Skip to main content
SpringerLink
Log in

Guideline-Directed Medical Therapies for Heart Failure with a Reduced Ejection Fraction in Older Adults: A Narrative Review on Efficacy, Safety and Timeliness

  • Review Article
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

Heart failure is a prevalent syndrome among older adults, with a major impact on morbidity and mortality. Higher age is correlated with underuse of guideline-directed medical therapies which, in turn, has been linked to worse clinical outcomes. Importantly, most evidence so far has been collected in adults who were younger, less multi-morbid and polymedicated compared with those who are commonly treated in daily clinical practice. Hence, we aimed to assess and describe the evidence base for pharmacotherapy in older adults with heart failure with a reduced ejection. First, a narrative review was undertaken using Medline, from inception to January 2023. Four foundational therapies were selected based on the latest European Society of Cardiology clinical practice guideline: angiotensin-converting enzyme inhibitors/angiotensin receptor neprilysin inhibitors, beta blockers, mineralocorticoid receptor antagonists and sodium–glucose cotransporter-2 inhibitors. Post hoc analyses from landmark heart failure drug trials were searched and included if they contained data on the impact of age on efficacy, safety and/or timeliness of therapies in the management of heart failure with a reduced ejection fraction. Second, a proposal was developed to support and promote the use of evidence-based heart failure pharmacotherapy in complex, older adults. In total, 11 articles were selected: 4 meta-analyses, 6 post hoc analyses and 1 review paper. No attenuation of efficacy for any of the foundational agents was found in older adults. Regarding safety, dedicated analyses showed that beta blockers, mineraloid receptor antagonists, sacubitril–valsartan, dapagliflozin and empagliflozin retained their overall benefit–risk profile regardless of age. Time to benefit was short and occurred generally within 1 month. Consensus was achieved on a five-step proposal to manage complex medication regimens in older adults suffering from heart failure. In conclusion, older adults suffering from heart failure with a reduced ejection fraction should not be denied treatment based on their age.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Maggioni AP, Dahlstrom U, Filippatos G, Chioncel O, Crespo Leiro M, Drozdz J, Fruhwald F, Gullestad L, Logeart D, Fabbri G, Urso R, Metra M, Parissis J, Persson H, Ponikowski P, Rauchhaus M, Voors AA, Nielsen OW, Zannad F, Tavazzi L. EURObservational Research Programme: regional differences and 1-year follow-up results of the Heart Failure Pilot Survey (ESC-HF Pilot). Eur J Heart Fail. 2013;15(7):808–17.

    PubMed  Google Scholar 

  2. Liao L, Allen LA, Whellan DJ. Economic burden of heart failure in the elderly. Pharmacoeconomics. 2008;26(6):447–62.

    PubMed  Google Scholar 

  3. Groenewegen A, Rutten FH, Mosterd A, Hoes AW. Epidemiology of heart failure. Eur J Heart Fail. 2020;22(8):1342–56.

    PubMed  Google Scholar 

  4. Lesyuk W, Kriza C, Kolominsky-Rabas P. Cost-of-illness studies in heart failure: a systematic review 2004–2016. BMC Cardiovasc Disord. 2018;18(1):74.

    PubMed  PubMed Central  Google Scholar 

  5. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Bohm M, Burri H, Butler J, Celutkiene J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine SA. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599–726.

    CAS  PubMed  Google Scholar 

  6. Kaplon-Cieslicka A, Benson L, Chioncel O, Crespo-Leiro MG, Coats AJS, Anker SD, Filippatos G, Ruschitzka F, Hage C, Drozdz J, Seferovic P, Rosano GMC, Piepoli M, Mebazaa A, McDonagh T, Lainscak M, Savarese G, Ferrari R, Maggioni AP, Lund LH. A comprehensive characterization of acute heart failure with preserved versus mildly reduced versus reduced ejection fraction—insights from the ESC-HFA EORP Heart Failure Long-Term Registry. Eur J Heart Fail. 2022;24(2):335–50.

    CAS  PubMed  Google Scholar 

  7. Savarese G, Stolfo D, Sinagra G, Lund LH. Heart failure with mid-range or mildly reduced ejection fraction. Nat Rev Cardiol. 2022;19(2):100–16.

