J Clin Med. 2020;9(2):jcm9020501.

Management and Prognosis of Heart Failure in Octogenarians: Final Report from the KorAHF Registry.

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제1저자 오규철 · 교신저자 이해영

PMID 32059515 PMC7074088 DOI 10.3390/jcm9020501 IF 3.3 순환기내과

소속 (10)

Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea.
Department of Cardiology, Asan Medical Center, Seoul 05505, Korea.
Department of Medicine, Sungkyunkwan University College of Medicine, Seoul 16419, Korea.
Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju 28644, Korea.
Department of Internal Medicine, Kyungpook National University College of Medicine, Daegu 37224, Korea.
Department of Internal Medicine, The Catholic University of Korea, Seoul 06591, Korea.
Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea.
Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea.
Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea.
Heart Research Center of Chonnam National University, Gwangju 61469, Korea.

Abstract

Treatment of heart failure (HF) in the elderly face many difficulties due to lack of robust evidence. We analyzed the outcome of HF in octogenarians using a nationwide HF registry. Among 5625 patients from the Korean Acute Heart Failure (KorAHF) registry, prognosis of octogenarian HF and the association of guideline-directed medical therapy (GDMT) with mortality and readmissions were analyzed. Octogenarian patients (1185, 22.4%) showed a higher mortality, and males were especially at increased risk (HR (hazard ratio) 1.19, 95% CI 1.01-1.40). A J-curve association between blood pressure (BP) and mortality was observed regardless of age, but the nadir value was lower in octogenarians (123.8 vs. 127.9 mmHg for systolic blood pressure (SBP); 67.1 vs. 73.9 mmHg for diastolic blood pressure (DBP), p < 0.001). Use of GDMT in octogenarian patients with HF and reduced ejection fraction (EF) were inadequate (74.3%, 47.1%, and 46.1% in octogenarians vs. 78.4%, 59.8%, and 55.2% in non-elderly for renin-angiotensin system inhibitors, beta-blockers, and aldosterone antagonists, respectively; all p < 0.05). However, those on medications had a significant reduction in 6 month mortality. For octogenarians with HF and preserved EF, angiotensin receptor blocker use reduced hospitalizations for HF in men (HR 0.19, 95% CI 0.04-0.87), but not in women (p-interaction = 0.037). HF in octogenarians were found to have different characteristics compared with the non-elderly. However, adequate use of GDMT was still associated with improved survival, and more attention should be given to prescribing medications with clinical benefits.

Keywords

J-curveguideline-directed medical therapyheart failuremortalityoctogenarianssex difference

Figures

**Figure 1** Prognosis of octogenarian HF. (A) Annual mortality of octogenarian patients compared with non-elderly patients. (B) All-cause mortality according to age and EF category. HF, heart failure; EF, ejection fraction; HFrEF, HF and reduced EF; HFmrEF, HF and mid-range EF; HFpEF, HF and preserved EF.

**Figure 2** Restricted cubic splines for all-cause mortality according to on-treatment (A) SBP and (B) DBP. SBP, systolic blood pressure; DBP, diastolic blood pressure; HF, heart failure.

**Figure 3** Kaplan–Meier curves for all-cause mortality according to guideline-directed medical therapies (GDMT). (A) RAS inhibitor; (B) beta-blocker; (C) appropriate use of AA. GDMT, guideline-directed medical therapy; RAS, renin angiotensin system; AA, aldosterone antagonist.

**Figure 4** Kaplan–Meier curves for all-cause mortality according to BP and RAS inhibitor use. BP, blood pressure; RAS, renin–angiotensin system; SBP, systolic blood pressure; DBP, diastolic blood pressure.

**Figure 5** Sex difference in HF readmissions according to use of ACE inhibitors and ARBs. HF, heart failure; ACE, angiotensin-converting enzyme; ARB, angiotensin receptor blocker.

그림 출처: PubMed Central 공개 논문 (PMC7074088)

Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

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