Impact of optimized guideline-directed medical therapy on mortality in octogenarians with heart failure and reduced ejection fraction: a real-world cohort study
E Amao Ruiz, A Sero Ariza, A S Mendela Andreychuk, P Cueto Quintana, B Carbonell Prat, M Ferre Vallverdu, H Tajes Pascual, O Palazon Molina, F Fernandez Salinas, C Moreno Ambroj, C Ligero Ferrer, P Valdovinos PerdicesAbstract
Background
Heart failure with reduced ejection fraction (HFrEF) in patients aged ≥80 years is associated with high mortality. Although optimized guideline-directed medical therapy (GDMT) improves outcomes in the general HFrEF population, its impact in very elderly patients remains insufficiently characterized.
Purpose
To evaluate the association between optimized GDMT and all-cause mortality in octogenarian patients with HFrEF in a real-world hospital cohort.
Methods
We conducted a retrospective observational study including patients aged ≥80 years with left ventricular eection fraction (LVEF) ≤40%. Patients were divided according to optimized GDMT, defined as the concurrent use of beta-blockers, renin–angiotensin system inhibitors (ACEi/ARB/ARNI), mineralocorticoid receptor antagonists, and sodium–glucose cotransporter-2 inhibitors. Baseline clinical characteristics and mortality were compared between groups. Continuous variables were expressed as mean ± SD or median (interquartile range), and categorical variables as percentages. Comparisons were performed using Student’s t-test or chi-square test, as appropriate. Survival was assessed using Kaplan–Meier curves and compared with the log-rank test.
Results
A total of 92 patients aged ≥80 years with LVEF ≤40% were identified; 69 received non-optimized therapy and 23 optimized GDMT. Patients receiving optimized GDMT were younger (82.4 vs 84.8 years; p=0.002) and had a lower prevalence of chronic kidney disease (27.8% vs 60.9%; p=0.009). Median NT-proBNP levels were 3,161 (1,300–4,749) pg/mL in the optimized GDMT group and 3,222 (2,121–6,625) pg/mL in the non-optimized group (p=0.075). No significant differences were observed in sex, atrial fibrillation, hypertension, diabetes mellitus, or chronic obstructive pulmonary disease( picture 1). Kaplan–Meier analysis showed higher survival in patients receiving optimized GDMT( picture 2); however, the difference did not reach statistical significance (log-rank p=0.09).
Conclusions
In this real-world cohort of octogenarians with HFrEF, optimized GDMT was associated with lower mortality, although without statistical significance. Patients receiving optimized GDMT were younger and had less renal dysfunction, suggesting better treatment tolerability or patient selection. Larger studies are needed to better define the impact of optimized GDMT in this high-risk population.For image description, please refer to the figure legend and surrounding text.Graphic 1For image description, please refer to the figure legend and surrounding text.