Guideline-directed medical therapy underused in elderly HF patients
Among patients with HFrEF aged ≥65 years in the Korean Acute Heart Failure (KorAHF) registry, only 43.8 percent were treated with both beta-blockers and renin-angiotensin system (RAS) inhibitors. The use of GDMT decreased with increasing age and was mainly attributable to decreased prescription of beta-blockers. [BMJ Open 2020, doi: 10.1136/bmjopen-2019-030514]
Similarly, data from the CHECK-HF registry showed that only 29.9 percent of HFrEF patients aged ≥80 years were treated with a beta-blocker, a RAS inhibitor and a mineralocorticoid receptor antagonist (MRA), and only 43.8 percent of the patients received ≥50 percent of the target doses of triple therapy. According to the investigators, comorbidities and reported contraindications or intolerance (beta-blockers, 3.5 percent; RAS inhibitors, 7.2 percent; MRAs, 6.1 percent) did not fully explain the underuse of recommended HF therapies. [Clin Res Cardiol 2020, doi: 10.1007/s00392-020-01607-y]In the Korean study, GDMT use was associated with a significant 53 percent reduction in risk of all-cause mortality vs no GDMT.