Heart failure in octogenarians: clinical characteristics, outcome, and treatment pattern in the Asian population
D Kim, S K Ryu, J H Jang, S H ShinAbstract
Background
With increasing life expectancy, octogenarians represent a growing proportion of patients with heart failure (HF), and the rising socioeconomic burden in this age group suggests the need for understanding of their clinical characteristics and outcomes. However, data on octogenarian with HF, particularly in Asian population, remain limited.
Purpose
To investigate the clinical characteristics, outcome, and medication use of octogenarians with HF in Asian population.
Methods
We included 962 consecutive patients hospitalized for HF between January 2021 and Jun 2024 at a single tertiary center. Patients were stratified by octogenarian status, and clinical characteristics, laboratory and echocardiographic findings, and medication use were compared across HF phenotypes: preserved, mildly reduced, and reduced ejection fraction (HFpEF, HFmrEF, and HFrEF). The primary outcome was a composite of cardiovascular (CV) mortality and HF hospitalization.
Results
Of all patients, 366 (38%) were octogenarians (HFpEF 45%, HFmrEF 43%, and HFrEF 33%). Compared with non-octogenarians, octogenarians were more likely to be female, underweight (body mass index (BMI) <18.5 kg/m2), and had a higher comorbidity burden incluing hypertension, valvular heart disease (VHD), atrial fibrillation, and anemia, lower estimated glomerular filtration rate (eGFR), higher NT-proBNP levels, smaller left ventricular (LV) dimension, lower e’ velocity, and higher LVEF(Figure 1). During a median follow-up of 1.4 [0.5 – 2.7] years, 178 (19%) patients experienced primary outcome (CV death 5%, HF hospitalization 15%). Octogenarians exhibited poorer clinical outcomes than non-octogenarian patients (p<0.001), mainly driven by increased risk of HF hospitalization (Figure 2). Among the guideline-directed medical therapies, sodium-glucose cotransporter 2 (SGLT2) inhibitors were substantially underused in octogenarians, particularly in the HFrEF group. Octogenarian status, female sex, underweight, absence of diabetes, VHD, anemia, lower eGFR, and absence of left atrial and ventricular remodeling were associated with underuse of SGLT2 inhibitors.
Conclusion
In an Asian HF population, octogenarians showed worse clinical outcomes but significantly lower use of SGLT2 inhibitors, highlighting an unmet need for optimized, evidence-based management in this population.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.