Abstract
Treatment of heart failure (HF) in the elderly face many difficulties due to lack of robust evidence. We analyzed the outcome of HF in octogenarians using a nationwide HF registry. Among 5625 patients from the Korean Acute Heart Failure (KorAHF) registry, prognosis of octogenarian HF and the association of guideline-directed medical therapy (GDMT) with mortality and readmissions were analyzed. Octogenarian patients (1185, 22.4%) showed a higher mortality, and males were especially at increased risk (HR (hazard ratio) 1.19, 95% CI 1.01–1.40). A J-curve association between blood pressure (BP) and mortality was observed regardless of age, but the nadir value was lower in octogenarians (123.8 vs. 127.9 mmHg for systolic blood pressure (SBP); 67.1 vs. 73.9 mmHg for diastolic blood pressure (DBP), p < 0.001). Use of GDMT in octogenarian patients with HF and reduced ejection fraction (EF) were inadequate (74.3%, 47.1%, and 46.1% in octogenarians vs. 78.4%, 59.8%, and 55.2% in non-elderly for renin-angiotensin system inhibitors, beta-blockers, and aldosterone antagonists, respectively; all p < 0.05). However, those on medications had a significant reduction in 6 month mortality. For octogenarians with HF and preserved EF, angiotensin receptor blocker use reduced hospitalizations for HF in men (HR 0.19, 95% CI 0.04–0.87), but not in women (p-interaction = 0.037). HF in octogenarians were found to have different characteristics compared with the non-elderly. However, adequate use of GDMT was still associated with improved survival, and more attention should be given to prescribing medications with clinical benefits.
Highlights
In recent years, there has been a steep rise in global life expectancy, and more countries are expected to enter “aged” and “super-aged” societal classifications
Among the 5625 patients enrolled in the Korean Acute Heart Failure (KorAHF) registry, 5293 patients survived to discharge after a median of 9 (IQR 6–14) hospital days
They were more likely to be female, have an ischemic etiology of heart failure (HF), have preserved left ventricular systolic function, and present with a lower body mass index (BMI) and hemoglobin levels, while levels of natriuretic peptides were increased compared with the non-elderly population
Summary
There has been a steep rise in global life expectancy, and more countries are expected to enter “aged” and “super-aged” societal classifications. Large-scaled, randomized clinical trials that have incorporated renin–angiotensin system (RAS) inhibitors, beta-blockers, and aldosterone antagonists (AA) into guidelines have been mostly performed on patients in their mid-60s [2,3,4,5] Trials such as SENIORS (Study of Effects of Nebivolol Intervention on Outcomes and Rehospitalization in Seniors With Heart Failure) [6], I-PRESERVE (Irbesartan in Heart Failure With Preserved Ejection Fraction) [7], and PEP-CHF (Perindopril in Elderly People With Chronic Heart Failure) [8] have expanded the age limit and compared treatments in patients aged ≥70 years, real-world HF patients are still different from ideal study candidates [9,10]. The current study aimed to help reduce the gap regarding patient management between clinical trials and real-world practice, as well as to provide evidence for the adequate treatment of elderly HF patients using data from a large-scaled, long-term follow-up acute HF registry
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