Use of evidence-based therapy in heart failure with reduced ejection fraction across age strata
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Use of evidence-based therapy in heart failure with reduced ejection fraction across age strata. / Stolfo, Davide; Lund, Lars H; Becher, Peter Moritz; Orsini, Nicola; Thorvaldsen, Tonje; Benson, Lina; Hage, Camilla; Dahlström, Ulf; Sinagra, Gianfranco; Savarese, Gianluigi.
in: EUR J HEART FAIL, Jahrgang 24, Nr. 6, 06.2022, S. 1047-1062.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Use of evidence-based therapy in heart failure with reduced ejection fraction across age strata
AU - Stolfo, Davide
AU - Lund, Lars H
AU - Becher, Peter Moritz
AU - Orsini, Nicola
AU - Thorvaldsen, Tonje
AU - Benson, Lina
AU - Hage, Camilla
AU - Dahlström, Ulf
AU - Sinagra, Gianfranco
AU - Savarese, Gianluigi
N1 - © 2022 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
PY - 2022/6
Y1 - 2022/6
N2 - AIMS: In older patients, guideline-directed medical therapy (GDMT) for heart failure (HF) with reduced ejection fraction (<40%; HFrEF) is not contraindicated, but adherence to guidelines is limited. We investigated the implementation of GDMT in HFrEF across different age strata in a large nationwide cohort.METHODS AND RESULTS: Patients with HFrEF and HF duration ≥3 months registered in the Swedish HF Registry between 2000-2018 were analysed according to age. Multivariable logistic and multinomial regressions were fitted to investigate factors associated with underuse/underdosing. Of 27 430 patients, 31% were <70 years old, 34% 70-79 years old, and 35% ≥80 years old. Use of treatments progressively decreased with increasing age. Use of renin-angiotensin system/angiotensin receptor-neprilysin inhibitors, beta-blockers and mineralocorticoid receptor antagonists was 80%, 88% and 35% in age ≥80 years; 90%, 93% and 47% in age 70-79 years; and 95%, 95% and 54% in age <70 years, respectively. Among patients with an indication, use of implantable cardioverter defibrillator and cardiac resynchronization therapy (CRT) was 7% and 23% in age ≥ 80 years; 22% and 42% in age 70-79 years; and 29% and 50% in age <70 years, respectively. Older patients were less likely treated with target doses or combinations of HF medications. Except for CRT, after extensive adjustments, age was inversely associated with the likelihood of GDMT use and target dose achievement.CONCLUSION: In HFrEF, gaps persist in the use of medications and devices. In disagreement with current recommendations, older patients remain undertreated. Improving strategies and a more individualized approach for implementing use of GDMT in HFrEF are required, particularly in older patients.
AB - AIMS: In older patients, guideline-directed medical therapy (GDMT) for heart failure (HF) with reduced ejection fraction (<40%; HFrEF) is not contraindicated, but adherence to guidelines is limited. We investigated the implementation of GDMT in HFrEF across different age strata in a large nationwide cohort.METHODS AND RESULTS: Patients with HFrEF and HF duration ≥3 months registered in the Swedish HF Registry between 2000-2018 were analysed according to age. Multivariable logistic and multinomial regressions were fitted to investigate factors associated with underuse/underdosing. Of 27 430 patients, 31% were <70 years old, 34% 70-79 years old, and 35% ≥80 years old. Use of treatments progressively decreased with increasing age. Use of renin-angiotensin system/angiotensin receptor-neprilysin inhibitors, beta-blockers and mineralocorticoid receptor antagonists was 80%, 88% and 35% in age ≥80 years; 90%, 93% and 47% in age 70-79 years; and 95%, 95% and 54% in age <70 years, respectively. Among patients with an indication, use of implantable cardioverter defibrillator and cardiac resynchronization therapy (CRT) was 7% and 23% in age ≥ 80 years; 22% and 42% in age 70-79 years; and 29% and 50% in age <70 years, respectively. Older patients were less likely treated with target doses or combinations of HF medications. Except for CRT, after extensive adjustments, age was inversely associated with the likelihood of GDMT use and target dose achievement.CONCLUSION: In HFrEF, gaps persist in the use of medications and devices. In disagreement with current recommendations, older patients remain undertreated. Improving strategies and a more individualized approach for implementing use of GDMT in HFrEF are required, particularly in older patients.
KW - Adrenergic beta-Antagonists/therapeutic use
KW - Aged
KW - Aged, 80 and over
KW - Angiotensin Receptor Antagonists/therapeutic use
KW - Cardiac Resynchronization Therapy
KW - Heart Failure/drug therapy
KW - Humans
KW - Mineralocorticoid Receptor Antagonists/therapeutic use
KW - Stroke Volume
KW - Ventricular Dysfunction, Left/therapy
U2 - 10.1002/ejhf.2483
DO - 10.1002/ejhf.2483
M3 - SCORING: Journal article
C2 - 35278267
VL - 24
SP - 1047
EP - 1062
JO - EUR J HEART FAIL
JF - EUR J HEART FAIL
SN - 1388-9842
IS - 6
ER -