Improved outcome with preventive cardiac resynchronization therapy in the elderly: A MADIT-CRT substudy

Justin Penn, Ilan Goldenberg, Arthur J. Moss, Scott McNitt, Wojciech Zareba, Helmut U. Klein, David S. Cannom, Scott D. Solomon, Alon Barsheshet, David T. Huang

Research output: Contribution to journalArticlepeer-review


Preventive Cardiac Resynchronization in the Elderly. Background: Elderly patients comprise a large portion of patients with heart failure (HF). Limited data exist on the effectiveness of cardiac resynchronization therapy with defibrillator (CRT-D) in patients with mild HF symptoms in this population. Methods and Results: The benefit of CRT-D compared with ICD-only therapy in reducing HF or death was assessed by age categories (prespecified as <60 [n = 548], 60-74 [n = 941], and ≥75 [n = 331] years) among 1,820 patients in MADIT-CRT. In patients with ICD-only, there was a graded age-related increase in the Kaplan-Meier cumulative probability of HF or death at 3-year follow-up (19%, 33%, and 36%, in patients aged <60, 60-74, and ≥75 years, respectively, P = 0.003). Multivariate analysis demonstrated that CRT-D therapy was associated with a significant reduction in the risks of HF or death in patients aged 60-74, and ≥75 years (HR = 0.57, P = <0.001 and HR = 0.59, P = 0.017, respectively), and no significant benefit in patients aged <60 years (HR = 0.81, P = 0.3; P-value for all treatment-by-age interactions >0.10). There was no significant difference in the rate of device-related adverse events within 90 days following CRT-D implantation among age-subgroups (16.7%, 15.7%, and 11.7%, in patients <60, 60-74, and ≥75 years, respectively, P = 0.42). Conclusion: CRT-D was associated with a significant clinical benefit in older patients (≥60 years) during an average 2.4-year follow-up. These effects were preserved for the elderly patients ≥75 years of age but attenuated in patients <60 years. Elderly patients had no increase in device-related adverse events compared with younger patients.

Original languageEnglish
Pages (from-to)892-897
Number of pages6
JournalJournal of Cardiovascular Electrophysiology
Issue number8
StatePublished - Aug 2011
Externally publishedYes


  • cardiac resynchronization therapy
  • cardiomyopathy
  • congestive heart failure
  • coronary artery disease
  • elderly
  • implantable cardioverter defibrillator


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