CRT upgrade improves frailty status in patients with HFrEF and RV pacing-a post hoc analysis of the BUDAPEST-CRT trial.

Authors

Luca Kuthi, Eperke Merkel, Marianna Németh, Boglárka Veres, Zoltán Szakács, Anett Behon, Richárd Masszi, Zsuzsanna Kis, Roland Papp, Levente Molnár, Attila Kovács, Annamária Kosztin, Béla Merkely, Walter Richard Schwertner

Published in

GeroScience. Jun 18, 2026. Epub Jun 18, 2026.

Abstract

Frailty and heart failure (HF) both have become increasingly prevalent and each adversely affects prognosis. Data regarding the potential frailty-modifying effect of cardiac resynchronization therapy (CRT) upgrade remain scarce. This study aimed to evaluate the impact of frailty on clinical outcomes in the Budapest-CRT Upgrade trial population. Patients with heart failure and reduced ejection fraction (HFrEF), an implanted pacemaker or implantable cardioverter-defibrillator (ICD) and ≥ 20% right ventricular pacing burden were randomized to CRT-D upgrade (n = 215) or ICD alone (n = 145). Our primary endpoint was all-cause mortality, HF-hospitalization and or < 15% reduction of left ventricular end-systolic volume at 12 months. Frailty was assessed using a 31-item frailty index (FI) based on the Rockwood method, and patients were dichotomized according to the median FI. Among 360 patients, the mean baseline FI was 0.39 ± 0.10, with follow-up FI available in 282 patients at 12 months. CRT-D upgrade significantly decreased the risk of the primary endpoint regardless of baseline FI compared to ICD alone (interaction p = 0.17). CRT-D upgrade led to a 0.03-point greater reduction in the mean FI change compared to the ICD arm (mean FI difference at 12-month - 0.03; 95% CI - 0.04 to - 0.01; p = 0.005). In this highly comorbid cohort, frailty was common but it did not diminish the clinical benefit of CRT-D upgrade. CRT-D upgrade decreased the risk of the primary endpoint regardless of baseline frailty status and led to a significant decrease in mean FI change compared to ICD alone.

PMID:
42313253
Bibliographic data and abstract were imported from PubMed on 18 Jun 2026.

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