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Bernard J, St-Louis R, Robichaud M, Kalavrouziotis D, Dumont É, Paradis JM, Babaki S, Rodés-Cabau J, Mohammadi S. Is Transcatheter Aortic Valve Replacement Futile in Patients Over Ninety Years of Age? CJC Open 2023; 5:784-791. [PMID: 37876887 PMCID: PMC10591129 DOI: 10.1016/j.cjco.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/03/2023] [Indexed: 10/26/2023] Open
Abstract
Background Clinical outcomes and quality of life (QoL) indices are not well described after transcatheter aortic valve replacement (TAVR) in patients aged ≥ 90 years. Methods We conducted a retrospective cohort study of TAVR among nonagenarian patients between 2008 and 2020. The survival of TAVR patients among nonagenarians was compared to the provincial estimated survival for an age- and sex-matched general population. QoL was assessed up to 1 year postintervention, using standardized questionnaires. Results During the study period, n = 268 patients aged ≥ 90 years were evaluated for severe aortic stenosis. TAVR was performed in n = 171 (48% female; median [IQR] Rockwood Clinical Frailty Scale score: 4 [3-4]); n = 84 underwent medical therapy; and n = 13 underwent surgical aortic valve replacement. Survival was significantly better following TAVR, compared to that after MT (adjusted hazard ratio [95% CI]: 1.99 [1.37-2.88], P < 0.001). TAVR patients demonstrated a survival advantage compared with the general population, with an estimated relative mortality of 0.86 (0.75-0.87). TAVR patients showed sustained improvements in functional status and QoL up to 1 year compared to baseline (all P < 0.05): the 6-minute walk test results improved from 192 to 252 m; the Kansas City Cardiomyopathy Questionnaire score improved from 64 to 81; the Duke Activity Status Index score improved from 13 to 16; and the health state scale result of the Euro Quality of life - 5 Dimensions improved from 63% to 74%. Conclusions Nonagenarians undergoing TAVR experience a slightly better survival rate, compared to that of an age- and sex-matched general population, and they have significant improvements in functional status and several QoL indices following the procedure.
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Affiliation(s)
- Jérémy Bernard
- Division of Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec (Université Laval/Quebec Heart and Lung Institute), Laval University, Quebec City, Quebec, Canada
| | - Roxanne St-Louis
- Division of Cardiac Surgery, Institut universitaire de cardiologie et de pneumologie de Québec (Université Laval/Quebec Heart and Lung Institute), Laval University, Quebec City, Quebec, Canada
| | - Mathieu Robichaud
- Division of Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec (Université Laval/Quebec Heart and Lung Institute), Laval University, Quebec City, Quebec, Canada
| | - Dimitri Kalavrouziotis
- Division of Cardiac Surgery, Institut universitaire de cardiologie et de pneumologie de Québec (Université Laval/Quebec Heart and Lung Institute), Laval University, Quebec City, Quebec, Canada
| | - Éric Dumont
- Division of Cardiac Surgery, Institut universitaire de cardiologie et de pneumologie de Québec (Université Laval/Quebec Heart and Lung Institute), Laval University, Quebec City, Quebec, Canada
| | - Jean-Michel Paradis
- Division of Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec (Université Laval/Quebec Heart and Lung Institute), Laval University, Quebec City, Quebec, Canada
| | - Shervin Babaki
- Division of Research, Institut universitaire de cardiologie et de pneumologie de Québec (Université Laval/Quebec Heart and Lung Institute), Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Division of Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec (Université Laval/Quebec Heart and Lung Institute), Laval University, Quebec City, Quebec, Canada
| | - Siamak Mohammadi
- Division of Cardiac Surgery, Institut universitaire de cardiologie et de pneumologie de Québec (Université Laval/Quebec Heart and Lung Institute), Laval University, Quebec City, Quebec, Canada
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Champ-Rigot L, Cornille AL, Ollitrault P, Pellissier A, Chequel M, Legallois D, Milliez P. Predictors of clinical outcomes after cardiac resynchronization therapy in patients ≥75 years of age: a retrospective cohort study. BMC Geriatr 2019; 19:325. [PMID: 31752707 PMCID: PMC6873499 DOI: 10.1186/s12877-019-1351-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 11/07/2019] [Indexed: 11/20/2022] Open
Abstract
