Key result
Cardiac resynchronization therapy outcomes, including heart failure hospitalization and mortality, were independent of age (P=0.52), gender (P=0.46), and heart failure etiology (P=0.12).
Why the study?
Does cardiac resynchronization therapy improve outcomes equally across age, gender, and etiology subgroups in patients with drug-refractory heart failure?
Cohort (n=117)
No
Does cardiac resynchronization therapy improve outcomes equally across age, gender, and etiology subgroups in patients with drug-refractory heart failure?
Cardiac resynchronization therapy provides comparable long-term benefits regardless of patient age, gender, or underlying heart failure etiology.
Supports CRT consideration across ages/genders in HF; leaves open confirmation in larger trials.
BACKGROUND: Cardiac resynchronization therapy (CRT) outcome varies significantly among patients. We aimed to determine the impact of age, gender, and heart failure etiology on the long-term outcome of patients receiving CRT. METHODS: A total of 117 patients with drug-refractory heart failure, New York Heart Association (NYHA) Class III or IV, and a wide QRS complex, who received CRT, were followed for one year. Long-term outcome was measured as a combined end point of hospitalization for heart failure and/or all cause mortality. Efficacy of CRT was compared between men and women, between older and younger patients, and between patients with ischemic and nonischemic heart disease. Time to the primary end point was estimated by the Kaplan-Meier method and comparisons were made using the Breslow-Wilcoxon test. RESULTS: Baseline clinical characteristics were comparable between gender, age, and heart failure etiology subgroups. There was no significant difference in the combined end point between older versus younger (age >70, (n = 71), versus age < 70, (n = 46), P = 0.52); both genders (men, n = 91 vs women, n = 26, P = 0.46) and etiology of the cardiomyopathy (ischemic (n = 79) vs nonischemic (n = 38), P = 0.12). Substratification of the genders by the etiology of the cardiomyopathy, showed that women with ischemic cardiomyopathy (IW, n = 10) had a trend to a worse outcome compared to the other groups i.e., nonischemic women (NIW, n = 16), ischemic men (IM, n = 69), and nonischemic men (NIM, n = 22), P = 0.04. After adjusting for potential covariates, a Cox regression analysis showed no significant difference between the groups (P = 0.61). CONCLUSIONS: CRT outcome appears independent of age, gender, and heart failure etiology in this single institution study.
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Zardkoohi et al. (2007) conducted a cohort in Drug-refractory heart failure (n=117). Age >70, female gender, and ischemic etiology vs. Age <70, male gender, and nonischemic etiology was evaluated on Combined end point of hospitalization for heart failure and/or all cause mortality (p=0.52 for age, 0.46 for gender, 0.12 for etiology). Cardiac resynchronization therapy outcomes, including heart failure hospitalization and mortality, were independent of age (P=0.52), gender (P=0.46), and heart failure etiology (P=0.12).
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