Influence of age on the management of heart failure: findings from Get With the Guidelines-Heart Failure (GWTG-HF).

BACKGROUND: Heart failure (HF) is common among elderly adults. Although multiple studies demonstrate age-related declines in the utilization of evidence-based therapies for coronary artery disease, there are few analyses of HF patients to distinguish possible age-related management differences. METHODS: We analyzed 57,937 HF admissions from January 2005 through April 2007 in 257 hospitals participating in the American Heart Association's Get With The Guidelines-Heart Failure program. Patient characteristics and management were stratified by age groups < or = 65, 66-75, 76-85, and >85 years. Multivariable regression analyses were used to assess the influence of age on use of therapies and inhospital mortality. RESULTS: The mean patient age was 73 +/- 14 years; 18.7% were >85 years of age. Prescriptions of most HF therapies were relatively reduced with age but still remained high overall. Although 88.6% of patients < or = 65 years of age with left ventricular systolic dysfunction were prescribed angiotensin-converting enzyme inhibitor or angiotensin receptor blocker and 90.9% were prescribed beta-blockers, among those >85 years of age with left ventricular systolic dysfunction, 79% were prescribed angiotensin-converting enzyme inhibitor or angiotensin receptor blocker and 82.7% were prescribed beta-blockers. Regression analysis that accounted for typical confounders demonstrated that older age was associated with diminished utilization of most evidence-based treatment measures as well as increased mortality. CONCLUSIONS: Get With The Guidelines-Heart Failure data demonstrate that guidelines recommended therapies are frequently utilized for older patients with HF, including patients >85 years old. Nonetheless, age-related differences in therapy persist, suggesting that opportunities to improve care still remain.

Duke Scholars

Author Adrian Felipe Hernandez Medicine, Cardiology