Contemporary management of octogenarians hospitalized for heart failure in Europe: Euro Heart Failure Survey II

AP-HP, Department of Cardiology, Pitie Salpetriere Hospital, University Pierre et Marie Curie-Paris 6, Paris, France.
European Heart Journal (Impact Factor: 15.2). 12/2008; 30(4):478-86. DOI: 10.1093/eurheartj/ehn539
Source: PubMed


International guidelines are frequently not implemented in the elderly population with heart failure (HF). This study determined the management of octogenarians with HF enrolled in Euro Heart Failure Survey II (EHFS II) (2004-05).
We compared the clinical profile, 12 month outcomes, and management modalities between 741 octogenarians (median age 83.7 years) and 2836 younger patients (median age 68.4 years) hospitalized for acute/decompensated HF. Management modalities were also compared with those observed in EHFS I (2000-01). Female gender, new onset HF (de novo), hypertension, atrial fibrillation, co-morbidities, disabilities, and low quality of life were more common in the elderly (all P < 0.001). Mortality rates during hospital stay and during 12 months after discharge were increased in octogenarians (10.7 vs. 5.6% and 28.4 vs. 18.5%, P < 0.001). Underuse and underdosage of medications recommended for HF were observed in the elderly. However, a significant improvement was observed when compared with EHFS I both in the overall HF octogenarian population and in the subgroup with ejection fraction < or =45% for prescription rates of ACE-I/ARBs, beta-blockers, and aldosterone antagonists at discharge (82 vs. 71%; 56 vs. 29%; 54 vs. 18.5%, respectively, all P < 0.01), as well as for recommended combinations and dosage. Prescription rates remained stable for 12 months after discharge in survivors.
Our study confirms that the contemporary management of very elderly patients with HF remains suboptimal but that the situation is improving.

