Evidence-based therapy for HF less utilized among patients aged at least 80 years
In patients with HF, evidence-based therapy was less utilized among patients aged 80 years and older compared with younger patients, according to new data.
“Underuse and underdosing of HF treatments in HF with reduced ejection fraction is a major concern,” David Stolfo, MD, PhD student from the division of cardiology in the department of medicine at Karolinska Institute in Stockholm, said during a presentation at the European Society of Cardiology’s Heart Failure and World Congress on Acute Heart Failure virtual meeting. “Specific subgroups of patients are underrepresented in [randomized controlled trials], and there is a lack of evidence on the effects of [guideline-directed medical therapy] in such subsets.”
The large nationwide cohort included data from 27,430 inpatients and outpatients with HF (mean age, 74 years; 27% women) from the SwedeHF Registry. All patients were registered in the SwedeHF Registry from May 2000 to December 2018 and had HF with left ventricular ejection fraction less than 40% for 3 months or longer. Patients were stratified by age: younger than 70 years, 70 to 79 years or at least 80 years.
Researchers observed a decrease in prescription of treatments as patients’ age increased (renin-angiotensin system inhibitors or angiotensin receptor/neprilysin inhibitors: < 70 years, 95%; 70 to 79 years, 90%; 80 years, 80%; renin-angiotensin system inhibitors: < 70 years, 87%; 70 to 79 years, 85%; 80 years, 78%; angiotensin receptor/neprilysin inhibitors: < 70 years, 25%; 70 to 79 years, 18%; 80 years, 7%; mineralocorticoid receptor antagonists: < 70 years, 54%; 70 to 79 years, 47%; 80 years, 35%; beta-blockers: < 70 years, 95%; 70 to 79 years, 93%; 80 years, 88%; three or more classes of medications: < 70 years, 50.1%; 70 to 79 years, 41.6%; 80 years, 26.1%).
In addition, those aged at least 80 years were less likely to receive treatment with the recommended medication dose.
Use of implantable cardioverter defibrillators and cardiac resynchronization therapy was also low among older patients with 29% and 50%, respectively, for those aged < 70 years, 22% and 42%, respectively, for those aged 70 to 79 years and 7% and 23%, respectively, among those aged at least 80 years.
According to the researchers, even after statistical adjustment for other variables, nearly all HF treatments were underused in patients aged at least 80 years.
“Studies in older age groups with heart failure are needed to provide clinicians with greater certainty about the effectiveness of full-dose treatment,” Stolfo said in a press release. “We should follow the example of a study investigating this question according to gender, which suggested that women with heart failure might need lower doses of some medications than men.”
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Stolfo D, et al. Abstract 60364. Presented at: Heart Failure and World Congress on Acute Heart Failure; June 29-July 1, 2021 (virtual meeting).