0369: Heart failure octogenarians are poorly managed and treated: a cohort study in the French national healthcare insurance database

Abstract

Part of over 80-year-old heart failure (HF) patients is increasing. These patients are poorly studied. The present study undertook a ‘real-life’ analysis of various aspects of the prognosis of over 80-year-old HF patients in France. Analysis was based on the EGB (“Echantillon Généraliste des Bénéficiaires”) database, a continuously updated representative sample of the population covered by the French national health insurance system. A cohort of adult patients with a first admission for HF was created between 2009 and 2011 and followed until June 2013 for survival analysis. Over 80-year-old patients represented 53% (n=969/1825) of hospitalizations for HF. In octogenarians, in-hospital mortality was 10.9% [9.6-12.2] and mean 12 –, and 24-months survival 62.3% (range, 59.1-65.4) and 48.2% (44.8-51.5). Only prescription levels for beta-blockers (BB) (p=0.02) increased during the follow-up period. Only 5% of patients received at discharge an optimal treatment [association of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB) +BB+mineralocorticoid receptor antagonists (MRA)]. During this period there was no increase of ACEi and ACEi/ ARB+BB+MRA prescription at discharge (p=0.48 and p=0.87, respectively). On multivariate analysis, atrial fibrillation [HR: 0.77(0.65–0.91), p=0.003], female gender [0.80(0.67–0.95), p=0.01] and the associations ACEi/ ARB+BB+MRA [0.49(0.29–0.85), p=0.01] and ACEi/ARB+BB [0.54(0.43– 0.68), p<0.001] were associated with improved survival, in contrast to denutrition [1.64(1.27–2.13), p<0.001] and cardiogenic shock at admission [3.11(1.78–5.46), p<0.001]. Octogenarians HF patients are poorly managed and treated according to international guidelines despite the clinical benefit of such drugs confirmed in this un-selected cohort with several comorbidities.