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Available from: Luigi Tavazzi, Aug 06, 2014
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    • "Similar differences are seen between HF patients hospitalised in internal medicine and cardiology departments [18]. These differences may be a reflection of the greater heterogeneity and older age of internal medicine patients, as a higher number of comorbidities is associated with older age in patients with HF [17] [19]. "
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    ABSTRACT: Objective: We sought to determine and compare clinical profile and management of outpatients with heart failure with reduced ejection fraction (HFREF) treated by cardiologists and general practitioners (GPs) in Poland. Methods: All the 790 randomly selected cardiologists and GPs in the DATA-HELP registry, which included 5563 patients, filled out questionnaires about 10 consecutive outpatients with HFREF. Results: Outpatients managed by GPs were older (69±10 vs 66±12 years), and the prevalence of men was less marked (58% vs 67%). They also had higher left ventricular ejection fraction (38±6% vs 35±8%) and had more pulmonary congestion (63% vs 49%) and peripheral oedema (66% vs 51%), compared with those treated by cardiologists (all p<0.001). Hypertension (74% vs 66%), previous stroke and/or transient ischaemic attack (21% vs 16%), diabetes (40% vs 30%), and chronic obstructive pulmonary disease (14% vs 11%) were more common in outpatients of GPs (all p<0.001). GPs were less likely to prescribe β-blocker (95% vs 97%, p<0.01), mineralocorticoid receptor antagonist (MRA) (56% vs 64%, p<0.001), and loop diuretic (61% vs 64%, p<0.05) or use PCI (33% vs 44%, p<0.001), CABG (11% vs 16%, p<0.001), ICD (4% vs 10%, p<0.001), or CRT (1% vs 5%, p<0.001). Prescription of renin-angiotensin system inhibitors (94% vs 94%, p>0.2) and digoxin (20% vs 21%, p>0.2) by GPs and cardiologists was similar. Conclusion: In contemporary Poland, most outpatients with HFREF receive drugs that improve survival and undergo revascularisation procedures, although devices are rare, but the clinical profiles and management of those treated by GPs and cardiologists differ. Outpatients treated by GPs are older and have more co-morbidities. Outpatients treated by cardiologists more commonly receive β-blocker, MRA, ICD, and CRT, and undergo coronary revascularisations.
    International Journal of Cardiology 08/2014; 176(3). DOI:10.1016/j.ijcard.2014.08.005 · 4.04 Impact Factor
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    • "However, survey data have confirmed that the uptake of beta-blockers in HF patients is still sub-optimal. Although the percentage of eligible patients prescribed beta-blockers increased between the first and second Euro Heart Failure surveys, a substantial number of patients remain untreated or receive sub-maximal therapy [5,6]. Paradoxically, those at the greatest risk of death are less likely to receive evidence-based therapy after a HF hospitalization [7]. "
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    ABSTRACT: The Beta-Blockers in Heart Failure Collaborative Group (BB-HF) was formed to obtain and analyze individual patient data from the major randomized controlled trials of beta-blockers in heart failure. Even though beta-blockers are an established treatment for heart failure, uptake is still sub-optimal. Further, the balance of efficacy and safety remains uncertain for common groups including older persons, women, those with impaired renal function and diabetes. Our aim is to provide clinicians with a thorough and definitive evidence-based assessment of these agents. We have identified 11 large randomized trials of beta-blockers versus placebo in heart failure and plan to meta-analyze the data on an individual patient level. In total, these trials have enrolled 18,630 patients. Uniquely, the BB-HF group has secured access to the individual data for all of these trials, with the participation of key investigators and pharmaceutical companies. Our principal objectives include deriving an overall estimate of efficacy for all-cause mortality and cardiovascular hospitalization. Importantly, we propose a statistically-robust sub-group assessment according to age, gender, diabetes and other key factors; analyses which are only achievable using an individual patient data meta-analysis. Further, we aim to provide an assessment of economic benefit and develop a risk model for the prognosis of patients with chronic heart failure. This paper outlines inclusion criteria, search strategies, outcome measures and planned statistical analyses. Trial registration Clinical trial registration information:
    Systematic Reviews 01/2013; 2(1):7. DOI:10.1186/2046-4053-2-7
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    • "In spite of different baseline characteristics, the acute clinical presentation in KaRen was similar to HFpEF and HFrEF patients [22] [26]. As in the OPTMIZE-HF registry [14], 69% of patients presented with signs of left ventricular and right ventricular failure and only 24% presented with isolated left ventricular failure. "
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    ABSTRACT: Summary Background Karolinska Rennes (KaRen) is a prospective observational study to characterize heart failure patients with preserved ejection fraction (HFpEF) and to identify prognostic factors for long-term mortality and morbidity. Aims To report characteristics and echocardiography at entry and after 4-8 weeks of follow-up. Methods Patients were included following an acute heart failure presentation with B-type natriuretic peptide (BNP) > 100 ng/L or N-terminal pro-BNP (NT-proBNP) > 300 ng/L and left ventricular ejection fraction (LVEF) > 45%. Results The mean ± SD age of 539 included patients was 77 ± 9 years and 56% were women. Patient history included hypertension (78%), atrial tachyarrhythmia (44%), prior heart failure (40%) and anemia (37%), but left bundle branch block was rare (3.8%). Median NT-proBNP was 2448 ng/L (n = 438), and median BNP 429 ng/L (n = 101). Overall, 101 patients did not return for the follow-up visit, including 13 patients who died (2.4%). Apart from older age (80 ± 9 vs. 76 ± 9 years; P = 0.006), there were no significant differences in baseline characteristics between patients who did and did not return for follow-up. Mean LVEF was lower at entry than follow-up (56% vs. 62%; P < 0.001). At follow-up, mean E/e′ was 12.9 ± 6.1, left atrial volume index 49.4 ± 17.8 mL/m2. Mean global left ventricular longitudinal strain was -14.6 ± 3.9%; LV mass index was 126.6 ± 36.2 g/m2. Conclusions Patients in KaRen were old with slight female dominance and hypertension as the most prevalent etiological factor. LVEF was preserved, but with increased LV mass and depressed LV diastolic and longitudinal systolic functions. Few patients had signs of electrical dyssynchrony ( NCT00774709).
    Archives of cardiovascular diseases 01/2013; 107(2). DOI:10.1016/j.acvd.2013.11.002 · 1.84 Impact Factor
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