Background Cardiac resynchronization therapy has been shown to benefit selected patients with heart failure and reduced ejection fraction. Older patients have been underrepresented in randomized trials. This study was conducted to determine whether predictive factors for cardiac resynchronization therapy outcomes differ in patients older and younger than 75 years of age. Methods Consecutive patients who received a cardiac resynchronization device cardiac resynchronization therapy between 2013 and 2016 in our center were retrospectively included in this cohort study. The primary endpoint was cardiac resynchronization therapy effectiveness, which was defined as survival for one year with both no heart failure hospitalization and improvement by one or more NYHA class. The secondary endpoints were mortality, complications, and device therapies. Results Among the 243 patients included, 102 were ≥ 75 years old. Cardiac resynchronization therapy effectiveness was observed in 70 patients (50%) < 75 years old and in 48 patients (47%) ≥75 years old (p = 0.69). NYHA class ≥III (OR = 6.02; CI95% [1.33–18.77], p = 0.002) was a predictive factor for cardiac resynchronization therapy effectiveness only in the ≥75-year-old group, while atrial fibrillation was independently negatively associated with the primary endpoint in the < 75-year-old group (OR = 0.28; CI95% [0.13–0.62], p = 0.001). The one-year mortality rate was 14%, with no difference between age groups. Rescue cardiac resynchronization therapy and atrial fibrillation were independent predictive factors for mortality in both age groups. Eighty-two complications occurred in 45 patients (19%), with no difference between groups. Defibrillator use and QRS duration were independent predictive factors for complications in both age groups. There was no difference between groups considering device therapies. Conclusion At one year, cardiac resynchronization therapy response is not compromised by patient age. In older patients, highly symptomatic individuals with NYHA class ≥III have better outcomes after cardiac resynchronization therapy.
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Affiliation(s)
- Laure Champ-Rigot
- Normandie University, UNICAEN, CHU de Caen Normandie, Service de Cardiologie, EA4650 (Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique), 14000, Caen, France.
| | - Anne-Laure Cornille
- Normandie University, UNICAEN, CHU de Caen Normandie, Service de Cardiologie, 14000, Caen, France
| | - Pierre Ollitrault
- Normandie University, UNICAEN, CHU de Caen Normandie, Service de Cardiologie, 14000, Caen, France
| | - Arnaud Pellissier
- Normandie University, UNICAEN, CHU de Caen Normandie, Service de Cardiologie, 14000, Caen, France
| | - Mathieu Chequel
- Normandie University, UNICAEN, CHU de Caen Normandie, Service de Cardiologie, 14000, Caen, France
| | - Damien Legallois
- Normandie University, UNICAEN, CHU de Caen Normandie, Service de Cardiologie, EA4650 (Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique), 14000, Caen, France
| | - Paul Milliez
- Normandie University, UNICAEN, CHU de Caen Normandie, Service de Cardiologie, EA4650 (Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique), 14000, Caen, France
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Méndez-Flórez J, Agudelo-Zapata Y, Torres Villarreal MC, Paola-León L, Guarín-Loaiza G, Torres-Saavedra F, Burgos-Cárdenas Á, Mora-Pabón G. Uso de desfibriladores implantables y terapia de resincronización cardiaca en ancianos mayores de 70 a 80 años: controversias y evidencia. REVISTA COLOMBIANA DE CARDIOLOGÍA 2019. [DOI: 10.1016/j.rccar.2019.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Mlynarska A, Mlynarski R, Marcisz C, Golba KS. Modified frailty as a novel factor in predicting the response to cardiac resynchronization in the elderly population. Clin Interv Aging 2019; 14:437-443. [PMID: 30880925 PMCID: PMC6394238 DOI: 10.2147/cia.s193577] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background The response to cardiac resynchronization therapy (CRT) is an important element of the treatment of advanced heart failure, especially in the geriatric population. The aim of the study was to examine the impact of frailty syndrome on the response to treatment with CRT. Methods Two hundred and forty-six patients of 60 years or older (aged 73.35±6.95; 22.4% women) with an implanted CRT were included in this single-center prospective study. There was a 12-month follow-up. The Tilburg Frailty Indicator was used to determine frailty (5 or more points). The response to CRT was evaluated based on an analysis of clinical criteria. Results One hundred and sixty-nine of 246 (68.9%) patients were found to be clinical CRT responders. Frailty syndrome was recognized in 173 (70.32%). There were 63.0% responders in the frailty-affected group, whereas there were statistically more responders (79.5%) in the robust group (P=0.0116). In the logistic regression, frailty emerged as an independent predictor of the response to CRT (OR=0.81, 95% CI=0.71–0.92; P=0.0008). The area under the curve of the ROC curve for frailty in the responders to CRT was 0.62. The cut-off value for a designation of frailty was 6 (P=0.0014). Conclusion Frailty is a novel independent factor that can be used to predict the clinical response to CRT in the elderly population. Modifying the level of recognition in the Tilburg Frailty Indicator can improve the prediction of a response to CRT.