    PubMed  Google Scholar 

  8. Nations U. World Population Prospects 2022. 2022.

  9. Sharma A, Verma S, Bhatt DL, Connelly KA, Swiggum E, Vaduganathan M, Zieroth S, Butler J. Optimizing foundational therapies in patients with HFrEF: how do we translate these findings into clinical care? JACC Basic Transl Sci. 2022;7(5):504–17.

    PubMed  PubMed Central  Google Scholar 

  10. Davis RC, Hobbs FD, Lip GY. ABC of heart failure. History and epidemiology. BMJ. 2000;320(7226):39–42.

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Butler AR, Feelisch M. Therapeutic uses of inorganic nitrite and nitrate: from the past to the future. Circulation. 2008;117(16):2151–9.

    CAS  PubMed  Google Scholar 

  12. Moser M, Feig PU. Fifty years of thiazide diuretic therapy for hypertension. Arch Intern Med. 2009;169(20):1851–6.

    CAS  PubMed  Google Scholar 

  13. Cohn JN, Archibald DG, Ziesche S, Franciosa JA, Harston WE, Tristani FE, Dunkman WB, Jacobs W, Francis GS, Flohr KH, et al. Effect of vasodilator therapy on mortality in chronic congestive heart failure. Results of a Veterans Administration Cooperative Study. N Engl J Med. 1986;314(24):1547–52.

    CAS  PubMed  Google Scholar 

  14. The CONSENSUS trial study group. Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). N Engl J Med. 1987;316(23):1429–35.

    Google Scholar 

  15. Yusuf S, Pitt B, Davis CE, Hood WB, Cohn JN. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med. 1991;325(5):293–302.

    PubMed  Google Scholar 

  16. Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: a Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022;79(17):e263–421.

    PubMed  Google Scholar 

  17. Packer M, McMurray JJV. Rapid evidence-based sequencing of foundational drugs for heart failure and a reduced ejection fraction. Eur J Heart Fail. 2021;23(6):882–94.

    CAS  PubMed  Google Scholar 

  18. Tromp J, Ouwerkerk W, van Veldhuisen DJ, Hillege HL, Richards AM, van der Meer P, Anand IS, Lam CSP, Voors AA. A systematic review and network meta-analysis of pharmacological treatment of heart failure with reduced ejection fraction. JACC Heart Fail. 2022;10(2):73–84.

    PubMed  Google Scholar 

  19. Voors AA, Angermann CE, Teerlink JR, Collins SP, Kosiborod M, Biegus J, Ferreira JP, Nassif ME, Psotka MA, Tromp J, Borleffs CJW, Ma C, Comin-Colet J, Fu M, Janssens SP, Kiss RG, Mentz RJ, Sakata Y, Schirmer H, Schou M, Schulze PC, Spinarova L, Volterrani M, Wranicz JK, Zeymer U, Zieroth S, Brueckmann M, Blatchford JP, Salsali A, Ponikowski P. The SGLT2 inhibitor empagliflozin in patients hospitalized for acute heart failure: a multinational randomized trial. Nat Med. 2022;28(3):568–74.

    CAS  PubMed  PubMed Central  Google Scholar 

  20. Wachter R, Senni M, Belohlavek J, Straburzynska-Migaj E, Witte KK, Kobalava Z, Fonseca C, Goncalvesova E, Cavusoglu Y, Fernandez A, Chaaban S, Bohmer E, Pouleur AC, Mueller C, Tribouilloy C, Lonn EJALB, Gniot J, Mozheiko M, Lelonek M, Noe A, Schwende H, Bao W, Butylin D, Pascual-Figal D. Initiation of sacubitril/valsartan in haemodynamically stabilised heart failure patients in hospital or early after discharge: primary results of the randomised TRANSITION study. Eur J Heart Fail. 2019;21(8):998–1007.

    CAS  PubMed  Google Scholar 

  21. Velazquez EJ, Morrow DA, DeVore AD, Duffy CI, Ambrosy AP, McCague K, Rocha R, Braunwald E. Angiotensin-neprilysin inhibition in acute decompensated heart failure. N Engl J Med. 2019;380(6):539–48.

    CAS  PubMed  Google Scholar 

  22. Mebazaa A, Davison B, Chioncel O, Cohen-Solal A, Diaz R, Filippatos G, Metra M, Ponikowski P, Sliwa K, Voors AA, Edwards C, Novosadova M, Takagi K, Damasceno A, Saidu H, Gayat E, Pang PS, Celutkiene J, Cotter G. Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): a multinational, open-label, randomised, trial. Lancet. 2022;400(10367):1938–52.

