect of CRT was estimated using an adjusted Bayesian survival model. Using age as a categorical (<70 vs ≥70 years) or continuous variable, the interaction between age and CRT on the composite end point of HFH or all-cause mortality or all-cause mortality alone was assessed.

RESULTS: The median age was 67 years with 2436 (38%) being 70+; 1,554 (24%) were women; 2,586 (41%) had nonischemic cardiomyopathy and median QRS duration was 160 ms. Overall, CRT was associated with a delay in time to the composite end point (adjusted hazard ratio [aHR] 0.75, 95% credible interval [CI] 0.66-0.85, P = .002) and all-cause mortality alone (aHR of 0.80, 95% CI 0.69-0.96, P = .017). When age was treated as a categorical variable, there was no interaction between age and the effect of CRT for either end point (P > .1). When age was treated as a continuous variable, older patients appeared to obtain greater benefit with CRT for the composite end point (P for interaction = .027) with a similar but nonsignificant trend for mortality (P for interaction = .35).

CONCLUSION: Reductions in HFH and mortality with CRT are as great or greater in appropriately indicated older patients. Age should not be a limiting factor for the provision of CRT.

Sider (fra-til)81-90
Antal sider10
TidsskriftAmerican heart journal
Tidlig onlinedato19 nov. 2023
StatusUdgivet - jan. 2024

Bibliografisk note

Copyright © 2023 Elsevier Inc. All rights reserved.


Udforsk hvilke forskningsemner 'Benefit of cardiac resynchronization therapy among older patients: A patient-level meta-analysis' indeholder.