Stolfo Davide, Sinagra Gianfranco, Savarese Gianluigi
Division of Cardiology, Department of Medicine, Karolinska Institutet Stockholm, Sweden.
Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University Hospital of Trieste Trieste, Italy.
Card Fail Rev. 2022 Apr 28;8:e16. doi: 10.15420/cfr.2021.34. eCollection 2022 Jan.
Older patients are becoming prevalent among people with heart failure (HF) as the overall population ages. However, older patients are largely under-represented, or even excluded, from randomised controlled trials on HF with reduced ejection fraction, limiting the generalisability of trial results in the real world and leading to weaker evidence supporting the use and titration of guideline-directed medical therapy (GDMT) in older patients with HF with reduced ejection fraction. This, in combination with other factors limiting the application of guideline recommendations, including a fear of poor tolerability or adverse effects, the heavy burden of comorbidities and the need for multiple therapies, classically leads to lower adherence to GDMT in older patients. Although there are no data supporting the under-use and under-dosing of HF medications in older patients, large registry-based studies have confirmed age as one of the major obstacles to treatment optimisation. In this review, the authors provide an overview of the contemporary state of implementation of GDMT in older groups and the reasons for the lower use of treatments, and discuss some measures that may help improve adherence to evidence-based recommendations in older age groups.
随着总体人口老龄化，老年患者在心力衰竭（HF）患者中越来越普遍。然而，在射血分数降低的心力衰竭随机对照试验中，老年患者在很大程度上代表性不足，甚至被排除在外，这限制了试验结果在现实世界中的普遍性，并导致支持在射血分数降低的老年心力衰竭患者中使用和滴定指南导向药物治疗（GDMT）的证据不足。这与其他限制指南建议应用的因素相结合，包括担心耐受性差或不良反应、合并症负担沉重以及需要多种治疗，传统上导致老年患者对GDMT的依从性较低。尽管没有数据支持老年患者对HF药物使用不足和剂量不足，但基于大型注册研究已证实年龄是治疗优化的主要障碍之一。在这篇综述中，作者概述了老年群体中GDMT的当代实施状况以及治疗使用率较低的原因，并讨论了一些可能有助于提高老年群体对循证建议依从性的措施。