    CAS  PubMed  Google Scholar 

  23. Hellemans L, Nuyts S, Hias J, van den Akker M, Van Pottelbergh G, Rygaert X, Spriet I, Vaes B, Tournoy J, Van der Linden L. Polypharmacy and excessive polypharmacy in community-dwelling middle aged and aged adults between 2011 and 2015. Int J Clin Pract. 2021;75(4): e13942.

    PubMed  Google Scholar 

  24. Van der Linden L, Decoutere L, Walgraeve K, Milisen K, Flamaing J, Spriet I, Tournoy J. Combined use of the rationalization of home medication by an adjusted STOPP in older patients (RASP) List and a pharmacist-led medication review in very old inpatients: impact on quality of prescribing and clinical outcome. Drugs Aging. 2017;34(2):123–33.

    PubMed  Google Scholar 

  25. Van der Linden L, Hias J, Walgraeve K, Flamaing J, Tournoy J, Spriet I. Clinical pharmacy services in older inpatients: an evidence-based review. Drugs Aging. 2020;37(3):161–74.

    PubMed  Google Scholar 

  26. El Morabet N, Uitvlugt EB, van den Bemt BJF, van den Bemt P, Janssen MJA, Karapinar-Carkit F. Prevalence and preventability of drug-related hospital readmissions: a systematic review. J Am Geriatr Soc. 2018;66(3):602–8.

    PubMed  Google Scholar 

  27. Scott IA, Hilmer SN, Reeve E, Potter K, Le Couteur D, Rigby D, Gnjidic D, Del Mar CB, Roughead EE, Page A, Jansen J, Martin JH. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med. 2015;175(5):827–34.

    PubMed  Google Scholar 

  28. Gnjidic D, Johansson M, Meng DM, Farrell B, Langford A, Reeve E. Achieving sustainable healthcare through deprescribing. Cochrane Database Syst Rev. 2022;10(10): ED000159.

    PubMed  Google Scholar 

  29. Stolfo D, Lund LH, Becher PM, Orsini N, Thorvaldsen T, Benson L, Hage C, Dahlstrom U, Sinagra G, Savarese G. Use of evidence-based therapy in heart failure with reduced ejection fraction across age strata. Eur J Heart Fail. 2022;24(6):1047–62.

    CAS  PubMed  Google Scholar 

  30. Greene SJ, Butler J, Albert NM, DeVore AD, Sharma PP, Duffy CI, Hill CL, McCague K, Mi X, Patterson JH, Spertus JA, Thomas L, Williams FB, Hernandez AF, Fonarow GC. Medical therapy for heart failure with reduced ejection fraction: the CHAMP-HF Registry. J Am Coll Cardiol. 2018;72(4):351–66.

    PubMed  Google Scholar 

  31. Mordi IR, Ouwerkerk W, Anker SD, Cleland JG, Dickstein K, Metra M, Ng LL, Samani NJ, van Veldhuisen DJ, Zannad F, Voors AA, Lang CC. Heart failure treatment up-titration and outcome and age: an analysis of BIOSTAT-CHF. Eur J Heart Fail. 2021;23(3):436–44.

    CAS  PubMed  Google Scholar 

  32. Komajda M, Lapuerta P, Hermans N, Gonzalez-Juanatey JR, van Veldhuisen DJ, Erdmann E, Tavazzi L, Poole-Wilson P, Le Pen C. Adherence to guidelines is a predictor of outcome in chronic heart failure: the MAHLER survey. Eur Heart J. 2005;26(16):1653–9.

    PubMed  Google Scholar 

  33. Seo WW, Park JJ, Park HA, Cho HJ, Lee HY, Kim KH, Yoo BS, Kang SM, Baek SH, Jeon ES, Kim JJ, Cho MC, Chae SC, Oh BH, Choi DJ. Guideline-directed medical therapy in elderly patients with heart failure with reduced ejection fraction: a cohort study. BMJ Open. 2020;10(2): e030514.

    PubMed  PubMed Central  Google Scholar 

  34. Duong MH, Gnjidic D, McLachlan AJ, Sakiris MA, Goyal P, Hilmer SN. The prevalence of adverse drug reactions and adverse drug events from heart failure medications in frail older adults: a systematic review. Drugs Aging. 2022;39(8):631–43.

