Key result
RAASi plus beta-blockers linked to ~50% lower 1-year mortality, regardless of physical frailty.
Why the study?
The potential effects of physical frailty on the benefits of heart failure medications in elderly patients with reduced or mildly reduced ejection fraction were unclear.
Does combination therapy with RAASi and beta-blockers reduce 1-year all-cause mortality in elderly patients with HFrEF/HFmrEF, and is this effect modified by physical frailty?
Cohort (n=1,021)
Yes
Does combination therapy with RAASi and beta-blockers reduce 1-year all-cause mortality in elderly patients with HFrEF/HFmrEF, and is this effect modified by physical frailty?
Hazard Ratio: 0.5 (95% CI 0.34–0.75)
RAASi and beta-blocker combination therapy is associated with a 50% reduction in 1-year mortality in elderly patients with HFrEF/HFmrEF, with consistent benefits observed even in those with physical frailty.
Physical frailty does not modify RAASi plus beta-blocker benefits in elderly HFr/mrEF; supports GDMT use irrespective of frailty but leaves open randomized confirmation.
AIMS: Frailty is highly prevalent and associated with poor prognoses in elderly patients with heart failure (HF). However, the potential effects of physical frailty on the benefits of HF medications in elderly patients with HF are unclear. We aimed to determine the influence of physical frailty on the prognosis of HF medications in elderly patients with HF with reduced and mildly reduced ejection fraction (HFr/mrEF). METHODS AND RESULTS: From the combined HF database of the FRAGILE-HF and Kitasato cohorts, hospitalized HF patients with a left ventricular ejection fraction < 50% and age ≥ 65 years were analysed. Patients treated with or without renin-angiotensin-aldosterone system inhibitors (RAASi) and beta-blockers at discharge were compared. Physical frailty was defined by the presence of ≥3 items on the Japanese version of the Cardiovascular Health Study criteria. The primary endpoint was all-cause mortality rate. Among the 1021 enrolled patients, 604 patients (59%) received both RAASi and beta-blockers, and 604 patients (59%) were diagnosed as physically frail. Patients receiving both RAASi and beta-blockers showed a significantly lower 1 year mortality than those not receiving either, even after adjusting for covariates (hazard ratio: 0.50, 95% confidence interval: 0.34-0.75). This beneficial effect of both medications on 1 year mortality was comparable between patients with and without physical frailty (hazard ratio: 0.53 and 0.51, respectively; P for interaction = 0.77). CONCLUSIONS: The presence of physical frailty did not interact with the beneficial prognostic impact of RAASi and beta-blocker combination therapy in elderly patients with HFr/mrEF.
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Abe et al. (2023) conducted a cohort in Heart failure with reduced and mildly reduced ejection fraction (HFr/mrEF) (n=1,021). Renin-angiotensin-aldosterone system inhibitors (RAASi) and beta-blockers vs. Not receiving either RAASi or beta-blockers was evaluated on All-cause mortality rate (HR 0.50, 95% CI 0.34-0.75). Combination therapy with RAASi and beta-blockers was associated with lower 1-year all-cause mortality (HR 0.50; 95% CI 0.34-0.75), with no significant interaction by physical frailty status.
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