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

Zeitler, E. P. et al. (2024) Benefit of cardiac resynchronization therapy among older patients: A patient-level meta-analysis. American Heart Journal, 267, pp. 81-90. (doi: 10.1016/j.ahj.2023.11.002) (PMID:37984672)

Abstract

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.

• Item Type: Articles
• Additional Information: Primary funding was provided by the National Heart, Lung, and Blood Institute (1R01HL131754).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Cleland, Professor John
• Authors: Zeitler, E. P., Dalgaard, F., Abraham, W. T., Cleland, J. G.F., Curtis, A. B., Friedman, D. J., Gold, M. R., Kutyifa, V., Linde, C., Tang, A. S., Olivas-Martinez, A., Inoue, L. Y.T., Sanders, G. D., and Al-Khatib, S. M.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: American Heart Journal
• Publisher: Elsevier
• ISSN: 0002-8703
• ISSN (Online): 1097-6744
• Published Online: 19 November 2023