    CAS  PubMed  PubMed Central  Google Scholar 

  35. Rosano GMC, Moura B, Metra M, Bohm M, Bauersachs J, Ben Gal T, Adamopoulos S, Abdelhamid M, Bistola V, Celutkiene J, Chioncel O, Farmakis D, Ferrari R, Filippatos G, Hill L, Jankowska EA, Jaarsma T, Jhund P, Lainscak M, Lopatin Y, Lund LH, Milicic D, Mullens W, Pinto F, Ponikowski P, Savarese G, Thum T, Volterrani M, Anker SD, Seferovic PM, Coats AJS. Patient profiling in heart failure for tailoring medical therapy. A consensus document of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2021;23(6):872–81.

    PubMed  Google Scholar 

  36. Walgraeve K, Van der Linden L, Flamaing J, Fagard K, Spriet I, Tournoy J. Feasibility of optimizing pharmacotherapy in heart failure patients admitted to an acute geriatric ward: role of the clinical pharmacist. Eur Geriatr Med. 2018;9(1):103–11.

    PubMed  Google Scholar 

  37. De Schutter H, Hias J, Hellemans L, Walgraeve K, Tournoy J, Verhamme P, Sinnaeve P, Willems R, Droogne W, Vandenbriele C, Van Aelst L, Vanassche T, Van der Linden L. Consensus validation of a screening tool for cardiovascular pharmacotherapy in geriatric patients: the RASP_CARDIO list (Rationalization of Home Medication by an Adjusted STOPP list in Older Patients). Eur Geriatr Med. 2022;13(6):1467–76.

    PubMed  Google Scholar 

  38. Cherubini A, Oristrell J, Pla X, Ruggiero C, Ferretti R, Diestre G, Clarfield AM, Crome P, Hertogh C, Lesauskaite V, Prada GI, Szczerbinska K, Topinkova E, Sinclair-Cohen J, Edbrooke D, Mills GH. The persistent exclusion of older patients from ongoing clinical trials regarding heart failure. Arch Intern Med. 2011;171(6):550–6.

    PubMed  Google Scholar 

  39. Ferreira JP, Rossello X, Eschalier R, McMurray JJV, Pocock S, Girerd N, Rossignol P, Pitt B, Zannad F. MRAs in elderly HF patients: individual patient-data meta-analysis of RALES, EMPHASIS-HF, and TOPCAT. JACC Heart Fail. 2019;7(12):1012–21.

    PubMed  Google Scholar 

  40. Kotecha D, Manzano L, Krum H, Rosano G, Holmes J, Altman DG, Collins PD, Packer M, Wikstrand J, Coats AJ, Cleland JG, Kirchhof P, von Lueder TG, Rigby AS, Andersson B, Lip GY, van Veldhuisen DJ, Shibata MC, Wedel H, Bohm M, Flather MD. Effect of age and sex on efficacy and tolerability of beta blockers in patients with heart failure with reduced ejection fraction: individual patient data meta-analysis. BMJ. 2016;353: i1855.

    PubMed  PubMed Central  Google Scholar 

  41. Flather MD, Yusuf S, Kober L, Pfeffer M, Hall A, Murray G, Torp-Pedersen C, Ball S, Pogue J, Moye L, Braunwald E. Long-term ACE-inhibitor therapy in patients with heart failure or left-ventricular dysfunction: a systematic overview of data from individual patients. ACE-Inhibitor Myocardial Infarction Collaborative Group. Lancet. 2000;355(9215):1575–81.

    CAS  PubMed  Google Scholar 

  42. Zannad F, Ferreira JP, Pocock SJ, Anker SD, Butler J, Filippatos G, Brueckmann M, Ofstad AP, Pfarr E, Jamal W, Packer M. SGLT2 inhibitors in patients with heart failure with reduced ejection fraction: a meta-analysis of the EMPEROR-Reduced and DAPA-HF trials. Lancet. 2020;396(10254):819–29.

    PubMed  Google Scholar 

  43. Jhund PS, Fu M, Bayram E, Chen CH, Negrusz-Kawecka M, Rosenthal A, Desai AS, Lefkowitz MP, Rizkala AR, Rouleau JL, Shi VC, Solomon SD, Swedberg K, Zile MR, McMurray JJ, Packer M. Efficacy and safety of LCZ696 (sacubitril-valsartan) according to age: insights from PARADIGM-HF. Eur Heart J. 2015;36(38):2576–84.

