Benefit of cardiac resynchronization therapy among older patients: A patient-level meta-analysis - 07/12/23
, Frederik Dalgaard, MD, PhD b, c, William T. Abraham, MD d, John G.F. Cleland, MD, PhD e, f, Anne B. Curtis, MD g, Daniel J. Friedman, MD b, Michael R. Gold, MD, PhD h, Valentina Kutyifa, MD, PhD i, Cecilia Linde, MD, PhD j, Anthony S. Tang, MD k, Antonio Olivas-Martinez, MD l, Lurdes Y.T. Inoue, PhD l, Gillian D. Sanders, PhD b, m, Sana M. Al-Khatib, MD, MHS bRésumé |
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.
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Vol 267
P. 81-90 - janvier 2024 Retour au numéro
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