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Affiliation(s)
- Agnieszka Mlynarska
- Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia, Katowice, Poland, .,Department of Electrocardiology, Upper Silesian Heart Centre, Katowice, Poland,
| | - Rafal Mlynarski
- Department of Electrocardiology, Upper Silesian Heart Centre, Katowice, Poland, .,Department of Electrocardiology and Heart Failure, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - Czeslaw Marcisz
- Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia, Katowice, Poland,
| | - Krzysztof S Golba
- Department of Electrocardiology, Upper Silesian Heart Centre, Katowice, Poland, .,Department of Electrocardiology and Heart Failure, School of Health Sciences, Medical University of Silesia, Katowice, Poland
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Pombo Jiménez M, Cano Pérez O, Lorente Carreño D, Chimeno García J. Registro Español de Marcapasos. XV Informe Oficial de la Sección de Estimulación Cardiaca de la Sociedad Española de Cardiología (2017). Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2018.07.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Spanish Pacemaker Registry. 15th Official Report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2017). ACTA ACUST UNITED AC 2018; 71:1059-1068. [PMID: 30348615 DOI: 10.1016/j.rec.2018.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 07/17/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES This report describes the data reported to the Spanish Pacemaker Registry concerning the activity in cardiac pacing in 2017 in Spain. METHODS The analysis is based on the data obtained from the European Pacemaker Identification Card and the information reported by supplier companies related to global number of implanted pacemakers. RESULTS Information was received from 106 hospitals, with a total of 12672 cards, representing the 32.1% of the total pacing activity. Conventional pacemaker and resynchronization pacemaker rate was 820 units/million and 26 units/million inhabitants respectively. A total of 333 leadless pacemakers were implanted. The mean age was 77.9 years, predominantly men (58.5%). Most electrodes were bipolar, with active fixation and only 20% had magnetic resonance protection. Atrioventricular block was the most common electrocardiographic disturb. Most patients received bicameral sequential pacing although single chamber VVIR pacing was used in up to 21.8% of patients. Patients older than 80 years benefited less from physiological pacing and resynchronization therapy. CONCLUSIONS Total use of pacemaker generators remains stable with respect to 2016. Age is the main factor that influences pacing mode selection, which could be improved in around 22% of patients. Leadless pacing continues to rise.
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Fowler NR, Shaaban CE, Torke AM, Lane KA, Saba S, Barnato AE. "I'm Not Sure We Had A Choice": Decision Quality and The Use of Cardiac Implantable Electronic Devices In Older Adults With Cognitive Impairment. ACTA ACUST UNITED AC 2018. [PMID: 29521380 PMCID: PMC5839643 DOI: 10.26502/fccm.92920032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background The decision to implant a cardiac device in a person with Alzheimer’s disease or related dementia requires considering the possible trade-offs of quality of life (QOL) and quantity of life. This study measured the decision-making experience of patients with and without cognitive impairment (CI) who received a cardiac device and their family members who were involved in the decision. Methods and Results Semi-structured interviews and questionnaires were administered with 15 patient-family member dyads. Interviews revealed few conversations between physicians, patients and family members about the patient’s cognitive status or about the benefits, risks, and long-term implications of the device for someone with CI. Participants largely stated that the decision to get the device was based on the patient’s functional status at the time of the implant, and not on expectations about future functioning. Patients with CI had more regret, measured with the Decision Regret Scale (DRS), (p=0.037) and family members of patients without CI reported more decisional conflict, measured with the Decisional Conflict Scale (p=0.057). Conclusions Although CI impacts life expectancy and QOL, cognitive status was largely not discussed prior to device implant. Few differences were found between the experiences of dyads that included patients with or without CI.