    CAS  PubMed  PubMed Central  Google Scholar 

  44. Martinez FA, Serenelli M, Nicolau JC, Petrie MC, Chiang CE, Tereshchenko S, Solomon SD, Inzucchi SE, Kober L, Kosiborod MN, Ponikowski P, Sabatine MS, DeMets DL, Dutkiewicz-Piasecka M, Bengtsson O, Sjostrand M, Langkilde AM, Jhund PS, McMurray JJV. Efficacy and safety of dapagliflozin in heart failure with reduced ejection fraction according to age: insights from DAPA-HF. Circulation. 2020;141(2):100–11.

    CAS  PubMed  Google Scholar 

  45. Filippatos G, Anker SD, Butler J, Farmakis D, Ferreira JP, Gollop ND, Brueckmann M, Iwata T, Pocock S, Zannad F, Packer M. Effects of empagliflozin on cardiovascular and renal outcomes in heart failure with reduced ejection fraction according to age: a secondary analysis of EMPEROR-Reduced. Eur J Heart Fail. 2022;24(12):2297–304.

    CAS  PubMed  Google Scholar 

  46. Butt JH, Dewan P, Merkely B, Belohlavek J, Drozdz J, Kitakaze M, Inzucchi SE, Kosiborod MN, Martinez FA, Tereshchenko S, Ponikowski P, Bengtsson O, Lindholm D, Langkilde AM, Schou M, Sjostrand M, Solomon SD, Sabatine MS, Chiang CE, Docherty KF, Jhund PS, Kober L, McMurray JJV. Efficacy and safety of dapagliflozin according to frailty in heart failure with reduced ejection fraction : a post hoc analysis of the DAPA-HF trial. Ann Intern Med. 2022;175(6):820–30.

    PubMed  Google Scholar 

  47. Dewan P, Jackson A, Jhund PS, Shen L, Ferreira JP, Petrie MC, Abraham WT, Desai AS, Dickstein K, Kober L, Packer M, Rouleau JL, Solomon SD, Swedberg K, Zile MR, McMurray JJV. The prevalence and importance of frailty in heart failure with reduced ejection fraction—an analysis of PARADIGM-HF and ATMOSPHERE. Eur J Heart Fail. 2020;22(11):2123–33.

    PubMed  Google Scholar 

  48. Van der Linden L, Hias J, Walgraeve K, Tournoy J, Van Aelst L, Vandenbriele C. Estimating the time to benefit for therapies in heart failure with reduced ejection fraction: a case study of sacubitril-valsartan using reconstructed data from a randomized controlled trial. Drugs Aging. 2022;39(12):959–66.

    PubMed  Google Scholar 

  49. McMurray JJV, Solomon SD, Inzucchi SE, Kober L, Kosiborod MN, Martinez FA, Ponikowski P, Sabatine MS, Anand IS, Belohlavek J, Bohm M, Chiang CE, Chopra VK, de Boer RA, Desai AS, Diez M, Drozdz J, Dukat A, Ge J, Howlett JG, Katova T, Kitakaze M, Ljungman CEA, Merkely B, Nicolau JC, O’Meara E, Petrie MC, Vinh PN, Schou M, Tereshchenko S, Verma S, Held C, DeMets DL, Docherty KF, Jhund PS, Bengtsson O, Sjostrand M, Langkilde AM. Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med. 2019;381(21):1995–2008.

    CAS  PubMed  Google Scholar 

  50. Sze S, Pellicori P, Zhang J, Weston J, Squire IB, Clark AL. Effect of frailty on treatment, hospitalisation and death in patients with chronic heart failure. Clin Res Cardiol. 2021;110(8):1249–58.

    CAS  PubMed  PubMed Central  Google Scholar 

  51. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752–62.

    PubMed  Google Scholar 

  52. Hamada T, Kubo T, Kawai K, Nakaoka Y, Yabe T, Furuno T, Yamada E, Kitaoka H. Frailty interferes with the guideline-directed medical therapy in heart failure patients with reduced ejection fraction. ESC Heart Fail. 2023;10(1):223–33.

    PubMed  Google Scholar 

  53. Ko DT, Hebert PR, Coffey CS, Curtis JP, Foody JM, Sedrakyan A, Krumholz HM. Adverse effects of beta-blocker therapy for patients with heart failure: a quantitative overview of randomized trials. Arch Intern Med. 2004;164(13):1389–94.

