Cardiac resynchronization therapy with a defibrillator (CRT-D) is associated with “significant improvements” in mortality and heart failure (HF) hospitalization rates among older Medicare patients, according to new research published in JACC: Heart Failure.[1]

“Despite the transition of the population of patients with HF to one that is older and more comorbid, evidence that supports that most HF therapies were derived in younger, healthier patients,” wrote first author Emily P. Zeitler, MD, MHS, a cardiovascular medicine specialist with Dartmouth-Hitchcock Medical Center in New Hampshire, and colleagues. “Evidence that supports the implantable cardioverter-defibrillator (ICD) and CRT for eligible subjects largely comes from high-quality randomized controlled trials, but the average age of randomized subjects was 64-66 years, and the enrollment of older patients was limited. This evidence is reflected in age-agnostic guidelines by relevant professional societies. Indeed, the benefit of CRT in older patients has been identified as a major gap in knowledge and as a priority for future research.”

Zeitler et al. examined data from nearly 14,000 fee-for-service Medicare beneficiaries with a confirmed diagnosis of HF with reduced ejection fraction (HFrEF). All patients were over the age of 65 and underwent CRT-D or ICD implantation from January 2008 to August 2015. Overall, the authors found, the CRT-D group more likely to be white, female and present with left bundle branch block.

One-year mortality was on the high end for all patients. However, among patients 75 years old and older, CRT-D implantation was associated with a lower risk of mortality than ICD implantation.