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Affiliation(s)
- Nicole R. Fowler
- Indiana University Center for Aging Research, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Corresponding Author: Nicole R. Fowler, Indiana University School of Medicine, Indiana University Center for Aging Research, 1101 West 10th Street, Indianapolis, IN 46202, USA, Telephone: (317) 274-9021;
| | - C. Elizabeth Shaaban
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alexia M. Torke
- Indiana University Center for Aging Research, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kathleen A. Lane
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Samir Saba
- Division of Cardiology, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Amber E. Barnato
- The Dartmouth Institute of Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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Manian U, Gula LJ. Arrhythmia Management in the Elderly—Implanted Cardioverter Defibrillators and Prevention of Sudden Death. Can J Cardiol 2016; 32:1117-23. [DOI: 10.1016/j.cjca.2016.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/17/2016] [Accepted: 03/21/2016] [Indexed: 11/16/2022] Open
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Hatfield LA, Kramer DB, Volya R, Reynolds MR, Normand SLT. Geographic and Temporal Variation in Cardiac Implanted Electric Devices to Treat Heart Failure. J Am Heart Assoc 2016; 5:e003532. [PMID: 27468928 PMCID: PMC5015279 DOI: 10.1161/jaha.116.003532] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 07/05/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Cardiac implantable electric devices are commonly used to treat heart failure. Little is known about temporal and geographic variation in use of cardiac resynchronization therapy (CRT) devices in usual care settings. METHODS AND RESULTS We identified new CRT with pacemaker (CRT-P) or defibrillator generators (CRT-D) implanted between 2008 and 2013 in the United States from a commercial claims database. For each implant, we characterized prior medication use, comorbidities, and geography. Among 17 780 patients with CRT devices (median age 69, 31% women), CRT-Ps were a small and increasing share of CRT devices, growing from 12% to 20% in this study period. Compared to CRT-D recipients, CRT-P recipients were older (median age 76 versus 67), and more likely to be female (40% versus 30%). Pre-implant use of β-blockers and angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers was low in both CRT-D (46%) and CRT-P (31%) patients. The fraction of CRT-P devices among all new implants varied widely across states. Compared to the increasing national trend, the share of CRT-P implants was relatively increasing in Kansas and relatively decreasing in Minnesota and Oregon. CONCLUSIONS In this large, contemporary heart failure population, CRT-D use dwarfed CRT-P, though the latter nearly doubled over 6 years. Practice patterns vary substantially across states and over time. Medical therapy appears suboptimal in real-world practice.
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Affiliation(s)
| | - Daniel B Kramer
- Harvard Medical School, Boston, MA Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA
| | | | | | - Sharon-Lise T Normand
- Harvard Medical School, Boston, MA Harvard T. H. Chan School of Public Health, Boston, MA
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Is cardiac resynchronisation therapy feasible, safe and beneficial in the very elderly? JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2015; 12:497-501. [PMID: 26512240 PMCID: PMC4605944 DOI: 10.11909/j.issn.1671-5411.2015.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate whether cardiac resynchronisation therapy (CRT) implantation was feasible and safe in octogenarians and the association with symptoms. METHODS Consecutive patients undergoing CRT implantation were recruited from two UK centers. Patients grouped according to age: < 80 & ≥ 80 years. Baseline demographics, complications and outcomes were compared between those groups. RESULTS A total of 439 patients were included in this study, of whom 26% were aged ≥ 80 years. Octogenarians more often received cardiac resynchronization therapy pacemaker in comparison to cardiac resynchronisation therapy-defibrillator. Upgrade from pacemaker was common in both groups (16% < 80 years vs. 22% ≥ 80 years, P = NS). Co-morbidities were similarly common in both groups (overall diabetes: 25%, atrial fibrillation: 23%, hypertension: 45%). More patient age ≥ 80 years had significant chronic kidney disease (CKD, estimated glomerular filtration rate < 45 mL/min per 1.73 m(2), 44% vs. 22%, P < 0.01). Overall complication rates (any) were similar in both groups (16% vs. 17%, P = NS). Both groups demonstrated symptomatic benefit. One-year mortality rates were almost four fold greater in octogenarians as compared with the younger cohort (13.9% vs. 3.7%, P < 0.01). CONCLUSIONS CRT appears to be safe in the very elderly despite extensive co-morbidity, and in particular frequent severe CKD. Symptomatic improvement appears to be meaningful. Strategies to increase the appropriate identification of elderly patients with CHF who are potential candidates for CRT are required.
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Clinical impact of a new left bundle branch block following TAVI implantation: 1-year results of the TAVIK cohort. Clin Res Cardiol 2014; 104:351-62. [DOI: 10.1007/s00392-014-0791-2] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 11/06/2014] [Indexed: 12/15/2022]
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WILSON DAVIDG, DUNCAN EDWARDR. Letter to the Editor Regarding Survival in Octogenarians Undergoing Cardiac Resynchronization Therapy Compared to the General Population. Pacing Clin Electrophysiol 2014; 37:1587. [DOI: 10.1111/pace.12515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- DAVID G. WILSON
- Department of Cardiology; University Hospital Southampton NHS Foundation Trust; Southampton UK
- University Hospitals Bristol NHS Foundation Trust; Bristol UK
| | - EDWARD R. DUNCAN
- Department of Cardiology; University Hospital Southampton NHS Foundation Trust; Southampton UK
- University Hospitals Bristol NHS Foundation Trust; Bristol UK
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