The Prognostic and Therapeutic Values of Adherence to Current Guidelines in Elderly Patients with LV Systolic Dysfunction

Fadel Bahouth Internal Medicine, Rambam Health Care Campus, Haifa, Israel Danny Epstein Internal Medicine, Rambam Health Care Campus, Haifa, Israel Sharbel Babab Internal Medicine, Rambam Health Care Campus, Haifa, Israel Doron Aronson Internal Medicine, Rambam Health Care Campus, Haifa, Israel Uri Waksman Internal Medicine, Rambam Health Care Campus, Haifa, Israel Zaher Azzam Internal Medicine, Rambam Health Care Campus, Haifa, Israel

Background: Heart Failure (HF) is a major public health problem, especially in the elderly population. Current guidelines that are based principally on large randomized clinical trials (RCTs), were recommended by the European Society of Cardiology as the standard of care on HF with reduced ejection fraction (HFrEF). However, concerns exist regarding the implementation of those guidelines on elderly patients as they were either excluded or underrepresented. Therefore, we aimed to examine whether adherence to current ESC pharmacologic guidelines improves the outcome of HFrEF Patients aged > 75 years.

Methods: This study is a single center trial of patients admitted to Rambam Health Care Campus with the primary diagnosis of acute decompensated HF and EF of ≤40%. The primary endpoint was the composite end point of all cause 30-days mortality and rehospitalization 30 days following discharge. Patients were stratified into two groups of patients over 75 years old as compared to those who are younger. Adherence to medication, defined as treated with at least two of following three groups of medications; beta blockers, ACEI/ARB or spironolactone, at discharge was recorded for all groups.

Results: Data were retrieved from the Rambam registry database of HF. 187 patients with HFrEF and NYHA classification were included. 40% were over 75 years. In patients < 75 years, multi variable logistic regression analysis, showed that NYHA classification and decreased compliance were increased risk of composite endpoints; P=0.0132 (OR 8.77; 95%CI -1.56 to 48.84) and P=0.0172 (OR 15.34; 95%CI -1.62 to 145.07) respectively. Whereas, in older patients, low compliance was not associate with increased risk of composite endpoints.

Conclusions: In elderly patients, adherence to guidelines had no effect on the prognosis of HFrEF patients over 75 years old; probably, due to other comorbidities that may adversely influence prognosis. Larger study is needed to further address this issue.









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