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Heart failure prognosis and management in over-80-year-old patients: data from a French national observational retrospective cohort

  • Pharmacoepidemiology and Prescription
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Abstract

Purpose

The aim of the study was to assess the impact of clinical characteristics and management on the mid- to long-term follow-up prognosis of unselected over-80-year-old patients hospitalized for a first heart failure (HF) episode in a real-life setting. Despite the increasing proportion of HF patients over 80 years of age, the latter remain a poorly studied population.

Methods

Analysis was based on the EGB (“Echantillon Généraliste des Bénéficiaires”) database. A cohort comprising 1825 adult patients with a first admission for HF between 2009 and 2011 was created and followed until June 2013 for survival analysis.

Results

Over-80-year-old patients represented 53 % of this cohort, with a median follow-up of 18.6 (3.3–29.5) months. Only 5 % of patients over 80 years received an optimal treatment at discharge [combination of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB), beta-blockers (BB), and mineralocorticoid receptor antagonists (MRA)]. During the follow-up period, only BB prescription levels (p = 0.02) increased. In over-80-year-olds, in-hospital mortality was 12 % (range, 10–14) and survival was 62.8 % (59.6–65.7) and 48.7 % (45.4–51.9) at 12 and 24 months, respectively. On multivariate analysis, dyslipidemia [0.74 (0.58–0.94), p = 0.02], vitamin K antagonists [0.55 (0.44–0.69), p < 0.001], ACEi/ARB + BB + MRA [0.56 (0.32–0.96), p = 0.04], and ACEi/ARB + BB [0.57 (0.45–0.72), p < 0.001] were associated with improved survival, conversely to cardiogenic shock [3.37 (1.90–5.98), p < 0.001], denutrition [1.61 (1.24–2.09), p < 0.001], and age over 90 [1.35 (1.09–1.67), p = 0.01].

Conclusions

These real-life HF data provide insight into prognostic factors and demonstrate that over-80-year-old HF patients displaying several comorbidities are poorly managed, despite the confirmed clinical benefit of HF drugs.

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Acknowledgment

We thank Mr. Pierre Pothier for editing this manuscript.

Conflict of interest

None

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Authors and Affiliations

  1. Clermont Université, ISIT–CaVITI, BP 10448, 63001, Clermont-Ferrand, France

    Guillaume Clerfond, Pascal Motreff, Jean-R Lusson & Romain Eschalier

  2. Cardiology Department, CHU Clermont-Ferrand, 63003, Clermont-Ferrand, France

    Charles Vorilhon, Guillaume Clerfond, Frédéric Jean, Pascal Motreff, Bernard Citron, Jean-R Lusson & Romain Eschalier

  3. Pharmacology Department, CHU Clermont-Ferrand, 63003, Clermont-Ferrand, France

    Chouki Chenaf, Nicolas Authier & Alain Eschalier

  4. Biostatistics Unit (Clinical Research and Innovation Direction), CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France

    Aurélien Mulliez & Bruno Pereira

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  1. Charles Vorilhon
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  2. Chouki Chenaf
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Correspondence to Romain Eschalier.

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Vorilhon, C., Chenaf, C., Mulliez, A. et al. Heart failure prognosis and management in over-80-year-old patients: data from a French national observational retrospective cohort. Eur J Clin Pharmacol 71, 251–260 (2015). https://doi.org/10.1007/s00228-014-1794-7

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  • DOI: https://doi.org/10.1007/s00228-014-1794-7

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