CRT-D in older adults improves survival compared with ICD alone

After one and four years, older patients with heart failure were more likely to be alive if they received cardiac resynchronization therapy with defibrillator (CRT-D) compared with a group who received only an implantable cardioverter-defibrillator (ICD), according to a registry analysis.

Paul A. Heidenreich, MD, MS, of Veterans Administration Palo Alto Healthcare System in California, and colleagues published their findings online in the Journal of the American College of Cardiology: Heart Failure on June 1.

They evaluated data from the National Cardiovascular Disease Registry registry, which the Centers of Medicare & Medicaid Services approved in 2006 for hospitals to report data on ICD implantations, including patient characteristics, outcomes and devices used.

The final analysis included 70,854 patients from 1,187 hospitals who underwent ICD implantation from 2006 to 2009 and were candidates for CRT. The mean age was 69, and 39 percent of patients were 75 or older. In addition, 69 percent of the patients were males.

Of the patients, 82 percent received CRT-D and 18 percent received an ICD. The mean age of the groups was 69.4 and 68.9 years, respectively.

For patients who were 65 and older, 82.1 percent of patients in the CRT-D group and 77.1 percent of patients in the ICD group survived at one year. At four years, the survival rates were 54 percent and 46.2 percent, respectively.

The survival benefit of CRT-D was found in all age groups and did not significantly differ between the age groups, according to the researchers. They mentioned that more than 30 percent of patients undergoing CRT-D in the U.S. are at least 75 years old.

Heidenreich et al wrote that the study had a few limitations. They could not determine the number of older patients who received CRT without an ICD and whether age was related to the degree of symptom improvement following CRT.