Clinical Characteristics and Outcomes of Older Cardiac Resynchronization Therapy Recipients Using a Pacemaker versus a Defibrillator

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Abstract
CRT‐P versus CRT‐D Outcomes: Background: Cardiac resynchronization therapy (CRT) is commonly used to manage heart failure, yet published guidelines do not distinguish between recommendations for pacemakers (CRT‐P) and defibrillators (CRT‐D) despite significant differences in size, longevity, and cost between these devices. The purpose of this study is to compare the clinical characteristics and outcomes between elderly recipients of CRT‐P and CRT‐D.Methods and Results: Data from 512 patients (405 CRT‐D, 107 CRT‐P) aged ≥75 years with LV ejection fraction ≤35% and QRS duration >120 milliseconds were retrospectively analyzed for baseline characteristics and followed to the primary outcome of all‐cause mortality. Cox proportional hazards models were used to adjust for possible confounders. Results were further validated through propensity matching cohorts. Compared to CRT‐D recipients, CRT‐P patients were older (83 years vs. 81 years, P < 0.001) and had more comorbid conditions (Charlson index = 5 [3–6] vs. 4 [3–5], P = 0.007). During 40.8 months of follow‐up, there were 280 deaths. Compared to CRT‐D patients, CRT‐P recipients had higher unadjusted mortality (HR 1.54, 95% CI 1.15–2.08, P = 0.004). However, this difference lost significance after adjusting for baseline differences between the groups (HR 1.18, 95% CI 0.78–1.77, P = 0.435).Conclusion: Higher all‐cause mortality in older CRT‐P versus CRT‐D patients is largely explained by baseline clinical and demographic differences between the two groups, which are likely the drivers of device selection in real‐world clinical practice, where the published guidelines remain ambiguous. There is a need for randomized studies to determine optimal CRT device selection.

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