CRT-D in the Elderly:
Although current guidelines rarely provide recommendations on the
selection of patients for CRT-D and CRT-P, an older age, multiple
comorbidity and frail patient is inclined to receive a CRT-P across the
centers generally. Our work supported this clinical practice by
verifying the non-significant difference of all-cause mortality in the
elderly (≥75 years) between CRT-D and CRT-P. With the progression of HF,
pump-failure represents the most frequent cause of death [13,42]. In
addition, the risk of death caused by non-cardiac diseases in older
patients will increase due to more comorbidities and frailty. Assuming
pump-failure and non-cardiac death as a competing risk of SCD, the
benefits of additional ICD therapy would be attenuated in the elderly.
Furthermore, a multicenter observational study by Barra et al including
3008 subjects reported an association of CRT-D and increased occurrence
of late complications (a complication occurring or diagnosed following
hospital discharge and which had not been seen to occur during the index
hospitalization), especially the complication of device-related
infection [43]. It may result in a potential increase in admissions
and long-term mortality. Meanwhile, Liang et al reported a 5.9%
incidence of inappropriate shock in CRT-D patients, which may affect
quality of life and increase the risk of death [33]. As our work
indicated that an additional ICD seems to have no advantage in mortality
in aged patients, we should not only take clinical index (LVEF, QRS
duration) into consideration in aspect of individual device selection,
but also patient’s age, comorbidities and life expectancy.