Treatment with Optimal Dose Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers Has a Positive Effect on Long-Term Survival in Older Individuals (Aged >70Years) and Octogenarians with Systolic Heart Failure.

Abstract

Heart failure with reduced ejection fraction (HFrEF) is a disease of older people, but the target doses of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) are unknown. To evaluate the association of ACEI/ARB dose level with long-term survival in stable older patients (aged >70years) and octogenarian outpatients with HFrEF. A total of 138 outpatients aged >70years (35.5%>80years), with an LVEF <40% and who were clinically stable on optimal therapy were followed up for 3years. The ACEI/ARB doses were categorized as: none (0), low (1-50% target dose), and high (50-100% target dose). The Cox regression survival model was adjusted for age, ischemic etiology, and renal function. ACEIs/ARBs were prescribed to 91.3% of patients, and 52.9% received the high dose. Survival improved with increasing ACEI/ARB dose level in the total population (Hazard Ratio [HR]=0.67; 95% confidence interval [CI] 0.55-0.82; p<0.001), older patients aged >70years (HR=0.65; 95% CI 0.51-0.83; p<0.001), and octogenarians (HR=0.71; 95% CI 0.51-0.99; p=0.045). The low (HR=0.35; 95% CI 0.16-0.76; p=0.008) and high doses (HR=0.13; 95% CI 0.06-0.32; p<0.001) improved survival compared with not receiving ACEIs/ARBs. The high dose was associated with a better survival than the low dose in the total population (HR=0.35; 95% CI 0.19-0.67; p=0.001) and in a propensity score-matched cohort (HR=0.41; 95% CI 0.16-1.02; p=0.056). In octogenarians, all dose levels were associated with improved survival compared with not receiving ACEIs/ARBs, but there was no difference between ACEI/ARB doses. The achieved optimal dose of ACEIs/ARBs in ambulatory older people with HFrEF is associated with long-term survival.