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. 2023 Jul 4;25(7):euad187.
doi: 10.1093/europace/euad187.

Age-stratified comparison of prognosis in cardiac resynchronization therapy with or without prophylactic defibrillator for nonischemic cardiomyopathy-a nationwide cohort study

Maiwand Farouq  1   2 , Cecilia Rorsman  3 , Sofia Marinko  1   2 , David Mörtsell  1   2 , Uzma Chaudhry  1   2 , Lingwei Wang  1   2 , Pyotr G Platonov  1   2 , Rasmus Borgquist  1   2
Affiliations

Age-stratified comparison of prognosis in cardiac resynchronization therapy with or without prophylactic defibrillator for nonischemic cardiomyopathy-a nationwide cohort study

Maiwand Farouq et al. Europace. .

Abstract

Aims: Prior studies have suggested that the benefit from primary preventive defibrillator treatment for patients with nonischemic cardiomyopathyy, treated with cardiac resynchronization therapy, may be age-dependent. We aimed to compare age-stratified mortality rates and mode of death in patients with nonischemic cardiomyopathy who are treated with either primary preventive cardiac resynchronization therapy with defibrillator (CRT-D) or CRT with pacemaker (CRT-P).

Methods and results: All patients with nonischemic cardiomyopathy and CRT-P or primary preventive CRT-D who were implanted in Sweden during the period 2005-2020 were included. Propensity scoring was used to create a matched cohort. Primary outcome was all-cause mortality within 5 years. In all, 4027 patients were included: 2334 with CRT-P and 1693 with CRT-D. Crude 5-year mortality was 635 (27%) vs. 246 (15%), P < 0.001. In Cox regression analysis, adjusted for clinically relevant covariables, CRT-D was independently associated with higher 5-year survival [0.72 (0.61-0.85), P < 0.001]. Cardiovascular mortality was similar between groups (62 vs. 64%, P = 0.64), but death from heart failure was more common in the CRT-D group (46 vs. 36%, P = 0.007). In the matched cohort (n = 2414), 5-year mortality was 21% (24 vs. 16%, P < 0.001). In age-stratified analyses, CRT-P was associated with higher mortality in age groups <60 years and 70-79 years, but there was no difference in age groups 60-69 years or 80-89 years.

Conclusion: In this nationwide registry-based study, patients with CRT-D had better 5-year survival compared to patients with CRT-P. The interaction between age and mortality reduction was not consistent, but patients with CRT-D aged <60 years had the largest absolute mortality reduction.

Keywords: Cardiac resynchronization therapy; Heart failure; Pacemaker; Prognosis.

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Figures

Graphical Abstract
Graphical Abstract
CRT, cardiac resynchronization therapy; ICD, implantable cardioverter defibrillator.
Figure 1
Figure 1
Kaplan–Meier curve for CRT-P– and CRT-D–treated patients for all age groups, in the propensity score–matched cohort. CRT-D, cardiac resynchronization therapy with defibrillator; CRT-P, cardiac resynchronization therapy with pacemaker.
Figure 2
Figure 2
Kaplan–Meier curves stratified by age groups, in the propensity score–matched cohort. CRT-D, cardiac resynchronization therapy with defibrillator; CRT-P, cardiac resynchronization therapy with pacemaker.
See this image and copyright information in PMC

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