Gerard C M Linssen1, Jesse F Veenis2, Alexandra Kleberger3, Marcel J W Grosfeld4, Eric P Viergever5, Bas M van Dalen6, Wendy de Valk-Bedijn7, Jorina Langerveld8, Hans-Peter Brunner-La Rocca9, Arno W Hoes10, Jasper J Brugts2. 1. Department of Cardiology, Hospital Group Twente (Almelo and Hengelo), Zilvermeeuw 1, 7609 PP, Almelo, The Netherlands. g.linssen@zgt.nl. 2. Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. 3. Department of Cardiology, Hospital Group Twente (Almelo and Hengelo), Zilvermeeuw 1, 7609 PP, Almelo, The Netherlands. 4. Department of Cardiology, Bernhoven, Uden, The Netherlands. 5. Department of Cardiology, Groene Hart Ziekenhuis, Gouda, The Netherlands. 6. Department of Cardiology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands. 7. Department of Cardiology, Martini Ziekenhuis, Groningen, The Netherlands. 8. Department of Cardiology, Ziekenhuis Rivierenland, Tiel, The Netherlands. 9. Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands. 10. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.
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.
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 HFpatients 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.
Entities:
Keywords:
Adherence; Guidelines; Heart failure; Medication; Older people
Authors: Marcelo C Shibata; Jordan Curl-Roper; Dirk J Van Veldhuisen; Michael Roughton; Andrew J S Coats; Marcus Flather Journal: Clin Res Cardiol Date: 2020-11-02 Impact factor: 5.460