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Medical treatment of octogenarians with chronic heart failure: data from CHECK-HF

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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.

Graphic abstract

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Acknowledgements

We greatly acknowledge the participation of heart failure nurses and cardiologists of all participating sites for including patients and entering patient data.

Funding

Servier, the Netherlands, funded the inclusion of data and software program. The steering committee (HBRLR, GL, AH, JB) received no funding for this project. This analysis was initiated by the authors and was designed, conducted, interpreted, and reported independently of the sponsor.

Author information

Correspondence to Gerard C. M. Linssen.

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Conflict of interest

The authors declare no competing financial interest.

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Linssen, G.C.M., Veenis, J.F., Kleberger, A. et al. Medical treatment of octogenarians with chronic heart failure: data from CHECK-HF. Clin Res Cardiol (2020). https://doi.org/10.1007/s00392-020-01607-y

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Keywords

  • Heart failure
  • Older people
  • Guidelines
  • Adherence
  • Medication