Cardiac resynchronization effective in the elderly
Last Updated: 2011-04-25 19:15:08 -0400 (Reuters Health)
By David Douglas
NEW YORK (Reuters Health) - The benefits of cardiac resynchronization therapy (CRT) are independent of age, Italian researchers say.
Its effects on left ventricular performance and functional capacity were evident even in the study's oldest patients -- which means CRT "could be a very useful tool" for treating congestive heart failure in the elderly, said lead author Dr. Stefano Fumagalli from the University of Florence in email to Reuters Health.
The average patient in a CRT trial is less than 70 years old, according to a paper by Dr. Fumagalli and his colleagues. The researchers wanted more information on "real-world" outcomes.
While they found elderly patients don't have to worry about CRT being less effective, they also discovered something else. Many geriatric patients are not getting the right medications.
"Pharmacologic undertreatment is an important issue in a 'real-world' geriatric population," the research team reports in a March 21st online paper in the American Journal of Cardiology.
Altogether the investigators analyzed registry data on nearly 1800 patients who had received CRT alone or with an implantable defibrillator: 571 patients less than 64 years old, 740 between the ages of 65 and 74, and 476 who were 75 or older. The three groups had similar mean left ejection fractions.
Similar proportions of each group showed echocardiographic responses to CRT, and New York Heart Association class significantly improved independently of age.
During a mean of 19 months of follow-up, all-cause mortality was significantly higher in the oldest compared to the youngest patients (14% versus 10%) - but there were no age-related differences in cardiac deaths.
However, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers, and beta blockers were significantly underused, particularly in the oldest patients.
In the whole population, they add, mortality was associated with a nonresponsive condition, the presence of atrial fibrillation and the lack of prescription of recommended medical therapy.
Although the research showed a significant age-related increase only for noncardiac mortality causes, the authors conclude that pharmacologic undertreatment is an important issue in this geriatric population.
"Too often," added Dr. Fumagalli, "beta-blockers, ACE-inhibitors and angiotensin II receptor blockers are very scarcely adopted in the elderly, despite their great impact on survival. So, it is necessary that projects aimed at improving the adherence to guideline recommendations be planned."
"It is, in fact, important that the diffusion of new devices is paralleled by a similar diffusion of an optimal drug therapy."
SOURCE:http://bit.ly/fW0CfV
Am J Cardiol 2011.
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