Author + information
- Received March 1, 2017
- Revision received June 14, 2017
- Accepted June 30, 2017
- Published online December 18, 2017.
- Maciej Kubala, MDa,∗ (, )
- Laurence Guédon-Moreau, MDb,
- Frédéric Anselme, MD, PhDc,
- Didier Klug, MD, PhDb,
- Geneviève Bertaina, MDa,
- Sarah Traullé, MDa,
- Otilia Buiciuc, MDa,
- Arnaud Savouré, MDc,
- Momar Diouf, PhDa and
- Jean-Sylvain Hermida, MD, PhDa
- aCentre Hospitalier Universitaire, Amiens, France
- bCentre Hospitalier Régional Universitaire, Lille, France
- cCentre Hospitalier Régional Universitaire, Rouen, France
- ↵∗Address for correspondence:
Dr. Maciej Kubala, Service de Rythmologie et Stimulation Cardiaque, Centre Hospitalier Universitaire, Avenue Laennec, 80054 Amiens, France.
Objectives The aim of this study was to evaluate the impact of frailty in the elderly on response to cardiac resynchronization therapy (CRT).
Background CRT has been shown to improve symptoms and outcome of patients with congestive heart failure (HF) and impaired left ventricular ejection fraction (LVEF). The impact of frailty on the results of CRT is unknown.
Methods Frailty defined as <14 of 17 points using the ONCODAGE (Outil de dépistage gériatrique en oncologie) G8 score was assessed before device implantation in candidates for CRT who were >70 years of age. The primary endpoint was the response to CRT, defined as an improvement of >5% of the LVEF and the absence of hospitalization for HF or cardiovascular death at 9 months.
Results Ninety-two of 151 included patients (61%) were frail, and 89 (59%) were responders. Frailty was more frequent in nonresponders: 45 of 62 (73%) versus 47 of 89 (53%) (p = 0.014) and was identified as an independent predictor of nonresponse to CRT (R = 0.30; 95% confidence interval: 0.02 to 0.59; p = 0.039). Frailty was associated with a higher cumulative probability of hospitalization for HF (log-rank p = 0.032) and of all-cause death (log-rank p = 0.033). A G8 score <10.25 correlated with hospitalization for HF or death at 9 months (area under the curve: 0.75; 95% confidence interval: 0.63 to 0.87; cutoff <10.25; 77% sensitivity, 63% specificity).
Conclusions Frailty is as an independent predictor of nonresponse to CRT. Frail patients implanted with CRT devices have a higher risk of hospitalization for HF and mortality. Routine comprehensive geriatric assessment at the time of screening for device therapy should be recommended to optimize management. (Frailty Score Assessment for Elderly Patients Undergoing Cardiac Resynchronization Therapy [FRAILTY]; NCT02369419)
This work was supported in part by Biotronik (for data processing). Dr. Kubala has received honoraria from LivaNova and Boston Scientific. Dr. Guédon-Moreau has received consulting fees from LivaNova, Medtronic, St. Jude Medical, Boston Scientific, and Biotronik. Dr. Anselme has received honoraria and consulting fees from LivaNova, Medtronic, St. Jude Medical, Boston Scientific, and Biotronik. Dr. Klug has received consulting fees from Livanova, Medtronic, St Jude Medical, Boston Scientific, and Biotronik. Dr. Hermida has received consulting fees from St. Jude Medical and LivaNova. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors' institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received March 1, 2017.
- Revision received June 14, 2017.
- Accepted June 30, 2017.
- 2017 American College of Cardiology Foundation
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