Guideline-Directed Therapy In An Elderly Homebound Population of Heart Failure Patients

Abstract

Introduction Adherence to guideline-directed therapy in heart failure patients is an important goal. Traditionally, elderly patients have difficulties attaining target doses of these therapies and this may be exaggerated in a homebound population. Hypothesis We assessed the differences in use of Angiotensin-Converting Enzyme inhibitors (ACEis)/Angiotensin Receptor Blockers (ARBs) and Beta-Blockers (BBs) in homebound heart failure patients in 2 age groups (≥75 years old and Methods A total of 471 heart failure patients during January 2016-March 2020 were reviewed via electronic medical record (Refer to Table 1 for Characteristics). Homebound patients are characterized as those seen for medical visits at home or at a non-medical facility. Both groups were reviewed for the administration and dosage of ACEis/ARB and BBs. Due to the use of multiple ACEis and ARBs, daily doses were converted to a Lisinopril Equivalent Dose (LED) for a singular continuous variable for comparison. Similarly, beta-blocker daily dosages were converted to a Carvedilol Equivalent Dose (CED). Proportions of patients who reached target doses of Lisinopril (20-40 mg) and Carvedilol (25 mg BID) in both age groups were compared via t-test. Results Group 1 consisted of n=308 patients (65.4%). Group 2 consisted of n=163 patients (34.6%). Group 1 patients on ACEi/ARB and BB were 81.5% and 57.8%, respectively. Group 2 patients were on ACEi/ARB and BB at similar percentages (81.0% and 57.1%, respectively). Group 1 had a mean LED of 21.7±12.5 mg and a mean CED of 22.2±15.2 mg, with 49.0% reaching the target LED and 11.0% reaching the target CED. Group 2 had a mean LED of 23.2±12.5 mg and a mean CED of 24.5±17.6 mg, with 51.5% reaching the target LED and 12.9% reaching the target CED (Refer to Table 1). Both group means reached the target daily dose of Lisinopril (p=0.2440) but did not reach the minimum target daily dose of carvedilol (p=0.3087) (Refer to Figure 1). Conclusions Patients within both younger and older age demographics are able to reach similar daily doses of guideline-directed heart failure medication. Target doses of BBs were less frequently attained probably due to the frequent presence of numerous comorbidities.