An article titled, “Impact of sustained adherence to guideline-directed medical therapy on clinical outcomes in older adults with new-onset heart failure with reduced ejection fraction,” was published in American Heart Journal Plus: Cardiology Research and Practice by authors Xichong Liu, Chan Hee J. Choi, C. William Pike, Gavin Hui, Jananee Muralidharan, and Shriram Nallamshetty. The authors are affiliated with Stanford University, Atropos Health, and Veterans Affairs Palo Alto Healthcare System.
Short Summary:
Advanced age is a major risk factor for heart failure (HF), with a four-fold higher prevalence in patients over the age of 65. The 2022 AHA/ACC/HFSA guideline recommends initiation of four classes of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF)—beta blockers (BB), angiotensin-converting enzyme inhibitor (ACEi) or angiotensin II receptor blocker (ARB) or angiotensin receptor-neprilysin inhibitors (ARNi), mineralocorticoid receptor antagonists (MRA), and sodium-glucose cotransporter-2 inhibitors (SGLT2i). This recommendation is supported by multiple randomized control trials (RCTs) demonstrating improved outcomes with GDMT. However, patients ≥70 years are underrepresented in these trials.
Caring for older patients involves balancing their medical complexities and polypharmacy with various social, behavioral, and environmental challenges. While existing observational studies suggest benefits of single or dual GDMT with BB and ACEi/ARB/ARNi in older adults, they focus on prescriptions at discharge rather than sustained use. Therefore, we investigated the effect of sustained adherence to multi-drug GDMT in older patients with new HFrEF on all-cause mortality compared to younger counterparts.