National survey on the management of heart failure in individuals over 80 years of age in French geriatric care units

Abstract

Background: To evaluate the prevalence and management of heart failure (HF) in very old patients in geriatric settings.

Methods: Members of the French Society of Geriatrics and Gerontology throughout France were invited to participate in a point prevalence survey and to include all patients ≥80 years old, hospitalized in geriatric settings, with HF (stable or decompensated) on June 18, 2012. General characteristics, presence of comorbidities, blood tests and medications were recorded.

Results: Among 7,197 patients in geriatric institution, prevalence of HF was 20.5% (n = 1,478): (27% in acute care, 24.2% in rehabilitation care and 18% in nursing home). Mean age was 88.2 (SD = 5.2) and Charlson co morbidity score was high (8.49 (SD = 2.21)). Left ventricular ejection fraction (LVEF) was available in 770 (52%) patients: 536 (69.6%) had a preserved LVEF (≥ 50%), 120 (15.6%) a reduced LVEF (< 40%), and 114 (14.8%) a midrange LVEF (40-49%). Prescription of recommended HF drugs was low: 42.6% (629) used Angiotensin Converting Enzyme Inhibitors (ACEI) or Angiotensin Receptor Blockers (ARBs), 48.0% (709) β-blockers, and 21.9% (324) ACEI or ARB with β-blockers, even in reduced LVEF. In multivariate analysis ACEI or ARBs were more often used in patients with myocardial infarction (1.36 (1.04-1.78)), stroke (1.42 (1.06-1.91)), and diabetes (1.54 (1.14-2.06)). β blockers were more likely used in patients with myocardial infarction (2.06 (1.54-2.76)) and atrial fibrillation (1.70 (1.28-2.28)).

Conclusion: In this large very old population, prevalence of HF was high. Recommended HF drugs were underused even in reduced LVEF. These results indicate that management of HF in geriatric settings can still be improved.

Keywords: Age > 80 years old; Geriatric settings; Heart failure; Heart failure treatment; Left ventricular ejection fraction.

Fig. 1

Distribution of treatments according to LVEF level. Overall difference between the 3 groups, * p < 0.05; ** p < 0.01; *** p < 0.001. Diuretics, Loop and thiazide diuretics; ACEI, Angiotensin converting enzyme inhibitor; ARB, Angiotensin receptor blocker

Fig. 2

Factors associated with ACE inhibitor or ARB and with β-blocker prescription. * p < 0.05; ** p < 0.01; *** p < 0.001. ACEI, Angiotensin converting enzyme inhibitor; ARB, Angiotensin receptor blocker; eGFR, estimated glomerular filtration rate calculated with Cockcroft formula; MI, myocardial infarction