In:
Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 144, No. Suppl_1 ( 2021-11-16)
Kurzfassung:
Introduction: Numerous previous trials revealed that the effectiveness of guideline-directed medical therapy (GDMT) including beta-blockers (BB) and renin-angiotensin system inhibitors (RASi) in patients with heart failure (HF) with reduced/mildly reduced ejection fraction (HFr/mrEF). Although frailty is world-wide concern in HF patients, the impact of physical frailty on the prognostic effect of GDMT in geriatric patients with HFr/mrEF remains unclear. Hypothesis: The prognostic impact of GDMT in HF patients depends on whether they exhibit physical frailty or not. Methods: From the combined HF database of FRAGILE-HF and Kitasato cohort, 1,054 hospitalized HFr/mrEF patients 〉 65 year-old were analyzed. Of them, 715 patients (32%) were on the full GDMT (both BB and RASi) at discharge, and 604 patients (57%) were diagnosed as physically frail. The primary endpoint was death from any cause. Results: In the whole population, patients on GDMT at discharge showed a significantly lower 1-year mortality than those without GDMT in Kaplan-Meier analysis (Log-rank, p=0.0014). In multivariable Cox regression analysis including GWTG-HF risk score, log-transformed BNP, left ventricular ejection fraction, anemia and NYHA class, the superiority of GDMT was confirmed (HR 0.53, 95%CI: 0.36-0.78). The rate of risk reduction for 1-year mortality by receiving GDMT was comparable between patients with and without physical frailty after adjusting covariates (HR: 0.57 and 0.59, respectively). Additionally, the prognostic advantages of GDMT were not significantly interacted by the presence or absence of physical frailty (P for interaction=0.77). Conclusions: GDMT was associated with the improved prognosis in geriatric hospitalized HFr/mrEF patients regardless of the frailty. We should not hesitate the administration of GDMT in elderly patients even if they are physically frail.
Materialart:
Online-Ressource
ISSN:
0009-7322
,
1524-4539
DOI:
10.1161/circ.144.suppl_1.12903
Sprache:
Englisch
Verlag:
Ovid Technologies (Wolters Kluwer Health)
Publikationsdatum:
2021
ZDB Id:
1466401-X