Guideline-directed medical therapy in older adults with heart failure; Are there differences across age group?

Abstract Title Guideline-Directed Medical Therapy in Older Adults with Heart Failure; Are There Differences Across Age Groups? Background Older adults remain underrepresented in heart failure (HF) studies evaluating guideline-directed medical therapy (GDMT). This study aimed to assess clinical characteristics, HF GDMT pillars use, and outcomes across age groups of older adults with HF. Methods This retrospective, multicentre sub-analysis of the Sarawak Heart Failure Registry included patients aged ≥ 65 years. Participants were stratified into youngest-old (65–70 years), middle-old (71–75 years), and oldest-old (> 75 years). GDMT use, dosing, and clinical outcomes, including all-cause mortality and HF readmission, were evaluated at baseline, 3 and 6 months. Multivariable regression analyses were performed to identify factors associated with outcomes and GDMT optimisation. Results A total of 176 patients were included. Comorbidity burden increased with age, whereas coronary artery disease was more prevalent in the youngest-old group. HF GDMT pillars use declined with increasing age, particularly for renin–angiotensin system inhibitors and SGLT2 inhibitors, while beta-blocker use remained consistently high. At 6 months, 50% of the oldest-old achieved three GDMT pillars, although fewer achieved four compared with younger groups. LVEF improved in all age groups, most notably in the youngest-old. NYHA functional class improvement was greater in younger patients. Mortality at 6 months was numerically higher in the youngest-old (16.0%), while HF readmission was slightly higher in the oldest-old (12.5%), without statistical significance. In multivariable analyses, age, comorbidities, and LVEF were not independent predictors of outcomes. Conclusion Older adults with HF demonstrated consistent structural and functional improvement across age groups despite differences in GDMT use. Outcome variation was not independently explained by age or comorbidity burden, suggesting that disease phenotype and physiological reserve may play a greater role. These findings provide real-world evidence from a multiethnic Asian population and support individualized, multidisciplinary care strategies for older adults with HF.