IMAJ | volume 24
Journal 11, November 2022
Adherence to Guidelines in Heart Failure, Is It Valid for Elderly Patients?
1 Pulmonology Division, Carmel Medical Center, Haifa, Israel
2 Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut, USA
3 Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel
4 Department of Internal Medicine H, Rambam Health Care Campus, Haifa, Israel
5 Department of Heart Institute, Rambam Health Care Campus, Haifa, Israel
6 Rappaport Faculty of Medicine, Technion–Institute of Technology, Haifa, Israel
7 Heart Institute, Bnei Zion Medical Center, Haifa, Israel
Current guidelines for the treatment of heart failure with reduced ejection fraction (HFrEF) are based on studies that have excluded or underrepresented older patients.
To assess the value of guideline directed medical therapy (GDMT) in HFrEF patients 80 years of age and older.
A single-center retrospective study included patients hospitalized with a first and primary diagnosis of acute decompensated heart failure (ADHF) and ejection fraction (EF) of ≤ 40%. Patients 80 years of age and older were stratified into two groups: GDMT, defined as treatment at hospital discharge with at least two drugs of the following groups: beta-blockers, angiotensin converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB), or mineralocorticoid antagonists; and a personalized medicine group, which included patients who were treated with up to one of these drug groups. The primary outcomes were 90-day all-cause mortality, 90-day rehospitalization, and 3-years mortality.
The study included 1152 patients with HFrEF. 254 (22%) patients who were at least 80 years old. Of the group, 123 were GDMT at discharge. When GDMT group was compared to the personalized medicine group, there were no statistically significant differences in terms 90-day mortality (17% vs. 13%, P
= 0.169), 90-day readmission (51 % vs. 45.6%, P
= 0.27), or 3-year mortality (64.5% vs. 63.3%, P
Conclusions: Adherence to guidelines in the older adult population may not have the same effect as in younger patients who were studied in the randomized clinical trials. Larger prospective studies are needed to further address this issue.