Prognostic impact of neurohormonal modulation in very old patients with chronic heart failure

Abstract

Background A gap in evidence exists concerning the survival-benefit of neurohormonal blockade in older patients with chronic heart failure (HF). The purpose of our study was to investigate the neurohormonal modulation therapy in older HF patients. Methods We retrospectively analysed data on chronic HF patients with systolic dysfunction from January 2012 to May 2018 at a central tertiary academic hospital in Porto, Portugal. Very old (VO) patients were those ≥80 years. Endpoint under analysis: all-cause mortality; patients were followed until January 2021. The prognostic impact of beta-blockers (BBs) and renin-angiotensin system inhibitors (RASi) use was assessed with a Cox-regression analysis adjusting for confounders. Results We studied 934 patients, 65.5% male; 45.3% had ischemic HF. BBs were used in 92.2% and RASi in 83.5%; 255 (27.3%) were VO patients. VO more often presented co-morbidities, were more symptomatic, presented worse renal function and higher BNP levels. BB prescription was similar in VO and non-VO patients, however RASi were less used in VO: 74.9% versus 86.7%, respectively. During a median follow-up of 47 months, 479 (51.3%) patients died: 71.4% among VO versus 43.7% in non-VO. BBs increased survival both in non-VO and VO—multivariate adjusted HRs of 0.57 (95% CI: 0.38–0.85) and 0.59 (0.36–0.97), respectively. A survival-benefit was also observed with RASi—adjusted HR of 0.71 (0.50–1.01) and 0.59 (0.42–0.83) in non-VO and VO. Conclusions VO patients with chronic HF with systolic dysfunction have a very ominous outcome. Neurohormonal modulation therapy appears to portend survival-benefit also in this particularly vulnerable subgroup of patients.

Neurohumoral Activation in Heart Failure

“…This neurohormonal blockade has led to reduced morbidity and mortality in this population, particularly in those with HFrEF and sinus rhythm [113]. The survival benefit of this neurohumoral blockade strategy extends to all age groups, including the very old (≥80 years), whereby an average 40% mortality reduction has been reported [114]. A potential caveat in this particular group relates to the inability of older patients to tolerate the recommended doses of such therapy.…”