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Complications and Mortality Following CRT-D Versus ICD Implants in Older Medicare Beneficiaries With Heart Failure.

Publication ,  Journal Article
Zeitler, EP; Austin, AM; Leggett, CG; Gilstrap, LG; Friedman, DJ; Skinner, JS; Al-Khatib, SM
Published in: JACC Heart Fail
March 2022

OBJECTIVES: This study sought to assess the comparative effectiveness of cardiac resynchronization therapy with defibrillator (CRT-D) over implantable cardioverter-defibrillator (ICD) alone in older Medicare patients with heart failure with reduced ejection fraction (HFrEF). BACKGROUND: Despite growing numbers of older patients with HFrEF, the benefits of cardiac resynchronization therapy (CRT) in this group are largely unknown. METHODS: A cohort of fee-for-service Medicare beneficiaries ≥65 years of age with HFrEF and enrolled in Medicare Part D who underwent CRT-D or ICD implantation from January 2008 to August 2015 was identified. Beneficiaries were divided by age (65-74, 75-84, and 85+ years), and outcomes were compared between the CRT-D and ICD groups after inverse probability weighting. RESULTS: Compared with the ICD group, the CRT-D group was older and more likely to be White, be female, and have left bundle branch block. After weighting, overall complications were high across age and device groups (14%-20%). The 1-year mortality was high across all groups. In the 2 oldest age strata, the hazard of death was lower in the CRT-D group (HR: 0.90; 95% CI: 0.86-0.95 and HR: 0.81; 95% CI: 0.72-0.90, respectively; P < 0.001); the hazard of heart failure hospitalization was lower for CRT-D vs ICD in the 85+ years age group (HR: 0.82; 95% CI: 0.74-0.92; P < 0.001). CONCLUSIONS: In older Medicare beneficiaries undergoing ICD with or without CRT, complications and 1-year mortality were high. Compared with ICD alone, CRT-D was associated with a lower hazard of mortality in patients ≥74 years of age and lower hazard of HF hospitalization in those ≥85 years of age. These findings support the use of CRT in eligible older patients undergoing ICD implantation.

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Published In

JACC Heart Fail

DOI

EISSN

2213-1787

Publication Date

March 2022

Volume

10

Issue

3

Start / End Page

147 / 157

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • United States
  • Treatment Outcome
  • Stroke Volume
  • Medicare
  • Humans
  • Heart Failure
  • Female
  • Defibrillators, Implantable
  • Cardiac Resynchronization Therapy
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Zeitler, E. P., Austin, A. M., Leggett, C. G., Gilstrap, L. G., Friedman, D. J., Skinner, J. S., & Al-Khatib, S. M. (2022). Complications and Mortality Following CRT-D Versus ICD Implants in Older Medicare Beneficiaries With Heart Failure. JACC Heart Fail, 10(3), 147–157. https://doi.org/10.1016/j.jchf.2021.10.012
Zeitler, Emily P., Andrea M. Austin, Christopher G. Leggett, Lauren G. Gilstrap, Daniel J. Friedman, Jonathan S. Skinner, and Sana M. Al-Khatib. “Complications and Mortality Following CRT-D Versus ICD Implants in Older Medicare Beneficiaries With Heart Failure.JACC Heart Fail 10, no. 3 (March 2022): 147–57. https://doi.org/10.1016/j.jchf.2021.10.012.
Zeitler EP, Austin AM, Leggett CG, Gilstrap LG, Friedman DJ, Skinner JS, et al. Complications and Mortality Following CRT-D Versus ICD Implants in Older Medicare Beneficiaries With Heart Failure. JACC Heart Fail. 2022 Mar;10(3):147–57.
Zeitler, Emily P., et al. “Complications and Mortality Following CRT-D Versus ICD Implants in Older Medicare Beneficiaries With Heart Failure.JACC Heart Fail, vol. 10, no. 3, Mar. 2022, pp. 147–57. Pubmed, doi:10.1016/j.jchf.2021.10.012.
Zeitler EP, Austin AM, Leggett CG, Gilstrap LG, Friedman DJ, Skinner JS, Al-Khatib SM. Complications and Mortality Following CRT-D Versus ICD Implants in Older Medicare Beneficiaries With Heart Failure. JACC Heart Fail. 2022 Mar;10(3):147–157.
Journal cover image

Published In

JACC Heart Fail

DOI

EISSN

2213-1787

Publication Date

March 2022

Volume

10

Issue

3

Start / End Page

147 / 157

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • United States
  • Treatment Outcome
  • Stroke Volume
  • Medicare
  • Humans
  • Heart Failure
  • Female
  • Defibrillators, Implantable
  • Cardiac Resynchronization Therapy