Does Age Influence Cardiac Resynchronization Therapy Use and Outcome?
Does Age Influence Cardiac Resynchronization Therapy Use and Outcome?
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DOI：
10.1016/j.jchf.2015.01.012
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发表时间：
2015-06-01
影响因子：
13
通讯作者：
Masoudi, Frederick A.
中科院分区：
文献类型：
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作者：
Heidenreich, Paul A.;Tsai, Vivian;Masoudi, Frederick A.
本研究旨在描述CRT-D的使用及其与老年患者生存率的相关性。背景：许多在实践中接受除颤器心脏除颤治疗（CRT-D）的患者比临床试验中纳入的患者年龄更大。方法：我们确定了2006年至2009年在国家心血管疾病登记处（NCDR）ICD登记处接受ICD植入的患者，这些患者还符合CRT的临床试验标准，包括左心室射血分数（LVEF）= 120 ms，以及纽约心脏协会（NYHA）心功能III或IV级。NCDR登记数据与社会保障死亡指数相关联，以确定任何原因死亡的主要结局时间。我们确定了来自1,187家机构的70,854例符合CRT-D既往试验标准的患者。接受CRT-D的58，147例患者的平均年龄为69.4岁，6.4%的患者年龄≥ 85岁。在所有年龄组的候选人中，CRT的使用率为80%或更高。随访42，285例年龄≥ 65岁的患者，随访12个月。结果与仅接受ICD的患者相比，接受CRT-D的患者1年生存率（82. 1% vs. 77.1%）和4年生存率（54. 0% vs. 46.2%）更高（p < 0.001）。CRT与改善生存率的相关性在不同年龄组之间没有差异（p = 0.86）。结论：接受ICD植入的老年患者中，有80%以上是CRT-D的候选人，接受了联合器械。接受ICD植入的老年患者死亡率较高，但接受CRT-D的患者死亡率较低。(C)2015年由美国心脏病学会基金会。
OBJECTIVES This study sought to describe the use of CRT-D and its association with survival for older patients.BACKGROUND Many patients who receive cardiac resynchronization therapy with defibrillator (CRT-D) in practice are older than those included in clinical trials.METHODS We identified patients undergoing ICD implantation in the National Cardiovascular Disease Registry (NCDR) ICD registry from 2006 to 2009, who also met clinical trial criteria for CRT, including left ventricular ejection fraction (LVEF) = 120 ms, and New York Heart Association (NYHA) functional class III or IV. NCDR registry data were linked to the social security death index to determine the primary outcome of time to death from any cause. We identified 70,854 patients from 1,187 facilities who met prior trial criteria for CRT-D. The mean age of the 58,147 patients receiving CRT-D was 69.4 years with 6.4% of patients age 85 or older. CRT use was 80% or higher among candidates in all age groups. Follow-up was available for 42,285 patients age >= 65 years at 12 months.RESULTS Receipt of CRT-D was associated with better survival at 1 year (82.1% vs. 77.1%, respectively) and 4 years (54.0% vs. 46.2%, respectively) than in those receiving only an ICD (p < 0.001). The CRT association with improved survival was not different for different age groups (p = 0.86 for interaction).CONCLUSIONS More than 80% of older patients undergoing ICD implantation who were candidates for a CRT-D received the combined device. Mortality in older patients undergoing ICD implantation was high but was lower for those receiving CRT-D. (C) 2015 by the American College of Cardiology Foundation.