    CAS  PubMed  Google Scholar 

  54. Butler J, Talha KM, Fonarow GC. STRONG-HF and implementing heart failure therapies: godspeed … with care. Circulation. 2023;147(16):1189–91.

    PubMed  Google Scholar 

  55. Van der Linden L, Hias J, Spriet I, Walgraeve K, Flamaing J, Tournoy J. Medication review in older adults: importance of time to benefit. Am J Health Syst Pharm. 2019;76(4):247–50.

    PubMed  Google Scholar 

  56. American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. Guiding principles for the care of older adults with multimorbidity: an approach for clinicians: American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. J Am Geriatr Soc. 2012;60(10):E1–25.

    PubMed Central  Google Scholar 

  57. Ravn-Nielsen LV, Duckert ML, Lund ML, Henriksen JP, Nielsen ML, Eriksen CS, Buck TC, Pottegard A, Hansen MR, Hallas J. Effect of an in-hospital multifaceted clinical pharmacist intervention on the risk of readmission: a randomized clinical trial. JAMA Intern Med. 2018;178(3):375–82.

    PubMed  PubMed Central  Google Scholar 

  58. Kini V, Ho PM. Interventions to improve medication adherence: a review. JAMA. 2018;2461–2473.

  59. Petrovic M, Somers A, Onder G. Optimization of geriatric pharmacotherapy: role of multifaceted cooperation in the hospital setting. Drugs Aging. 2016;33(3):179–88.

    CAS  PubMed  Google Scholar 

  60. Birtcher KK, Allen LA, Anderson JL, Bonaca MP, Gluckman TJ, Hussain A, Kosiborod M, Mehta LS, Virani SS. 2022 ACC Expert Consensus decision pathway for integrating atherosclerotic cardiovascular disease and multimorbidity treatment: a framework for pragmatic, patient-centered care: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2023;81(3):292–317.

    PubMed  Google Scholar 

  61. Hias J, Hellemans L, Laenen A, Walgraeve K, Liesenborghs A, De Geest S, Luyten J, Spriet I, Flamaing J, Van der Linden L, Tournoy J. The effect of a trAnSitional Pharmacist Intervention in geRiatric inpatients on hospital visits after dischargE (ASPIRE): protocol for a randomized controlled trial. Contemp Clin Trials. 2022;119: 106853.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pharmacy Department, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium

    Lorenz Van der Linden, Julie Hias & Karolien Walgraeve

  2. Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium

    Lorenz Van der Linden & Julie Hias

  3. Section of Geriatrics, Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium

    Mirko Petrovic

  4. Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium

    Jos Tournoy

  5. Department of Public Health and Primary care, KU Leuven, Leuven, Belgium

    Jos Tournoy

  6. Adult intensive Care, Royal Brompton Hospital, Guy’s & St. Thomas’ NHS Foundations Trust, London, UK

    Christophe Vandenbriele

  7. Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium

    Christophe Vandenbriele & Lucas Van Aelst

  8. Department of Cardiology, University Hospitals Leuven, Leuven, Belgium

    Christophe Vandenbriele & Lucas Van Aelst

Authors
  1. Lorenz Van der Linden
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Julie Hias
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Karolien Walgraeve
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mirko Petrovic
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jos Tournoy
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christophe Vandenbriele
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Lucas Van Aelst
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lorenz Van der Linden.

Ethics declarations

Funding

JH, LVDL and CVDB are grant recipients of the Clinical Research Fund of UZ Leuven, Leuven, Belgium.

Conflicts of interest/competing interest

None of the authors have any conflict of interest to disclose which might be relevant to the content of this manuscript.

Availability of data and material

Not applicable.

Ethics approval

Not applicable.

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Code availability

Not applicable.

Author contributions

LVDL provided the idea and wrote the first draft. All authors reviewed the manuscript, provided substantial contributions and approved its submission.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 59 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Van der Linden, L., Hias, J., Walgraeve, K. et al. Guideline-Directed Medical Therapies for Heart Failure with a Reduced Ejection Fraction in Older Adults: A Narrative Review on Efficacy, Safety and Timeliness. Drugs Aging 40, 691–702 (2023). https://doi.org/10.1007/s40266-023-01046-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40266-023-01046-0

Search

Navigation