In HFrEF patients aged >80 years, renin-angiotensin system inhibitor use was associated with a lower risk of all-cause mortality (HR 0.78; 95% CI 0.72-0.86).
Cohort (n=6,710)
Yes
Does renin-angiotensin system inhibitor use reduce mortality and heart failure hospitalization in HFrEF patients aged >80 years?
In HFrEF patients over 80 years of age, RASi use is associated with significantly reduced all-cause mortality and heart failure hospitalization, similar to benefits seen in younger patients.
Hazard Ratio: 0.78 (95% CI 0.72–0.86)
Aims: In heart failure with reduced ejection fraction (HFrEF), renin-angiotensin system inhibitors (RASi) improve morbidity and mortality. However, patients aged >80 years constituted a small minority in trials. We assessed the association between RASi use and mortality/morbidity in HFrEF patients aged >80 years. Methods and results: We included patients with ejection fraction 80 years from the Swedish Heart Failure Registry. Propensity scores for RASi use were calculated from 37 variables. Cox regression models for RASi vs. non-RASi with all-cause mortality and all-cause mortality/heart failure (HF) hospitalization as outcomes were fitted in a 1:1 propensity-score-matched cohort. To assess consistency, the same analyses were performed in a 'positive control' cohort aged ≤80 years. Of 6710 patients median age (interquartile range) 85 (82-87) years; 38% women, 5384 (80%) received RASi. Propensity-score matching yielded 2416 patients, age 86 (83-91) years. RASi use was associated with hazard ratio (HR) (95% confidence interval) 0.78 (0.72-0.86) for all-cause mortality and 0.86 (0.79-0.94) for all-cause mortality/HF hospitalization. In positive control patients aged ≤80 years (17 842 patients in the overall cohort, 2126 after matching), HR for all-cause mortality was 0.81 (0.71-0.91), whereas it was 0.85 (0.76-0.94) for all-cause mortality/HF hospitalization. Conclusion: In HFrEF patients with age >80 years, RASi were relatively underused compared with in younger patients, despite similar association with reduced morbidity and mortality and no apparent association with risk of syncope-related hospitalization. These results may be interpreted as hypothesis generating for randomized clinical trials on RASi in this elderly HFrEF subpopulation.
Savarese et al. (2018) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=6,710). Renin-angiotensin system inhibitors (RASi) vs. non-RASi was evaluated on All-cause mortality (HR 0.78, 95% CI 0.72-0.86). In HFrEF patients aged >80 years, renin-angiotensin system inhibitor use was associated with a lower risk of all-cause mortality (HR 0.78; 95% CI 0.72-0.86).