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

Akita, Keitaro; Kohno, Takashi; Kohsaka, Shun; Shiraishi, Yasuyuki; Nagatomo, Yuji; Izumi, Yuki; Goda, Ayumi; Mizuno, Atsushi; Sawano, Mitsuaki; Inohara, Taku; Fukuda, Keiichi; Yoshikawa, Tsutomu

doi:10.1016/j.ijcard.2017.02.070

Cited by 48 publications

(48 citation statements)

References 48 publications

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“…22 Recently, in a subgroup of 237 elderly patients aged ≥80 years in the West Tokyo Heart Failure (WET-HF) registry, GDMT with beta-blockers and RAS inhibitors did not reduce the Open access rates of cardiac death or HF readmission. 23 By contrast, the present study showed that GDMT was associated with all-cause mortality in elderly (≥65 years) patients with HFrEF. In addition, GDMT was effective in very elderly patients (≥80 years).…”

Section: Gdmt and Outcomes In Elderly Patients With Hfcontrasting

confidence: 91%

Guideline-directed medical therapy in elderly patients with heart failure with reduced ejection fraction: a cohort study

Seo

Park

et al. 2020

BMJ Open

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Objectives and designGuideline-directed medical therapy (GDMT) with renin–angiotensin system (RAS) inhibitors and beta-blockers has improved survival in patients with heart failure with reduced ejection fraction (HFrEF). As clinical trials usually do not include very old patients, it is unknown whether the results from clinical trials are applicable to elderly patients with HF. This study was performed to investigate the clinical characteristics and treatment strategies for elderly patients with HFrEF in a large prospective cohort.SettingThe Korean Acute Heart Failure (KorAHF) registry consecutively enrolled 5625 patients hospitalised for acute HF from 10 tertiary university hospitals in Korea.ParticipantsIn this study, 2045 patients with HFrEF who were aged 65 years or older were included from the KorAHF registry.Primary outcome measurementAll-cause mortality data were obtained from medical records, national insurance data or national death records.ResultsBoth beta-blockers and RAS inhibitors were used in 892 (43.8%) patients (GDMT group), beta-blockers only in 228 (11.1%) patients, RAS inhibitors only in 642 (31.5%) patients and neither beta-blockers nor RAS inhibitors in 283 (13.6%) patients (no GDMT group). With increasing age, the GDMT rate decreased, which was mainly attributed to the decreased prescription of beta-blockers. In multivariate analysis, GDMT was associated with a 53% reduced risk of all-cause mortality (HR 0.47, 95% CI 0.39 to 0.57) compared with no GDMT. Use of beta-blockers only (HR 0.57, 95% CI 0.45 to 0.73) and RAS inhibitors only (HR 0.58, 95% CI 0.48 to 0.71) was also associated with reduced risk. In a subgroup of very elderly patients (aged ≥80 years), the GDMT group had the lowest mortality.ConclusionsGDMT was associated with reduced 3-year all-cause mortality in elderly and very elderly HFrEF patients.Trial registration numberNCT01389843.

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Section: Gdmt and Outcomes In Elderly Patients With Hfcontrasting

confidence: 91%

Guideline-directed medical therapy in elderly patients with heart failure with reduced ejection fraction: a cohort study

Seo

Park

et al. 2020

BMJ Open

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“…In our real‐world population, 86% of patients ≥80 years of age received beta‐blockers as compared to 93% in the younger subgroup, confirming the feasibility of beta‐blocker treatment in older age. Previous studies have reported more underuse, but their inpatient setting may explain the lower use of beta‐blockers as compared with our cohort.…”

Section: Discussioncontrasting

confidence: 53%

Association between beta‐blocker use and mortality/morbidity in older patients with heart failure with reduced ejection fraction. A propensity score‐matched analysis from the Swedish Heart Failure Registry

