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98 Cardiac resynchronisation therapy in the over 85s produces similar outcomes and complication rates as younger patients
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  1. Stewart Brown1,
  2. Guy Furniss2,
  3. Mark dayer2
  1. 1Musgrove Park Hospital, Musgrove Park Hospital, Taunton, SOM TA1 5DA, United Kingdom
  2. 2Musgrove Park Hospital

Abstract

Background Patients over 85 are rarely included in clinical trials but potentially have a lot to gain from interventions. They have less physiological reserve and clinicians may be hesitant to perform procedures for fear of higher complications without clear benefits.

Methods Electronic health record data was reviewed for all patients receiving a cardiac resynchronisation therapy (CRT) device between January 2014 and December 2021.Results529 CRT procedures were performed. 59 (11%) patients were over 85 (mean 87±1.9, 85% male) including 1 CRT defibrillator and 58 CRT pacemakers. Indications for device implant are described in table 1.34 (58%) were elective and 25 (42%) were inpatients. 12/25 (48%) were heart failure hospitalisations (HFH). 7/34 (21%) elective cases stayed overnight, 45/59 (76%) patients were discharged within 24 hours of the procedure. 19/25 inpatient cases were discharged within 72 hours of implant. The other 6 remained an inpatient for 1 week (2), 2 weeks (2), 3 weeks (2). Inpatients who remained in hospital more than 7 days from implant had a higher mortality than those discharged within 72 hours (67% vs 21% p=0.059), and elective cases (67% vs 36% p=0.075), reflecting their lower physiological reserve.Complications occurred in 7 (12%) of which 3 had to be re-admitted. 4 patients experienced a procedural complication. 1 haematoma, 2 coronary sinus dissections and 1 pneumothorax. All resolved without intervention. The haematoma patient was re-admitted for review and observation. 3 patients experienced a complication during follow up. 1 superficial wound infection managed with washout and antibiotics, 1 atrial lead displacement and re-do, (both readmitted) and 1 LV lead failure at four months.37/59 patients had a home monitor. Mean daily physical activity (PA) at baseline was 0.7 ± 0.5 hours per day. Overall, PA improved in 21/37 (61%) by 1.7±1.3 hours. No change in physical activity was seen in 16 patients.Patients with a HFH after CRT implant had a higher mortality than those who remained out of hospital (78% vs 20% p=0.001). Patients with a HFH before CRT implant were no more likely to have a HFH after implant (20%), than those who had never been admitted with HF (12%) (p=0.48)17 patients died during a median follow up of 1.8 years. 9 patients died from left ventricular systolic dysfunction (LVSD), the remainder were non-LVSD deaths (cancer, infection, aortic stenosis, aortic aneurysm rupture, dementia). Of those who died, 10 patients survived less than 1 year (0.5±0.3 years). The remaining 7 survived 2 years or more (3.1±1.3 years).

Abstract 98 Table 1

Indications for CRT implant or left ventricular lead upgrade

Conclusion In this selected population of very elderly patients, physical activity improved in 61% of patients. There was a trend towards a higher mortality in those with prolonged hospital stays and further HFH after CRT implant. Complication rates are similar to those seen in randomised control trials performed in younger patients.

Conflict of Interest nil

  • CRT
  • Upgrades
  • Elderly

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