Current use of guideline-based medical therapy in elderly patients admitted with acute heart failure with reduced ejection fraction and its impact on event-free survival

West Tokyo Heart Failure Registry Investigators

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background Acute heart failure (HF) is a frequently encountered cardiac condition. Its prevalence increases exponentially with age. In spite of this, elderly patients are underrepresented in clinical trials and the implementation of guideline-based medical therapy (GBMT) in them is not well established. We investigated the current use of GBMT and its effects on mortality and HF rehospitalization among elderly patients with acute HF with reduced ejection fraction (HFrEF) using data obtained from a contemporary multi-center registry. Methods and results We analyzed data from 1,441 consecutive acute HF patients registered in the West Tokyo Heart Failure (WET-HF) registry (mean age 73.2 ± 13.6 years). Reduced ejection fraction (< 45%) was noted in 803 patients (55.7%), of which 237 were aged ≥ 80 years (elderly group). The prescription rate of GBMT (use of renin-angiotensin system inhibitors and β-blockers at discharge) was significantly lower in the elderly than in the younger (aged < 80 years) group (46.8% vs. 66.9%, p < 0.001). Although GBMT at discharge was associated with reductions in HF readmission or the composite endpoint of cardiac death and HF readmission (HR 0.49, 95% CI 0.30–0.80; and HR 0.53, 95% CI 0.32–0.89, respectively) in the younger group, this association was not observed in the elderly group (HR 1.41, 95% CI 0.68–2.92; and HR 1.54, 95% CI 0.76–3.13, respectively) Conclusions GBMT implementation in elderly patients with HFrEF was found to be suboptimal. However, the underuse of GBMT did not appear to be responsible for poorer outcomes in elderly HFrEF patients. Further research is required to establish an ideal therapeutic approach for this population. Clinical trial registration URL: http://www.umin.ac.jp/icdr/index-j.html. Unique identifier: UMIN000001171.

Original languageEnglish
Pages (from-to)162-168
Number of pages7
JournalInternational Journal of Cardiology
Volume235
DOIs
Publication statusPublished - 2017 May 15

Fingerprint

Disease-Free Survival
Heart Failure
Guidelines
Therapeutics
Registries
Clinical Trials
Tokyo
Renin-Angiotensin System
Prescriptions
Mortality
Research
Population

Keywords

  • Elderly
  • Guideline-based medical therapy
  • Heart failure

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine

Cite this

Current use of guideline-based medical therapy in elderly patients admitted with acute heart failure with reduced ejection fraction and its impact on event-free survival. / West Tokyo Heart Failure Registry Investigators.

In: International Journal of Cardiology, Vol. 235, 15.05.2017, p. 162-168.

Research output: Contribution to journalArticle

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title = "Current use of guideline-based medical therapy in elderly patients admitted with acute heart failure with reduced ejection fraction and its impact on event-free survival",
abstract = "Background Acute heart failure (HF) is a frequently encountered cardiac condition. Its prevalence increases exponentially with age. In spite of this, elderly patients are underrepresented in clinical trials and the implementation of guideline-based medical therapy (GBMT) in them is not well established. We investigated the current use of GBMT and its effects on mortality and HF rehospitalization among elderly patients with acute HF with reduced ejection fraction (HFrEF) using data obtained from a contemporary multi-center registry. Methods and results We analyzed data from 1,441 consecutive acute HF patients registered in the West Tokyo Heart Failure (WET-HF) registry (mean age 73.2 ± 13.6 years). Reduced ejection fraction (< 45{\%}) was noted in 803 patients (55.7{\%}), of which 237 were aged ≥ 80 years (elderly group). The prescription rate of GBMT (use of renin-angiotensin system inhibitors and β-blockers at discharge) was significantly lower in the elderly than in the younger (aged < 80 years) group (46.8{\%} vs. 66.9{\%}, p < 0.001). Although GBMT at discharge was associated with reductions in HF readmission or the composite endpoint of cardiac death and HF readmission (HR 0.49, 95{\%} CI 0.30–0.80; and HR 0.53, 95{\%} CI 0.32–0.89, respectively) in the younger group, this association was not observed in the elderly group (HR 1.41, 95{\%} CI 0.68–2.92; and HR 1.54, 95{\%} CI 0.76–3.13, respectively) Conclusions GBMT implementation in elderly patients with HFrEF was found to be suboptimal. However, the underuse of GBMT did not appear to be responsible for poorer outcomes in elderly HFrEF patients. Further research is required to establish an ideal therapeutic approach for this population. Clinical trial registration URL: http://www.umin.ac.jp/icdr/index-j.html. Unique identifier: UMIN000001171.",
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author = "{West Tokyo Heart Failure Registry Investigators} and Keitaro Akita and Takashi Kohno and Shun Kosaka and Yasuyuki Shiraishi and Yuji Nagatomo and Yuki Izumi and Ayumi Goda and Atsushi Mizuno and Mitsuaki Sawano and Taku Inohara and Keiichi Fukuda and Tsutomu Yoshikawa",
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AU - West Tokyo Heart Failure Registry Investigators