Stolfo

Uijl

Benson

et al. 2019

European J of Heart Fail

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Background Beta‐blockers reduce mortality and morbidity in heart failure (HF) with reduced ejection fraction (HFrEF). However, patients older than 80 years are poorly represented in randomized controlled trials. We assessed the association between beta‐blocker use and outcomes in HFrEF patients aged ≥80 years. Methods and results We included patients with an ejection fraction <40% and aged ≥80 years from the Swedish HF Registry. The association between beta‐blocker use, all‐cause mortality and cardiovascular (CV) mortality/HF hospitalization was assessed by Cox proportional hazard models in a 1:1 propensity score‐matched cohort. To assess consistency, the same analyses were performed in a positive control cohort with age <80 years. A negative control outcome analysis was run using hospitalization for cancer as endpoint. Of 6562 patients aged ≥80 years, 5640 (86%) received beta‐blockers. In the matched cohort including 1732 patients, beta‐blocker use was associated with a significant reduction in the risk of all‐cause mortality [hazard ratio (HR) 0.89, 95% confidence interval (CI) 0.79–0.99]. Reduction in CV mortality/HF hospitalization was not significant (HR 0.94, 95% CI 0.85–1.05) due to the lack of association with HF hospitalization, whereas CV death was significantly reduced. After adjustment rather than matching for the propensity score in the overall cohort, beta‐blocker use was associated with reduced risk of all outcomes. In patients aged <80 years, use of beta‐blockers was associated with reduced risk of all‐cause death (HR 0.79, 95% CI 0.68–0.92) and of the composite outcome (HR 0.88, 95% CI 0.77–0.99). Conclusions In HFrEF patients ≥80 years of age, use of beta‐blockers was high and was associated with improved all‐cause and CV survival.

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“…The derivation cohort was the WET‐HF registry: a large, ongoing, prospective, multicenter cohort registry conducted in Tokyo, Japan (East Japan), from June 2005 to August 2016. Details of the registry have been described previously . Dedicated clinical research coordinators collected clinical data by reviewing individual patient medical records.…”

Section: Methodsmentioning

confidence: 99%

“…Details of the registry have been described previously. [12][13][14][15] Dedicated clinical research coordinators collected clinical data by reviewing individual patient medical records. Exclusive on-site auditing by the investigators (Y.S.…”

Section: Study Populationmentioning

confidence: 99%

Performance of the MAGGIC heart failure risk score and its modification with the addition of discharge natriuretic peptides

et al. 2018

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AimsPredictive models for heart failure patients are widely used in the clinical practice to stratify patients' mortality and enable clinicians to tailor and intensify their approach. However, such models have not been validated internationally. In addition, biomarkers are now frequently measured to obtain prognostic information, and the implications of this practice are not known. In this study, we aimed to validate the model performance of the Meta‐analysis Global Group in Chronic Heart Failure (MAGGIC) score in a Japanese acute heart failure registry and further explore the incremental prognostic value of discharge B‐type natriuretic peptide (BNP) level.Methods and ResultsIn this study, we evaluated the registered data of 2215 consecutive acute HF patients (with 694 119 person‐years follow‐up) from a prospective multicentre registry (the West Tokyo Heart Failure) conducted in Japan from April 2006 to August 2016. The mean age was 73.0 ± 13.0, and 61.2% were male. The MAGGIC score demonstrated modest discrimination (c‐index = 0.71, 95% confidence interval 0.67–0.74) and good calibration (R 2 value = 0.97); there was constant overestimation for 1 year mortality. However, when the BNP level was added to the original MAGGIC variables, the model demonstrated good discrimination (c‐index = 0.74, 95% confidence interval 0.70–0.78) with adequate calibration (R 2 value = 0.91). The modified MAGGIC BNP score was externally validated in a separate Japanese registry (NaDEF) and demonstrated moderate discrimination (c‐index = 0.69, 95% confidence interval 0.65–0.73) and calibration (R 2 value = 0.85).ConclusionThe original MAGGIC score performed modestly in Japanese patients, but the addition of discharge BNP level enhanced model performance. The addition of objective biomarkers may result in effective modification of preexisting internationally recognized risk models and aid in multinational comparisons of heart failure patients' outcomes.

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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

Cited by 48 publications

References 48 publications

Guideline-directed medical therapy in elderly patients with heart failure with reduced ejection fraction: a cohort study

Guideline-directed medical therapy in elderly patients with heart failure with reduced ejection fraction: a cohort study

Association between beta‐blocker use and mortality/morbidity in older patients with heart failure with reduced ejection fraction. A propensity score‐matched analysis from the Swedish Heart Failure Registry

Performance of the MAGGIC heart failure risk score and its modification with the addition of discharge natriuretic peptides

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