Journal Article

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

Baek, Sang Hong, Kim, Kye Hun, Yoo, Byung-Su, Jeon, Eun-Seok, Park, Hyun Ah, Seo, Won-Woo, Lee, Hae-Young, Cho, Hyun-Jai, Cho, Myeong-Chan, Kang, Seok-Min, Park, Jin Joo, Choi, Dong-Ju, Kim, Jae-Joong, Chae, Shung Chull, Oh, Byung-Hee

2020

Overview

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 number NCT01389843.

• Publisher: BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Adrenergic beta-Antagonists - therapeutic use / Age / Aged / Aged, 80 and over / Ambulatory Care - standards / Beta blockers / Cardiac arrhythmia / Cardiovascular Agents - therapeutic use / Cardiovascular Medicine / Chronic obstructive pulmonary disease / Clinical trials / Cohort analysis / Cohort Studies / Diabetes / Ejection fraction / Epidemiology / Female / Guideline Adherence - statistics & numerical data / Health risk assessment / Heart failure / Heart Failure - drug therapy / Heart Failure - epidemiology / Hospitals / Humans / Hypertension / Kidney diseases / Male / Mortality / Older people / Prospective Studies / Regression analysis / Republic of Korea / Variables