Guideline-directed medical therapy in elderly patients with heart failure with reduced ejection fraction: a cohort study

Abstract

Objectives and designGuideline-directed medical therapy (GDMT) with renin–angiotensin system (RAS) inhibitors and beta-blockers has improved survival in patients with heart failure with reduced ejection fraction (HFrEF). As clinical trials usually do not include very old patients, it is unknown whether the results from clinical trials are applicable to elderly patients with HF. This study was performed to investigate the clinical characteristics and treatment strategies for elderly patients with HFrEF in a large prospective cohort.SettingThe Korean Acute Heart Failure (KorAHF) registry consecutively enrolled 5625 patients hospitalised for acute HF from 10 tertiary university hospitals in Korea.ParticipantsIn this study, 2045 patients with HFrEF who were aged 65 years or older were included from the KorAHF registry.Primary outcome measurementAll-cause mortality data were obtained from medical records, national insurance data or national death records.ResultsBoth beta-blockers and RAS inhibitors were used in 892 (43.8%) patients (GDMT group), beta-blockers only in 228 (11.1%) patients, RAS inhibitors only in 642 (31.5%) patients and neither beta-blockers nor RAS inhibitors in 283 (13.6%) patients (no GDMT group). With increasing age, the GDMT rate decreased, which was mainly attributed to the decreased prescription of beta-blockers. In multivariate analysis, GDMT was associated with a 53% reduced risk of all-cause mortality (HR 0.47, 95% CI 0.39 to 0.57) compared with no GDMT. Use of beta-blockers only (HR 0.57, 95% CI 0.45 to 0.73) and RAS inhibitors only (HR 0.58, 95% CI 0.48 to 0.71) was also associated with reduced risk. In a subgroup of very elderly patients (aged ≥80 years), the GDMT group had the lowest mortality.ConclusionsGDMT was associated with reduced 3-year all-cause mortality in elderly and very elderly HFrEF patients.Trial registration numberNCT01389843.

Association Between Physical Status and the Effects of Combination Therapy With Renin-Angiotensin System Inhibitors and β-Blockers in Patients With Acute Heart Failure

“…Other studies reported that the proportion of CT prescriptions decreased with increasing age. 10,11 In the present study, we found that most physicians con-of these comorbidities; there may be strong drug interactions between these medications resulting in occasional or weak adverse events. In addition, the drug dosage used in CT may not have been sufficient to prevent adverse events.…”

“…These variables were used based on clinical relevance and previous studies. [10][11][12] Statistical analyses were performed using JMP version 14 (SAS Institute, Cary, NC, USA). Two-tailed P<0.05 was considered significant.…”

Coronary angiography in patients with acute heart failure: from the KCHF registry

“…There may be two speculative reasons: optimal medical therapies and revascularization for CAD. Optimal medical therapies for CAD may reduce the impact of coronary stenosis on mortality and HF rehospitalization 25,28 . Optimal coronary revascularization also may reduce the impact of coronary stenosis on mortality and HF rehospitalization 29,30 .…”

2020 Clinical practice guidelines for Chronic heart failure

“…За последние годы получены многочисленные доказательства определенных различий в патогенезе, механизмах развития, клинической симптоматики и ответе на лечение ХСН в зависимости от пола, воз- раста, национальных особенностей. Следует учитывать также тот факт, что в РКИ многие представители особых групп не составляли репрезентативную выборку [386] и имеются лишь результаты анализа подгрупп или когортные исследования [387]. Тем не менее, в настоящее время отсутствуют основания для разного подхода к лечению зависимости от пола, возраста, расы и национальной принадлежности пациента.…”

“…• У пациентов с ХСН рекомендуются единые стандарты лечения СН вне зависимости от пола, возраста, расы и национальной принадлежности пациента [386,387].…”