PMID- 34774750
OWN - NLM
STAT- MEDLINE
DCOM- 20220503
LR  - 20220503
IS  - 1532-8414 (Electronic)
IS  - 1071-9164 (Linking)
VI  - 28
IP  - 3
DP  - 2022 Mar
TI  - Comparative effectiveness of cardiac resynchronization therapy in older patients 
      with heart failure: Systematic review and meta-analysis.
PG  - 443-452
LID - S1071-9164(21)00439-5 [pii]
LID - 10.1016/j.cardfail.2021.10.013 [doi]
AB  - BACKGROUND: Pivotal CRT trials enrolled patients with HFrEF significantly younger 
      than the typical contemporary patient with HFrEF. Thus, the risks and benefits in 
      this older population with HFrEF are largely unknown. We sought to perform 
      meta-analyses comparing safety and effectiveness of cardiac resynchronization 
      therapy (CRT) in older vs younger patients with heart failure with reduced 
      ejection fraction (HFrEF). METHODS AND RESULTS: PubMed, The Cochrane Library, 
      Scopus, and Web of Science were queried for comparative effectiveness studies of 
      CRT in older patients with HFrEF. Title, abstract, and full-text screening was 
      performed to identify studies comparing at least 1 prespecified end point between 
      older and younger adult patients with at least 50 participants. Random effects 
      meta-analysis in the left ventricular ejection fraction (LVEF) mean difference 
      (older minus younger) and the relative risk (RR) of death, improvement in New 
      York Heart Association (NYHA) functional class, and complications are reported 
      along with estimates of heterogeneity. In 7 studies, there was similar LVEF 
      improvement between groups (mean difference 1.14, 95% confidence interval [CI] 
      -0.04 to 2.32, P = .06, I(2) = 53%). Older patients were equally likely as 
      younger patients to see an improvement in NYHA functional class of at least 1 in 
      6 studies (RR 0.99, 95% CI 0.93-1.06, P = .76, I(2) = 25%). No significant 
      differences in the incidence of hematoma, pneumothorax, lead dislodgment, cardiac 
      perforation, or infection requiring explant was observed. The RR of mortality in 
      11 studies demonstrated higher risk of all-cause mortality in older patients (RR 
      1.05, 95% CI 1.03-1.08, P < .01, I(2) = 0%). CONCLUSIONS: Compared with younger 
      patients, older patients receiving CRT were equally likely to experience 
      improvement in LVEF, left ventricular end-diastolic diameter, and NYHA functional 
      class. There was no difference in procedural complications. The higher rate of 
      all-cause mortality in older patients likely reflects a greater underlying risk 
      of death from competing causes.
CI  - Copyright (c) 2021 Elsevier Inc. All rights reserved.
FAU - Juggan, Saeed
AU  - Juggan S
AD  - From the Dartmouth College, Hanover, New Hampshire.
FAU - Ponnamreddy, Praveen K
AU  - Ponnamreddy PK
AD  - Dartmouth-Hitchcock Medical Center, Section of Cardiovascular Medicine, Lebanon, 
      New Hampshire.
FAU - Reilly, Clifford A
AU  - Reilly CA
AD  - Robert Larner M.D. College of Medicine, University of Vermont, Burlington, 
      Vermont.
FAU - Dodge, Shayne E
AU  - Dodge SE
AD  - Dartmouth-Hitchcock Medical Center, Section of Cardiovascular Medicine, Lebanon, 
      New Hampshire.
FAU - Gilstrap, Lauren G
AU  - Gilstrap LG
AD  - Dartmouth-Hitchcock Medical Center, Section of Cardiovascular Medicine, Lebanon, 
      New Hampshire; Robert Larner M.D. College of Medicine, University of Vermont, 
      Burlington, Vermont.
FAU - Zeitler, Emily P
AU  - Zeitler EP
AD  - Dartmouth-Hitchcock Medical Center, Section of Cardiovascular Medicine, Lebanon, 
      New Hampshire; The Dartmouth Institute, Lebanon, New Hampshire; The Geisel School 
      of Medicine at Dartmouth, Hanover, New Hampshire. Electronic address: 
      emily.p.zeitler@hitchcock.org.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20211110
PL  - United States
TA  - J Card Fail
JT  - Journal of cardiac failure
JID - 9442138
SB  - IM
MH  - Adult
MH  - Aged
MH  - *Cardiac Resynchronization Therapy/methods
MH  - *Heart Failure/diagnosis/therapy
MH  - Humans
MH  - Stroke Volume
MH  - Treatment Outcome
MH  - *Ventricular Dysfunction, Left/therapy
MH  - Ventricular Function, Left
OTO - NOTNLM
OT  - CRT
OT  - Heart failure
OT  - aging
OT  - quality and outcomes
EDAT- 2021/11/15 06:00
MHDA- 2022/05/04 06:00
CRDT- 2021/11/14 20:47
PHST- 2021/05/24 00:00 [received]
PHST- 2021/10/17 00:00 [revised]
PHST- 2021/10/19 00:00 [accepted]
PHST- 2021/11/15 06:00 [pubmed]
PHST- 2022/05/04 06:00 [medline]
PHST- 2021/11/14 20:47 [entrez]
AID - S1071-9164(21)00439-5 [pii]
AID - 10.1016/j.cardfail.2021.10.013 [doi]
PST - ppublish
SO  - J Card Fail. 2022 Mar;28(3):443-452. doi: 10.1016/j.cardfail.2021.10.013. Epub 
      2021 Nov 10.