Oh Gyu Chul, Cho Hyun-Jai, Lee Sang Eun, Kim Min-Seok, Kim Jae-Joong, Choi Jin-Oh, Jeon Eun-Seok, Hwang Kyung-Kuk, Chae Shung Chull, Baek Sang Hong, Kang Seok-Min, Yoo Byung-Su, Choi Dong-Ju, Ahn Youngkeun, Kim Kye Hun, Cho Myeong-Chan, Oh Byung-Hee, Lee Hae-Young
Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea.
Department of Cardiology, Asan Medical Center, Seoul 05505, Korea.
J Clin Med. 2020 Feb 12;9(2):501. doi: 10.3390/jcm9020501.
Treatment of heart failure (HF) in the elderly face many difficulties due to lack of robust evidence. We analyzed the outcome of HF in octogenarians using a nationwide HF registry. Among 5625 patients from the Korean Acute Heart Failure (KorAHF) registry, prognosis of octogenarian HF and the association of guideline-directed medical therapy (GDMT) with mortality and readmissions were analyzed. Octogenarian patients (1185, 22.4%) showed a higher mortality, and males were especially at increased risk (HR (hazard ratio) 1.19, 95% CI 1.01-1.40). A J-curve association between blood pressure (BP) and mortality was observed regardless of age, but the nadir value was lower in octogenarians (123.8 vs. 127.9 mmHg for systolic blood pressure (SBP); 67.1 vs. 73.9 mmHg for diastolic blood pressure (DBP), < 0.001). Use of GDMT in octogenarian patients with HF and reduced ejection fraction (EF) were inadequate (74.3%, 47.1%, and 46.1% in octogenarians vs. 78.4%, 59.8%, and 55.2% in non-elderly for renin-angiotensin system inhibitors, beta-blockers, and aldosterone antagonists, respectively; all < 0.05). However, those on medications had a significant reduction in 6 month mortality. For octogenarians with HF and preserved EF, angiotensin receptor blocker use reduced hospitalizations for HF in men (HR 0.19, 95% CI 0.04-0.87), but not in women (-interaction = 0.037). HF in octogenarians were found to have different characteristics compared with the non-elderly. However, adequate use of GDMT was still associated with improved survival, and more attention should be given to prescribing medications with clinical benefits.
由于缺乏充分的证据，老年人心力衰竭（HF）的治疗面临诸多困难。我们使用全国性的心力衰竭登记系统分析了八旬老人心力衰竭的治疗结果。在韩国急性心力衰竭（KorAHF）登记系统的5625例患者中，分析了八旬老人心力衰竭的预后以及指南指导的药物治疗（GDMT）与死亡率和再入院率的关系。八旬老人患者（1185例，占22.4%）的死亡率较高，男性尤其风险增加（风险比（HR）为1.19，95%置信区间为1.01-1.40）。无论年龄大小，均观察到血压（BP）与死亡率之间呈J形曲线关系，但八旬老人的最低点值较低（收缩压（SBP）为123.8 mmHg对127.9 mmHg；舒张压（DBP）为67.1 mmHg对73.9 mmHg，P<0.001）。八旬老人心力衰竭且射血分数（EF）降低的患者使用GDMT的情况不足（肾素-血管紧张素系统抑制剂、β受体阻滞剂和醛固酮拮抗剂的使用情况分别为八旬老人74.3%、47.1%和46.1%，非老年人78.4%、59.8%和55.2%；均P<0.05）。然而，接受药物治疗的患者6个月死亡率显著降低。对于心力衰竭且EF保留的八旬老人，使用血管紧张素受体阻滞剂可减少男性因心力衰竭住院的次数（HR为0.19，95%置信区间为0.04-0.87），但女性无此效果（交互作用P=0.037）。与非老年人相比，八旬老人的心力衰竭具有不同的特征。然而，充分使用GDMT仍与生存率提高相关，应更加关注开具具有临床益处的药物。
