Do Elderly Patients with Heart Failure and Reduced Ejection Fraction Benefit from Pharmacological Strategies for Prevention of Arrhythmic Events?

Abstract

Background Heart failure constitutes one of the leading causes of morbidity and mortality in Western countries, in which it is also the leading cause of hospitalization in elderly patients. The pharmacological therapy of patients with heart failure with reduced ejection fraction (HFrEF) has greatly improved during the last years. Summary The quadruple therapy (sacubitril/valsartan, beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter 2 inhibitors) is nowadays the cornerstone of medical treatment since it associates lower risk of heart failure hospitalizations and mortality (also of arrhythmic origin). Cardiac arrhythmias, including sudden cardiac death, are common in patients with HFrEF, entailing worse prognosis. Previous studies addressing the role of blocking the renin-angiotensin-aldosterone system and beta-adrenergic receptors in HFrEF have suggested different beneficial effects on arrhythmia mechanisms. Therefore, the lower mortality associated with the use of the four pillars of HFrEF therapy depends, in part, on lower sudden (mostly arrhythmic) cardiac death. Key Messages In this review, we highlight and assess the role of the four pharmacological groups that constitute the central axis of the medical treatment of patients with HFrEF in clinical prognosis and prevention of arrhythmic events, with special focus on the elderly patient, since evidence supports most benefits provided are irrespective of age, but elderly HF patients receive less frequently guideline recommended medical treatment.

Improving therapeutic outcomes in heart failure with reduced nonvalvular ejection fraction: A clinical study of heart failure education intervention

“…Following HF education intervention, the treatment outcomes for HF patients showed significant improvement, aligning with findings from previous studies 15,16 . This study found that the total effective rate of patients who received HF education intervention was higher than those who did not receive such intervention.…”

“…Following HF education intervention, the treatment outcomes for HF patients showed significant improvement, aligning with findings from previous studies. 15 , 16 This study found that the total effective rate of patients who received HF education intervention was higher than those who did not receive such intervention. Siennicka et al conducted a study on the long‐term effects of HF education intervention instable HF patients and observed significant improvements in their quality of life and functional motor abilities.…”

Prognostic effect of systematic geriatric assessment on patients with acute heart failure

“…In certain studies, it has been observed that frail patients have less often guideline‐recommended medical treatment at discharge and follow‐up, 38 although they obtained the most significant benefit. 39 Our data show similar neurohormonal treatment prescriptions at discharge between frail and non‐frail patients but lower prescriptions in dependent patients than in independent ones.…”