Older adults (≥70 years) with chronic heart failure received aldosterone antagonists significantly less frequently than younger adults (PR 0.64; 95% CI 0.54-0.77; p<0.0001).
Cohort (n=3,289)
Do older individuals with heart failure receive guideline-recommended heart failure medications less frequently than younger individuals?
Older patients with heart failure are significantly less likely to receive guideline-directed medical therapies like aldosterone antagonists and beta-blockers compared to younger patients, even after adjusting for comorbidities.
Relative Risk: 0.64 (95% CI 0.54–0.77)
p-value: p=< 0.0001
AIM: To investigate whether older individuals (≥70 years) with heart failure receive guideline-recommended heartfailure medications less frequently than younger individuals. FINDINGS: Older individuals had a higher prevalence of heart failure and greater polypharmacy but were treated lessoften with guideline-based therapies, including aldosterone antagonists and beta-blockers, even after adjustment forrenal function and comorbidities. In contrast, calcium channel blockers were prescribed more frequently in geriatricpatients. MESSAGE: Older individuals with heart failure appear to be undertreated with evidence-based therapies, highlightingage-related gaps in guideline-concordant care. BACKGROUND: In Germany, heart failure (HF) is the most common diagnosis in hospitalized patients. Its prevalence rises significantly with age. In addition, age-related conditions, such as hypertension, coronary artery disease, obesity, and diabetes mellitus, contribute to an elevated risk of heart failure. It is assumed that older patients are more likely to receive treatment that does not conform to the guidelines because of frequent comorbidities, such as chronic renal disease and pre-existing polypharmacy. METHODS: Data from a prospective cohort study on chronic HF (MyoVasc study, N = 3289; NCT04064450), were analyzed. Participants underwent a 5-h highly standardized examination, including assessment of medication with subsequent categorization according to the anatomical therapeutic chemical (ATC) coding system. Study participants were categorized as older adults aged ≥ 70 years and subsequently compared to younger adults regarding frequency of medication intake. Poisson regression with robust standard errors with adjustment for age, sex, cardiovascular risk factors, comorbidities, and kidney function was used to analyze medication intake by age status in subjects with chronic HF stages C/D. RESULTS: The analyzed sample comprised 1281 older adults (mean age: 75.4 ± 3.6 years, 33.1% women, 66.9% men) and 2,008 younger adults (mean age: 57.7 ± 8.5 years, 35,2% women, 64.8% men). A total of 68.5% (n = 878) of the older individuals presented with HF stage C/D, compared to 43% (n = 863) in younger adults. On average, older individuals took 6.53 (standard deviation (SD) ± 3.14) drugs as compared to younger participants taking 4.65 (SD ± 3.45) drugs regardless of the severity of HF. Poisson regression analysis demonstrated that older individuals received aldosterone antagonists less frequently (Prevalence Ratio (PR): 0.64, 95%CI 0.54; 0.77, p < 0.0001). This effect persisted after additional adjustment for kidney function (PR: 0.53, 95%CI 0.44; 0.63, p < 0.0001). Beta-blockers were used significantly less frequently in older adults compared to younger adults (PR: 0.93, 95%CI 0.88; 0.99, p = 0.016). In contrast, calcium channel blockers were prescribed significantly more often in the older group (PR: 1.22, 95%CI 1.01; 1.48, p = 0.035). Additionally, older adults with impaired renal function received loop diuretics less frequently (PR: 0.88, 95%CI 0.78; 0.99, p = 0.033). CONCLUSION: The present study identified age-related disparities in the use of guideline-based therapy for heart failure. These differences persisted even after adjusting for renal dysfunction, a common and relevant comorbidity in the aged population. These findings suggest a potential underutilization of evidence-based heart failure therapies in older individuals with heart failure. TRIAL REGISTRY: NCT04064450.
Mohr et al. (Tue,) conducted a cohort in Chronic heart failure (n=3,289). Older age (≥ 70 years) vs. Younger adults (< 70 years) was evaluated on Intake of aldosterone antagonists (PR 0.64, 95% CI 0.54-0.77, p=< 0.0001). Older adults (≥70 years) with chronic heart failure received aldosterone antagonists significantly less frequently than younger adults (PR 0.64; 95% CI 0.54-0.77; p<0.0001).