Araújo Catarina Silva, Marco Irene, Restrepo-Córdoba María Alejandra, Vila Costa Isidre, Pérez-Villacastín Julián, Goirigolzarri-Artaza Josebe
Internal Medicine, Braga Hospital, 4710-243 Braga, Portugal.
Cardiovascular Institute, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), C/Prof Martín Lagos S/N, Moncloa-Aravaca, 28040 Madrid, Spain.
J Clin Med. 2024 Nov 26;13(23):7171. doi: 10.3390/jcm13237171.
Despite significant advances in the management of heart failure with reduced ejection fraction (HFrEF), data concerning older patients remain limited. The purpose of this study was to evaluate the implementation of guideline-directed medical therapy (GDMT) in older patients with HFrEF along with cardiac events and variation in clinical and echocardiographic parameters during follow-up in a heart failure (HF) clinic. We conducted a retrospective observational analysis of patients with HFrEF aged ≥ 80 years who attended an HF clinic between March 2022 and February 2023. The primary outcome was a composite of the first episode of worsening HF or cardiovascular death. All-cause death was also recorded. We included 110 patients (30.9% females; mean age 82.9 years). After a median follow-up of 25.5 months, left ventricular ejection fraction (LVEF) improved (mean difference 12.5% ( < 0.001)). New York Heart Association class improved in 37% of patients, and N-terminal pro-B-type natriuretic peptide levels decreased (3091 (158-53354) to 1802 (145-19509), < 0.001). The primary outcome occurred in 34 patients (30.9%). Patients without the primary outcome were more likely to receive sodium-glucose co-transporter-2 inhibitors (SGLT2i) (23.5% versus 67.1%, < 0.001) and angiotensin receptor-neprilysin inhibitors, angiotensin-converting enzyme inhibitors, or angiotensin-receptor blockers (67.6% versus 84.2%, < 0.05). These patients also received a greater number of GDMT medications (2 (0-4) versus 3 (1-4), < 0.01) and demonstrated a higher LVEF at the last visit (41.2 ± 10.2% versus 47.1 ± 9.4%, < 0.05). Survival analysis demonstrated a significant association between LVEF recovery (hazard ratio (HR) 0.35, < 0.01), treatment with two or more GDMT medications (HR 0.29, < 0.01), vasodilator use (HR 0.36, < 0.01), and SGLT2i prescription (HR 0.17, < 0.001) and a reduced risk of the primary endpoint. The optimization of HF treatment is achievable in older patients and may be associated with a reduction in cardiac events.
尽管射血分数降低的心力衰竭（HFrEF）管理取得了显著进展，但关于老年患者的数据仍然有限。本研究的目的是评估在老年HFrEF患者中实施指南导向的药物治疗（GDMT）情况，以及心力衰竭（HF）门诊随访期间的心脏事件、临床和超声心动图参数的变化。我们对2022年3月至2023年2月期间在HF门诊就诊的年龄≥80岁的HFrEF患者进行了回顾性观察分析。主要结局是首次发生的HF恶化或心血管死亡的复合事件。还记录了全因死亡情况。我们纳入了110例患者（女性占30.9%；平均年龄82.9岁）。中位随访25.5个月后，左心室射血分数（LVEF）有所改善（平均差异12.5%（P<0.001））。37%的患者纽约心脏协会分级改善，N末端B型利钠肽原水平降低（从3091（158 - 53354）降至1802（145 - 19509），P<0.001）。34例患者（30.9%）发生了主要结局。未发生主要结局的患者更有可能接受钠 - 葡萄糖协同转运蛋白2抑制剂（SGLT2i）（23.5%对67.1%，P<0.001）以及血管紧张素受体脑啡肽酶抑制剂、血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂（67.6%对84.2%，P<0.05）。这些患者还接受了更多种类的GDMT药物（2（0 - 4）种对3（1 - 4）种，P<0.01），并且在最后一次就诊时LVEF更高（41.2±10.2%对47.1±9.4%，P<0.05）。生存分析表明，LVEF恢复（风险比（HR）0.35，P<0.01）、使用两种或更多种GDMT药物治疗（HR 0.29，P<0.01）、使用血管扩张剂（HR 0.36，P<0.01）以及开具SGLT2i处方（HR 0.17，P<0.001）与主要终点风险降低之间存在显著关联。老年患者的HF治疗优化是可以实现的，并且可能与心脏事件的减少有关。
