Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Elderly patients constitute substantial proportion of medical care beneficiaries, in same line; heart failure (HF); an extremely common comorbidity is predominately affecting older patients, yet, age disparity in managing this population still represents remarkable challenge in practice. However, little insight is available regarding adherence to evidence-based pharmacotherapy prescribed for this population in developing countries.
Purpose
this study sought to investigate age-based differences in clinical profile and pharmacotherapy prescription pattern in patients with HF.
Methods
This study recruited hospitalized patients with systolic HF, patientsꞌ demographic characteristics, investigational results as well as prescribed drugs in hospital and at discharge; all were recorded. Patients were grouped according to age into ≥65 years versus ˂65 years.
Results
The study recruited 201 patients, 89 (44.27%) of them at age ≥65 year vs 112 (55.72%) in younger group, mean age of older group was 72.4 ± 7.2 year vs 53.5 ± 8.9 year (p < 0.001), female gender constitutes 39.3% of older group vs 26.8% (p < 0.001), older patients were more to have hypertension (68.5% vs 63.4%, p < 0.001) and AF (19.1% vs 17.9%, p < 0.001) and less to be diabetic than younger counterparts (48.3% vs 54.5%, p < 0.001). IHD was most common cause of HF in both groups (92.1% in older group vs 82.1%), dilated cardiomyopathy caused more HF in younger group (12.5% vs 5.6%). No significant differences between both groups regarding heart rate, blood pressure at presentation nor blood urea, serum creatinine or ejection fraction. However, haemoglobin was lower in older group (12.3 ± 1.8 gm/dL vs 13.5 ± 2.2 gm/dL, p = 0.0001). Older patients were treated less with B-blockers 75.3% vs 79.5% while they were prescribed mineralocorticoid receptor antagonist (MRA) more than younger counterparts (46.1% vs 42.9%, p < 0.001), ACE/ARBs/ARNI were prescribed more in older population (62.9% vs 53.6%, p < 0.001). Among patients with heart failure in general: antiplatelet drugs were prescribed more in older patients 75.3% vs 71.4%, while statins used in 68.5% in elderly vs 69.6% in younger counterparts. However, in the context of HF and IHD, antiplatelet drugs were prescribed less in older patients (81.7% vs 86.95%, p < 0.001) same as statins (74.4% vs 84.8%, p < 0.001).
Conclusions
This study contradicted prior researches as ACEI/ARBs/ARNI and MRA were used more in older patients with HF compared to younger counterparts. However, there is still significant age disparity revealed in form of less use of B-blockers in elderly same as antiplatelet, statin and oral anticoagulant when indicated. Further studies are warranted to determine the predictors for age gap in practice in order to be bridged to achieve better cardiovascular outcomes.
Abstract Figure.
The Association Between Dispensed Evidence-based Medications and Outcomes Following Hospitalisation for Heart Failure in Older Patients in Western Australia