Heart failure
Value of Medical Therapy in Patients >80 Years of Age With Heart Failure and Preserved Ejection Fraction

https://doi.org/10.1016/j.amjcard.2008.11.047Get rights and content

Heart failure (HF) with preserved ejection fraction (EF) has a high prevalence in the geriatric population, and this cohort may be at risk of complications caused by polypharmacy. Effects of commonly used cardiac medications on long-term survival of patients >80 years with HF and preserved left ventricular EF were assessed. One hundred forty-two patients were evaluated. During a 5-year follow-up, 98 patients died (69%). There were no significant differences in baseline parameters in patients who died compared with those who survived at 5 years. None of the drug therapies appeared to make a significant difference in long-term survival, including β blockers (p = 0.89), angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (p = 0.91), calcium channel blockers (p = 0.69), diuretics (p = 0.30), digoxin (p = 0.22), and statins (p = 0.32). In conclusion, based on the present data, it appears that use of certain common cardiac medications may not be associated with a significant effect on long-term survival in octogenarians with HF and preserved EF.

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Methods

The study was approved by the internal review board of the medical institution as a subgroup analysis of a larger study of patients of any age with HF and preserved LVEF. In the original study, admission records during a 3-year period were reviewed for patients admitted with the primary diagnosis of HF. Inclusion criteria were echocardiographic evidence of an EF on admission ≥50% and a clinical diagnosis of HF. Patients were excluded for the presence of atrial fibrillation, severe valvular

Results

Baseline clinical characteristics of all patients and patients grouped by survival during five year follow up are listed in Table 1. One hundred forty-two octogenarians fulfilled the inclusion criteria of HF diagnosis with EF ≥50% and were included in data analysis. Mean age was 87 ± 5 years, and 31% were men. Ninety-eight patients died within the 5-year follow-up, and 44 patients survived beyond the 5-year follow-up. Between survivors and patients who died, there were no statistically

Discussion

Validated treatment options for patients with HF and preserved LV systolic function were lacking. Previous studies analyzing medical therapy with digoxin,4 candesartan,5 or perindopril6 did not show a mortality benefit or decrease in hospitalization rate for patients with HF with preserved systolic function. Verapamil may have increased exercise tolerance,7 but has not been shown to decrease mortality or hospitalizations. A new-generation β blocker, nebivolol, may decrease cardiac

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