Objectives: Heart failure is one of the leading causes of hospitalization in older adults. Guideline-directed medical therapy (GDMT) reduces the risk of decompensation and hospitalization, though it is challenging to implement GDMT in this group. Therefore, this study evaluated adherence to the 2021 ESC heart failure guideline in older patients and explored reasons for guideline deviations. Methods: A retrospective cohort study was performed in older patients (70+ years) with decompensated heart failure (ejection fraction 80 years) received GDMT less frequently at discharge compared to younger patients (4% vs. 26%, p = 0.03). Though this difference was resolved at follow-up. The other studied factors were not significantly associated with GDMT adherence. Common reasons for guideline deviations were adverse effects, contraindications, reduced life expectancy, and postponed treatment. Conclusions: Adherence to GDMT in older heart failure patients is low due to several reasons, such as relevant contraindications. Physicians should carefully balance the risks and benefits of the guideline versus individual benefit, considering life expectancy and individual care goals.
Raijmann et al. (2025) studied this question.