Age differences in contemporary treatment of patients with chronic heart failure and reduced ejection fraction

Eur J Prev Cardiol. 2019 Sep;26(13):1399-1407. doi: 10.1177/2047487319835042. Epub 2019 Mar 13.

Abstract

Background: Elderly patients are underrepresented in clinical trials but comprise the majority of heart failure patients. Data on age-specific use of heart failure therapy are limited. The European Society of Cardiology heart failure guidelines provide no age-specific treatment recommendations. We investigated practice-based heart failure management in a large registry at heart failure outpatient clinics.

Design and methods: We studied 8351 heart failure with reduced ejection fraction patients at 34 Dutch outpatient clinics between 2013 and 2016. The mean age was 72.3 ± 11.8 years and we divided age into three categories: less than 60 years (13.9%); 60-74 years (36.0%); and 75 years and over (50.2%).

Results: Elderly heart failure with reduced ejection fraction patients (≥75 years) received significantly fewer beta-blockers (77.8% vs. 84.2%), renin-angiotensin system inhibitors (75.2% vs. 89.7%), mineralocorticoid receptor antagonists (50.6% vs. 59.6%) and ivabradine (2.9% vs. 9.3%), but significantly more diuretics (88.1% vs. 72.6%) compared to patients aged less than 60 years (Pfor all trends < 0.01). Moreover, the prescribed target dosages were significantly lower in elderly patients. Also, implantable cardioverter defibrillator (18.9% vs. 44.1%) and cardiac resynchronisation therapy device (14.6% vs. 16.7%) implantation rates were significantly lower in elderly patients. A similar trend in drug prescription was observed in patients with heart failure with mid-range ejection fraction as in heart failure with reduced ejection fraction.

Conclusion: With increasing age, heart failure with reduced ejection fraction patients less often received guideline-recommended medication prescriptions and also in a lower dosage. In addition, a lower percentage of implantable cardioverter defibrillator and cardiac resynchronisation therapy device implantation in elderly patients was observed.

Keywords: HFrEF; Heart failure; age; guideline adherence; treatment.

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use
  • Age Factors
  • Aged
  • Angiotensin Receptor Antagonists / therapeutic use
  • Cardiac Resynchronization Therapy
  • Chronic Disease
  • Diuretics / therapeutic use
  • Female
  • Heart Failure / therapy*
  • Humans
  • Male
  • Mineralocorticoid Receptor Antagonists / therapeutic use
  • Netherlands
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Registries
  • Stroke Volume

Substances

  • Adrenergic beta-Antagonists
  • Angiotensin Receptor Antagonists
  • Diuretics
  • Mineralocorticoid Receptor Antagonists