Schmidt Insa Marie, Kreutz Reinhold, Dräger Dagmar, Zwillich Christine, Hörter Stefan, Kuhlmey Adelheid, Gellert Paul
Institute of Clinical Pharmacology and Toxicology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Institute of Medical Sociology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Drugs Aging. 2018 Oct;35(10):907-916. doi: 10.1007/s40266-018-0581-z.
Centenarians are considered as models of successful aging and represent a special group of patients. The aim of this study was to analyze heart failure epidemiology and treatment trajectories in centenarians compared to nonagenarians (90-99 years of age) and octogenarians (80-89 years of age) with heart failure and with heart failure and kidney disease combined.
This cohort study used quarterly structured routine data from 1398 German insurants over 6 years prior to death (398 centenarians were compared with 500 nonagenarians and 500 octogenarians). Of those, 525 individuals were diagnosed with heart failure before death; 164 had heart failure and kidney disease combined. Generalized estimation equations were used to assess the association of diagnoses of heart failure and other diseases with medication prescriptions.
Across age groups, heart failure was significantly more prevalent in centenarians compared with octogenarians and nonagenarians. Prevalence of heart failure increased over time. Female sex [odds ratio (men) = 0.70, p = 0.024], kidney disease (odds ratio = 1.31, p < 0.001), and hypertension (odds ratio = 1.52, p < 0.001) were all associated with heart failure. Overall, heart failure treatment changed significantly over time with an increased prescription rate of loop diuretics and a decreased rate of renin-angiotensin-system inhibitors. Centenarians were significantly less likely to receive treatment with renin-angiotensin-system inhibitors, loop diuretics, or beta-blockers compared with nonagenarians and octogenarians. Furthermore, aldosterone inhibitors were seldom prescribed; If-channel and neprilysin inhibitors were not routinely used in our sample. For those with heart failure and kidney disease combined, our data revealed that the prevalence of kidney disease was lower in centenarians than in younger patients before death. However, differences in prescription rates across age groups were non-significant, although numerically large. Finally, half of the patients in all three age groups with heart failure and kidney disease received treatment with renin-angiotensin-system inhibitors; about two out of five patients received beta-blockers, while prescription rates of aldosterone inhibitors were low.
While heart failure prevalence shows a continuous increase with age, prescription rates are lower in centenarians, emphasizing the need for further studies considering the quality of care and outcomes in this patient population. Disease management programs and trials are needed to develop guidelines that address the medically challenging treatment for very old patients with comorbid heart failure and kidney disease.
百岁老人被视为成功衰老的典范，代表着一类特殊的患者群体。本研究的目的是分析与患有心力衰竭以及同时患有心力衰竭和肾脏疾病的九旬老人（90 - 99岁）和八旬老人（80 - 89岁）相比，百岁老人的心力衰竭流行病学及治疗轨迹。
这项队列研究使用了1398名德国参保人在死亡前6年的季度结构化常规数据（将398名百岁老人与500名九旬老人和500名八旬老人进行比较）。其中，525人在死亡前被诊断患有心力衰竭；164人同时患有心力衰竭和肾脏疾病。使用广义估计方程来评估心力衰竭及其他疾病诊断与药物处方之间的关联。
在各个年龄组中，与八旬老人和九旬老人相比，百岁老人中心力衰竭的患病率显著更高。心力衰竭的患病率随时间增加。女性（男性的优势比 = 0.70，p = 0.024）、肾脏疾病（优势比 = 1.31，p < 0.001）和高血压（优势比 = 1.52，p < 0.001）均与心力衰竭相关。总体而言，心力衰竭治疗随时间发生显著变化，袢利尿剂的处方率增加，而肾素 - 血管紧张素系统抑制剂的处方率降低。与九旬老人和八旬老人相比，百岁老人接受肾素 - 血管紧张素系统抑制剂、袢利尿剂或β受体阻滞剂治疗的可能性显著更低。此外，醛固酮抑制剂很少被处方；在我们的样本中，If通道和中性肽链内切酶抑制剂未被常规使用。对于同时患有心力衰竭和肾脏疾病的患者，我们的数据显示，百岁老人在死亡前肾脏疾病的患病率低于年轻患者。然而，尽管各年龄组之间的处方率差异在数值上较大，但差异无统计学意义。最后，所有三个年龄组中一半患有心力衰竭和肾脏疾病的患者接受了肾素 - 血管紧张素系统抑制剂治疗；约五分之二的患者接受了β受体阻滞剂治疗，而醛固酮抑制剂的处方率较低。
虽然心力衰竭患病率随年龄持续增加，但百岁老人的处方率较低，这凸显了需要进一步研究考虑该患者群体的护理质量和治疗结果。需要疾病管理项目和试验来制定针对患有合并心力衰竭和肾脏疾病的高龄患者的具有医学挑战性的治疗指南。
