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Heart medications did not increase survival in octogenarians with HF, LVEF
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Patients aged older than 80 years who had HF with preserved left ventricular ejection fraction did not benefit from commonly prescribed heart medications in a recent study.
Researchers evaluated 142 patients with HF and LVEF >50% who were aged 80 or older. The primary endpoints of the study were mortality and rehospitalization after a five-year follow-up. Patients were treated with ACE inhibitors/angiotensin II receptor antagonists (n=67), beta-blockers (n=51), diuretics (n=88), calcium channel blockers (n=47), nitrates (n=28) and digoxin (n=43).
According to the study results, 98 (69%) patients died during follow-up, with a mean survival time of 23 months. The researcher reported that none of the medications, including ACE inhibitors/AII receptor antagonists (P=.91), beta-blockers (P=.89), calcium channel blockers (P=.69), diuretics (P=.30), digoxin (P=.22) and statins (P=.32) had an effect on long-term survival.
Statins were the only treatment reported to show a trend toward decreased mortality, although the trend was not statistically significant, according to the researchers. They also reported a trend toward decreased survival for patients treated with digoxin or diuretics.
“It was possible that the benefits seen in retrospective studies were not reflective of a pathophysiologic process but rather a manifestation of the level of care given by the patient’s health care providers,” the researchers wrote. “However, the benefit of statins and other common cardiac medication in patients aged older than 80 years with HF and preserved LVEF should be vigorously and specifically studied in this patient population with the intention of showing both a validated therapy and insights into novel mechanisms of disease and disease modification.”
Schwarz ER. Am J Cardiol. 2009;103:829-833.
This is a good study that raises many questions. We have many thousands of patients with systolic HF who have been studied but most are younger than 70 years, and the vast majority of them are men. HF in the community is more often HF with preserved ejection fraction or diastolic HF. We have little to no data on the major group of patients with HF that fills our hospitals. ADHERE results showed us the average age is 80 years and more than half have preserved ejection fraction. This study’s results show us we need more information on this group of people since many of the ideas and medications we have and use may not benefit these elderly patients. This study will make us try to get more data in a prospective trial or to set the stage for a larger meta-analysis.
– Frank Smart, MD
Cardiology Today Editorial Board member