AU - Akita, Keitaro

AU - Kohno, Takashi

AU - Kosaka, Shun

AU - Shiraishi, Yasuyuki

AU - Nagatomo, Yuji

AU - Izumi, Yuki

AU - Goda, Ayumi

AU - Mizuno, Atsushi

AU - Sawano, Mitsuaki

AU - Inohara, Taku

AU - Fukuda, Keiichi

AU - Yoshikawa, Tsutomu

PY - 2017/5/15

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N2 - Background Acute heart failure (HF) is a frequently encountered cardiac condition. Its prevalence increases exponentially with age. In spite of this, elderly patients are underrepresented in clinical trials and the implementation of guideline-based medical therapy (GBMT) in them is not well established. We investigated the current use of GBMT and its effects on mortality and HF rehospitalization among elderly patients with acute HF with reduced ejection fraction (HFrEF) using data obtained from a contemporary multi-center registry. Methods and results We analyzed data from 1,441 consecutive acute HF patients registered in the West Tokyo Heart Failure (WET-HF) registry (mean age 73.2 ± 13.6 years). Reduced ejection fraction (< 45%) was noted in 803 patients (55.7%), of which 237 were aged ≥ 80 years (elderly group). The prescription rate of GBMT (use of renin-angiotensin system inhibitors and β-blockers at discharge) was significantly lower in the elderly than in the younger (aged < 80 years) group (46.8% vs. 66.9%, p < 0.001). Although GBMT at discharge was associated with reductions in HF readmission or the composite endpoint of cardiac death and HF readmission (HR 0.49, 95% CI 0.30–0.80; and HR 0.53, 95% CI 0.32–0.89, respectively) in the younger group, this association was not observed in the elderly group (HR 1.41, 95% CI 0.68–2.92; and HR 1.54, 95% CI 0.76–3.13, respectively) Conclusions GBMT implementation in elderly patients with HFrEF was found to be suboptimal. However, the underuse of GBMT did not appear to be responsible for poorer outcomes in elderly HFrEF patients. Further research is required to establish an ideal therapeutic approach for this population. Clinical trial registration URL: http://www.umin.ac.jp/icdr/index-j.html. Unique identifier: UMIN000001171.

AB - Background Acute heart failure (HF) is a frequently encountered cardiac condition. Its prevalence increases exponentially with age. In spite of this, elderly patients are underrepresented in clinical trials and the implementation of guideline-based medical therapy (GBMT) in them is not well established. We investigated the current use of GBMT and its effects on mortality and HF rehospitalization among elderly patients with acute HF with reduced ejection fraction (HFrEF) using data obtained from a contemporary multi-center registry. Methods and results We analyzed data from 1,441 consecutive acute HF patients registered in the West Tokyo Heart Failure (WET-HF) registry (mean age 73.2 ± 13.6 years). Reduced ejection fraction (< 45%) was noted in 803 patients (55.7%), of which 237 were aged ≥ 80 years (elderly group). The prescription rate of GBMT (use of renin-angiotensin system inhibitors and β-blockers at discharge) was significantly lower in the elderly than in the younger (aged < 80 years) group (46.8% vs. 66.9%, p < 0.001). Although GBMT at discharge was associated with reductions in HF readmission or the composite endpoint of cardiac death and HF readmission (HR 0.49, 95% CI 0.30–0.80; and HR 0.53, 95% CI 0.32–0.89, respectively) in the younger group, this association was not observed in the elderly group (HR 1.41, 95% CI 0.68–2.92; and HR 1.54, 95% CI 0.76–3.13, respectively) Conclusions GBMT implementation in elderly patients with HFrEF was found to be suboptimal. However, the underuse of GBMT did not appear to be responsible for poorer outcomes in elderly HFrEF patients. Further research is required to establish an ideal therapeutic approach for this population. Clinical trial registration URL: http://www.umin.ac.jp/icdr/index-j.html. Unique identifier: UMIN000001171.

KW - Elderly

KW - Guideline-based medical therapy

KW - Heart failure

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