National survey on the management of heart failure in individuals over 80 years of age in French geriatric care units

Abstract

Background To evaluate the prevalence and management of heart failure (HF) in very old patients in geriatric settings. Methods Members of the French Society of Geriatrics and Gerontology throughout France were invited to participate in a point prevalence survey and to include all patients ≥80 years old, hospitalized in geriatric settings, with HF (stable or decompensated) on June 18, 2012. General characteristics, presence of comorbidities, blood tests and medications were recorded. Results Among 7,197 patients in geriatric institution, prevalence of HF was 20.5% ( n = 1,478): (27% in acute care, 24.2% in rehabilitation care and 18% in nursing home). Mean age was 88.2 (SD = 5.2) and Charlson co morbidity score was high (8.49 (SD = 2.21)). Left ventricular ejection fraction (LVEF) was available in 770 (52%) patients: 536 (69.6%) had a preserved LVEF (≥ 50%), 120 (15.6%) a reduced LVEF (< 40%), and 114 (14.8%) a midrange LVEF (40–49%). Prescription of recommended HF drugs was low: 42.6% (629) used Angiotensin Converting Enzyme Inhibitors (ACEI) or Angiotensin Receptor Blockers (ARBs), 48.0% (709) β-blockers, and 21.9% (324) ACEI or ARB with β-blockers, even in reduced LVEF. In multivariate analysis ACEI or ARBs were more often used in patients with myocardial infarction (1.36 (1.04–1.78)), stroke (1.42 (1.06–1.91)), and diabetes (1.54 (1.14–2.06)). β blockers were more likely used in patients with myocardial infarction (2.06 (1.54–2.76)) and atrial fibrillation (1.70 (1.28–2.28)). Conclusion In this large very old population, prevalence of HF was high. Recommended HF drugs were underused even in reduced LVEF. These results indicate that management of HF in geriatric settings can still be improved. Electronic supplementary material The online version of this article (10.1186/s12877-019-1215-y) contains supplementary material, which is available to authorized users.

Management of heart failure: an Italian national survey on fellows/specialists in geriatrics

“…Geriatricians are often in charge of the care of these patients [4,5]. Although these specialists commonly manage chronic and acute HF in all settings of care (acute care ward, community, and nursing homes) [6], little is known about their knowledge of current guidelines on HF and their clinical attitudes [7].…”

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“…Cependant, les antagonistes des minéralocorticoïdes sont très peu utilisés en gériatrie en raison du risque d'hyperkaliémie, en particulier en cas d'association avec un IEC ou un ARA2 et/ou en cas d'insuffisance rénale. Ainsi, dans l'étude menée par la Société franç aise de gériatrie et gérontologie, la prescription des antagonistes des minéralocorticoïdes chez des insuffisants cardiaques hospitalisés en gériatrie était seulement de 10 % chez les sujets ayant une FEVG < 40 % [19].…”

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“…Yet, as access to cardiologists in France is insufficient, recommended HF treatments are underutilised and left ventricular ejection fraction (LVEF) has been found to be available for only 52% of hospitalised geriatric patients, which is particularly problematic in this population [8]. Furthermore, the elderly often have comorbidities, including depression, cognitive disorders, delirium, malnutrition, sarcopenia, falls, and loss of autonomy that can delay HF diagnosis, contribute to frailty, trigger decompensation, have functional consequences and ultimately alter prognosis [4].…”