Journal Article

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

Dubail, Delphine, Timbely, Boubacar, Beauplet, Bérengère, Carrière, Isabelle, Vidal, Jean-Sébastien, Berrut, Gilles, Idiri, Houria, Fargier, Marc, Constensoux, Jean-Pierre, Boully, Clémence, Jeandel, Claude, Durocher, Anne-Marie, Hanon, Olivier, Guibert, Etienne, Ghazali, Fanny Nisrin, Pesce, Alain, Roger, Jean-Dominique

2019

Overview

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.

• Publisher: BioMed Central,BioMed Central Ltd,BMC
• Subject: Adrenergic beta-Antagonists / Adrenergic beta-Antagonists - therapeutic use / Aged, 80 and over / Age > 80 years old / Aging / Angiotensin converting enzyme / Angiotensin Receptor Antagonists / Angiotensin Receptor Antagonists - therapeutic use / Angiotensin-Converting Enzyme Inhibitors / Angiotensin-Converting Enzyme Inhibitors - therapeutic use / Angiotensins / Atrial fibrillation / Blood tests / Cardiac patients / Care and treatment / Cognitive science / Comorbidity / Disease Management / Elderly patients / Enzyme inhibitors / Enzymes / Female / Fibrillation / France / France - epidemiology / Geriatric clinics / Geriatric settings / Geriatrics/Gerontology / Gerontology / Health aspects / Health Services for the Aged / Health Services for the Aged - trends / Health services research / Heart attack / Heart Failure / Heart Failure - diagnosis / Heart Failure - epidemiology / Heart Failure - therapy / Heart failure treatment / Humans / Ivabradine / Left ventricular ejection fraction / Life Sciences / Male / Medical tests / Medicine / Medicine & Public Health / Morbidity / Professional associations / Psychology / Rehabilitation / Research Article / Services / Societies, Medical / Societies, Medical - trends / Stroke Volume / Stroke Volume - drug effects / Stroke Volume - physiology / Surveys / Surveys and Questionnaires / Ventricular Function, Left / Ventricular Function, Left - drug effects / Ventricular Function, Left - physiology