Few geriatric heart failure patients investigated according to clinical guidelines: a retrospective review of patient records

Background: Research on heart failure (HF) has often focused on younger patients. The aim of this study was to analyze extent of investigation and treatment among older patients prior to referral to inpatient geriatric care for worsening of HF. Methods: Data on etiology, ejection fraction (EF) by echocardiography (ECHO), level of functioning according to New York Heart Association (NYHA), analysis of N-terminal-pro-brain natriuretic peptide (NT-Pro-BNP), ongoing treatment, adherence to guidelines, and information from previous caregiver were collected from patient records prior to admission from a sample of 134 patients. Results: Few patients had been examined by a cardiologist (14%) during the year prior to referral. EF assessment had been performed in 78% (n=105). The patients were categorized as having HF with reduced (HFrEF 28%), preserved (HFpEF53%) or mid-range (HFmrEF 19%) EF. HFpEF patients had older EF assessments (mean 517 days) than those with HFrEF (385 days). In 61% (n=82) at least one assessment with NT-Pro-BNP had been performed, being older among patients with HFpEF (290 days vs 16 days). Information about NYHA class was found in 4 patients (3%) only.There was a strong positive correlation (OR 4.9, p=0.001) between having recent assessments of EF and NT-Pro-BNP (n=30, 21%) and being presented with etiology in the referral, adjusted for EF, age, sex, and comorbidity. It was not possible to estimate adherence to treatment guidelines since NYHA assessment was rarely performed. However, in a subgroup of patients with EF<35%, it was found that 19% were treated with mineral receptor antagonists according to guidelines. Conclusions: The three major findings were that only a minority of the patients had had a recent contact with a cardiologist, that the investigations were old and that information on investigations was strongly correlated to information about etiology in the referral. The insufficient investigations, the lack of contribution from cardiologists and the poor referral information on etiology may lead to less optimal treatment of HF in older people. Improving adherence to HF guidelines regarding investigation and treatment for HF in older people is therefore urgent and calls for more collaboration between specialists in cardiology and geriatric medicine.