Outcomes following cardiac resynchronisation therapy in older people.

INTRODUCTION: Older patients may be less likely to receive cardiac resynchronisation therapy (CRT) for the management of heart failure. We aimed to describe the differences in clinical response, complications, and subsequent outcomes following CRT implantation compared to younger patients. METHODS: We conducted a retrospective cohort study of unselected, consecutive patients implanted with CRT devices between March 2008 and July 2017. We recorded complications, symptomatic and echocardiographic response, hospitalisation for heart failure, and all-cause mortality comparing patients aged <70, 70-79 and ≥ 80 years. RESULTS: Five hundred and seventy-four patients (median age 76 years [interquartile range 68-81], 73.3% male) received CRT. At baseline, patients aged ≥80 years had worse symptoms, were more likely to have co-morbidities, and less likely to be receiving comprehensive medical therapy, although left ventricular function was similar. Older patients were less likely to receive CRT-defibrillators compared to CRT-pacemakers. Complications were infrequent and not more common in older patients. Age was not a predictor of symptomatic or echocardiographic response to CRT (67.2%, 71.2% and 62.6% responders in patients aged <70, 70-79 and ≥ 80 years, respectively; P = 0.43), and time to first heart failure hospitalisation was similar across age groups (P = 0.28). Ten-year survival was lower for older patients (49.9%, 23.9% and 6.8% in patients aged <70, 70-79 and ≥ 80 years, respectively; P < 0.001). CONCLUSIONS: The benefits of CRT on symptoms and left ventricular function were not different in older patients despite a greater burden of co-morbidities and less optimal medical therapy. These findings support the use of CRT in an ageing population.

Carbohydrate Mouth Rinsing Does Not Prevent the Decline in Maximal Strength After Fatiguing Exercise.

Black, CD, Schubert, DJ, Szczyglowski, MK, and Wren, JD. Carbohydrate mouth rinsing does not prevent the decline in maximal strength after fatiguing exercise. J Strength Cond Res 32(9): 2466-2473, 2018-Carbohydrate (CHO) rinsing has been shown to attenuate the decline of maximal voluntary contractions (MVCs) after fatiguing exercise-perhaps through a central mechanism. This study sought to determine the effect of a CHO rinse on MVC, voluntary activation, and contractile properties after fatiguing exercise. Thirteen adults participated in a double-blind, cross-over study. Maximal voluntary contraction of the dominant knee extensors was assessed, and voluntary activation (%VA) was determined using twitch interpolation. Participants then held 50% of MVC until volitional fatigue followed by a 20-second rinse with a solution of 8% maltodextrin (CHO) or placebo (PLA). Maximal voluntary contraction and %VA were reassessed immediately and 5 minutes after exercise. Maximal voluntary contraction did not differ between the CHO and PLA conditions initially (230 ± 90 vs. 232 ± 90 N·m; p = 0.69). Maximal voluntary contraction declined after exercise (p ≤ 0.01), but no differences were found between the CHO and PLA conditions (p ≥ 0.59). %VA did not differ between conditions (91.9 ± 2.9% vs. 91.5 ± 3.8%; p ≥ 0.11) nor did it change after exercise (p = 0.57). Twitch torque, rate of torque development, and rate of torque relaxation were reduced after exercise (p ≤ 0.05) but were unaffected by CHO rinsing (p > 0.05). Unlike a previous study, a CHO rinse did not preserve MVC after fatiguing exercise. This was likely due to a lack of central fatigue induced by the exercise protocol (as %VA was unaffected) as the CHO rinse is thought to work through a central mechanism.