Medical treatment of octogenarians with chronic heart failure: data from CHECK-HF

G.C.M. Linssen*, J.F. Veenis, A. Kleberger, M.J.W. Grosfeld, E.P. Viergever, B.M. van Dalen, W. de Valk-Bedijn, J. Langerveld, H.P. Brunner-La Rocca, A.W. Hoes, J.J. Brugts, CHECK-HF Investigators

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Background Elderly heart failure (HF) patients are underrepresented in clinical trials, though are a large proportion of patients in real-world practice. We investigated practice-based, secondary care HF management in a large group of chronic HF patients aged >= 80 years (octogenarians). Methods We analyzed electronic health records of 3490 octogenarians with chronic HF at 34 Dutch outpatient clinics in the period between 2013 and 2016 , 49% women. Study patients were divided into HFpEF [LVEF >= 50%; n = 911 (26.1%)], HFrEF [LVEF < 40%; n = 2009 (57.6%)] and HF with mid-range EF [HFmrEF: LVEF 40-49%; n = 570 (16.3%)]. Results Most HFrEF patients aged >= 80 years received a beta blocker and a renin-angiotensin system (RAS) inhibitor (angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker), i.e. 78.3% and 72.8% respectively, and a mineralocorticoid receptor antagonist (MRA) was prescribed in 52.0% of patients. All three of these guideline-recommended medications (triple therapy) were given in only 29.9% of octogenarians with HFrEF, and at least 50% of target doses of triple therapy, beta blockers, RAS inhibitor and MRA, were prescribed in 43.8%, 62.2% and 53.5% of the total group of HFrEF patients. Contraindications or intolerance for beta blockers was present in 3.5% of the patients, for RAS inhibitors and MRAs in, 7.2% and 6.1% Conclusions The majority of octogenarians with HFrEF received one or more guideline-recommended HF medications. However, triple therapy or target doses of the medications were prescribed in a minority. Comorbidities and reported contraindications and tolerances did not fully explain underuse of recommended HF therapies.[GRAPHICS].
Original languageEnglish
Pages (from-to)1155-1164
Number of pages10
JournalClinical research in cardiology
Volume109
Issue number9
DOIs
Publication statusPublished - 1 Sep 2020

Keywords

  • adherence
  • antagonists
  • association
  • beta-blockers
  • elderly-patients
  • guidelines
  • heart failure
  • impact
  • management
  • medication
  • mortality
  • older people
  • reduced ejection fraction
  • therapy
  • MORTALITY
  • GUIDELINES
  • Guidelines
  • Adherence
  • REDUCED EJECTION FRACTION
  • THERAPY
  • Older people
  • Medication
  • BETA-BLOCKERS
  • ANTAGONISTS
  • Heart failure
  • MANAGEMENT
  • IMPACT
  • ELDERLY-PATIENTS
  • ASSOCIATION

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