Department of Cardiology, Hospital Group Twente (Almelo and Hengelo), Zilvermeeuw 1, 7609 PP, Almelo, The Netherlands.
Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Clin Res Cardiol. 2020 Sep;109(9):1155-1164. doi: 10.1007/s00392-020-01607-y. Epub 2020 Feb 6.
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).
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%)].
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.
尽管老年心力衰竭（HF）患者在真实世界的实践中占很大比例，但在临床试验中却代表性不足。我们调查了一组在荷兰 34 家门诊诊所接受治疗的 3490 名年龄≥80 岁（80 岁以上）的慢性 HF 患者中，基于实践的二级保健 HF 管理情况。
我们分析了 2013 年至 2016 年期间在荷兰 34 家门诊诊所接受治疗的 3490 名年龄≥80 岁的慢性 HF 患者的电子健康记录，其中 49%为女性。研究患者分为射血分数保留型心力衰竭（HFpEF [LVEF≥50%]；n=911[26.1%]）、射血分数降低型心力衰竭（HFrEF [LVEF<40%]；n=2009[57.6%]）和射血分数中间值心力衰竭（HFmrEF：LVEF 40-49%；n=570[16.3%]）。
大多数年龄≥80 岁的 HFrEF 患者接受了β受体阻滞剂和肾素-血管紧张素系统（RAS）抑制剂（血管紧张素转换酶（ACE）抑制剂或血管紧张素受体阻滞剂），即分别有 78.3%和 72.8%的患者接受了治疗，并且有 52.0%的患者接受了盐皮质激素受体拮抗剂（MRA）。只有 29.9%的 80 岁以上 HFrEF 患者接受了这三种指南推荐的药物（三联疗法），并且在 HFrEF 患者总人群中，有 43.8%、62.2%和 53.5%的患者接受了至少 50%的三联疗法、β受体阻滞剂、RAS 抑制剂和 MRA 的目标剂量。在 3.5%的患者中存在对β受体阻滞剂的禁忌证或不耐受，在 7.2%和 6.1%的患者中存在对 RAS 抑制剂和 MRA 的禁忌证或不耐受。
大多数 HFrEF 年龄≥80 岁的患者接受了一种或多种指南推荐的 HF 药物治疗。然而，只有少数患者接受了三联疗法或药物的目标剂量。合并症以及报告的禁忌证和不耐受情况并不能完全解释 HF 治疗推荐药物的使用不足。
