Key result
In a national survey of very old patients with heart failure in French geriatric settings, guideline-recommended drugs were underused, with only 42.6% receiving ACE inhibitors or ARBs and 48.0% receiving beta-blockers.
Why the study?
The study was conducted to evaluate the prevalence and management of heart failure in very old patients hospitalized in geriatric settings.
Cross-Sectional (n=1,478)
Yes
Guideline-recommended heart failure medications are significantly underused in very old patients (≥80 years) managed in geriatric settings, even among those with reduced ejection fraction.
Answers are grounded in this paper and cite their sources.
Underuse signals a care gap for very old HF patients in geriatric settings; leaves open whether targeted interventions can safely improve uptake.
BACKGROUND: To evaluate the prevalence and management of heart failure (HF) in very old patients in geriatric settings. METHODS: Members of the French Society of Geriatrics and Gerontology throughout France were invited to participate in a point prevalence survey and to include all patients ≥80 years old, hospitalized in geriatric settings, with HF (stable or decompensated) on June 18, 2012. General characteristics, presence of comorbidities, blood tests and medications were recorded. RESULTS: Among 7,197 patients in geriatric institution, prevalence of HF was 20.5% (n = 1,478): (27% in acute care, 24.2% in rehabilitation care and 18% in nursing home). Mean age was 88.2 (SD = 5.2) and Charlson co morbidity score was high (8.49 (SD = 2.21)). Left ventricular ejection fraction (LVEF) was available in 770 (52%) patients: 536 (69.6%) had a preserved LVEF (≥ 50%), 120 (15.6%) a reduced LVEF (< 40%), and 114 (14.8%) a midrange LVEF (40-49%). Prescription of recommended HF drugs was low: 42.6% (629) used Angiotensin Converting Enzyme Inhibitors (ACEI) or Angiotensin Receptor Blockers (ARBs), 48.0% (709) β-blockers, and 21.9% (324) ACEI or ARB with β-blockers, even in reduced LVEF. In multivariate analysis ACEI or ARBs were more often used in patients with myocardial infarction (1.36 (1.04-1.78)), stroke (1.42 (1.06-1.91)), and diabetes (1.54 (1.14-2.06)). β blockers were more likely used in patients with myocardial infarction (2.06 (1.54-2.76)) and atrial fibrillation (1.70 (1.28-2.28)). CONCLUSION: In this large very old population, prevalence of HF was high. Recommended HF drugs were underused even in reduced LVEF. These results indicate that management of HF in geriatric settings can still be improved.
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Boully et al. (2019) conducted a cross-sectional in Heart failure (n=1,478). Guideline-recommended heart failure medications was evaluated on Prescription rate of ACE inhibitors or ARBs. In a national survey of very old patients with heart failure in French geriatric settings, guideline-recommended drugs were underused, with only 42.6% receiving ACE inhibitors or ARBs and 48.0% receiving beta-blockers.
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