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Use of evidence-bas...
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Stolfo, DavideKarolinska Institutet,Karolinska Inst, Sweden; Cardiothoracovasc Dept, Italy; Univ Trieste, Italy
(author)
Use of evidence-based therapy in heart failure with reduced ejection fraction across age strata
- Article/chapterEnglish2022
Publisher, publication year, extent ...
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2022-04-03
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Wiley,2022
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electronicrdacarrier
Numbers
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LIBRIS-ID:oai:DiVA.org:liu-184406
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https://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-184406URI
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https://doi.org/10.1002/ejhf.2483DOI
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http://kipublications.ki.se/Default.aspx?queryparsed=id:149215148URI
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Language:English
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Summary in:English
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Subject category:ref swepub-contenttype
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Subject category:art swepub-publicationtype
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Funding Agencies|Boehringer IngelheimBoehringer Ingelheim; EU/EFPIA Innovative Medicines Initiative 2 Joint Undertaking BigData@Heart grant [116074]
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Aims In older patients, guideline-directed medical therapy (GDMT) for heart failure (HF) with reduced ejection fraction (<40%; HFrEF) is not contraindicated, but adherence to guidelines is limited. We investigated the implementation of GDMT in HFrEF across different age strata in a large nationwide cohort. Methods and results Patients with HFrEF and HF duration >= 3 months registered in the Swedish HF Registry between 2000-2018 were analysed according to age. Multivariable logistic and multinomial regressions were fitted to investigate factors associated with underuse/underdosing. Of 27 430 patients, 31% were <70 years old, 34% 70-79 years old, and 35% >= 80 years old. Use of treatments progressively decreased with increasing age. Use of renin-angiotensin system/angiotensin receptor-neprilysin inhibitors, beta-blockers and mineralocorticoid receptor antagonists was 80%, 88% and 35% in age >= 80 years; 90%, 93% and 47% in age 70-79 years; and 95%, 95% and 54% in age <70 years, respectively. Among patients with an indication, use of implantable cardioverter defibrillator and cardiac resynchronization therapy (CRT) was 7% and 23% in age >= 80 years; 22% and 42% in age 70-79 years; and 29% and 50% in age <70 years, respectively. Older patients were less likely treated with target doses or combinations of HF medications. Except for CRT, after extensive adjustments, age was inversely associated with the likelihood of GDMT use and target dose achievement. Conclusion In HFrEF, gaps persist in the use of medications and devices. In disagreement with current recommendations, older patients remain undertreated. Improving strategies and a more individualized approach for implementing use of GDMT in HFrEF are required, particularly in older patients.
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Lund, Lars H.Karolinska Institutet,Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden
(author)
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Becher, Peter MoritzKarolinska Inst, Sweden; Univ Heart & Vasc Ctr Hamburg, Germany; German Ctr Cardiovasc Res DZHK, Germany
(author)
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Orsini, NicolaKarolinska Institutet,Karolinska Inst, Sweden
(author)
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Thorvaldsen, TonjeKarolinska Inst, Sweden; Karolinska Univ Hosp, Sweden
(author)
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Benson, LinaKarolinska Institutet,Karolinska Inst, Sweden
(author)
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Hage, CamillaKarolinska Institutet,Karolinska Inst, Sweden
(author)
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Dahlström, UlfLinköpings universitet,Avdelningen för diagnostik och specialistmedicin,Medicinska fakulteten,Region Östergötland, Kardiologiska kliniken US(Swepub:liu)ulfda85
(author)
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Sinagra, GianfrancoCardiothoracovasc Dept, Italy; Univ Trieste, Italy
(author)
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Savarese, GianluigiKarolinska Institutet,Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden
(author)
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Karolinska InstitutetKarolinska Inst, Sweden; Cardiothoracovasc Dept, Italy; Univ Trieste, Italy
(creator_code:org_t)
Related titles
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In:European Journal of Heart Failure: Wiley24:6, s. 1047-10621388-98421879-0844
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Stolfo, Davide
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Lund, Lars H.
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Becher, Peter Mo ...
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Orsini, Nicola
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Thorvaldsen, Ton ...
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Benson, Lina
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Hage, Camilla
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Dahlström, Ulf
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Sinagra, Gianfra ...
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Savarese, Gianlu ...
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cardiac and Card ...
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Linköping University
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Karolinska Institutet