Prescription pattern of evidence-based pharmacotherapy in heart failure: An age perspective

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
ZA Dakhil ◽  
HASAN Farhan
Keyword(s):  
Heart Failure ◽  
Older Patients ◽  
Female Gender ◽  
Antiplatelet Drugs ◽  
Evidence Based ◽  
Mineralocorticoid Receptor Antagonist ◽  
Prescription Pattern ◽  
Funding Sources ◽  
Age Gap ◽  
Age Disparity

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.

scholarly journals Physical frailty and long-term mortality in older people with chronic heart failure with preserved and reduced ejection fraction: a retrospective longitudinal study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shuo-Chun Weng ◽  
Chu-Sheng Lin ◽  
Der-Cherng Tarng ◽  
Shih-Yi Lin
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Older Patients ◽  
Handgrip Strength ◽  
Frailty Index ◽  
Timed Up And Go ◽  
Mineralocorticoid Receptor Antagonist ◽  
Reduced Ejection Fraction ◽  
Study Results ◽  
The Impact

Abstract Background Frailty, a syndrome characterized by a decline in function reserve, is common in older patients with heart failure (HF) and is associated with prognosis. This study aimed to evaluate the impact of frailty on outcomes in older patients with preserved and reduced cardiac function. Methods In total, 811 adults aged ≥65 years were consecutively enrolled from 2009 to 2018. HF was diagnosed according to the ICD9 code and a 2D echocardiogram was categorized by reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). The index date was registered at the time of HF. All patients received a comprehensive geriatric assessment, and clinical outcomes were examined with adjustment of the other prognostic variables. Results Mean age was 80.5 ± 7.1 years. The prevalence of HF, HFpEF, HFrEF, Fried, and Rockwood frailty indicators was 28.5, 10.4, 9.7, 52.5, and 74.9%, respectively. At baseline, scores in the Timed Up and Go test was closely associated with the severity of HF, either with HFpEF or HFrEF. After a mean follow-up of 3.2 ± 2.0 years, we found that HF patients with low handgrip strength (HGS) had the poorest survival, followed by non-HF patients with decreased HGS, and HF with fair HGS in comparison with non-HF with fair HGS (p = 0.008) if participants were arbitrarily divided into two HGS groups. In all patients, a high Rockwood frailty index was independently associated with increased mortality (adjusted hazard ratio [aHR] = 1.05; 95% confidence interval [CI]: 1.0004 to 1.10). In addition, the adjusted mortality HR was 3.42 with decreased HGS (95% CI: 1.03 to 11.40), 7.65 with use of mineralocorticoid receptor antagonist (95% CI: 2.22 to 26.32), and 1.26 with associated multi-comorbidities assessed by Charlson comorbidity index (95% CI: 1.05 to 1.51). Conclusions Our study results indicate that frailty and decreased physical functions were associated with HF. Besides, frailty and HGS predicted prognosis in the patients, and there was a combined effect of HF and low HGS on survival.

Evidence-based management of arrhythmogenic right ventricular cardiomyopathy in pregnancy

2020 ◽  
Author(s):  
Jagjit Khosla ◽  
Reshma Golamari ◽  
Alice Cai ◽  
Jamal Benson ◽  
Wilbert S Aronow ◽  
...  
Keyword(s):  
Heart Failure ◽  
Right Ventricular ◽  
Retrospective Studies ◽  
Arrhythmogenic Right Ventricular Cardiomyopathy ◽  
Genetic Disorder ◽  
Ventricular Myocardium ◽  
Evidence Based ◽  
Ventricular Cardiomyopathy ◽  
Genes Encoding ◽  
In Pregnancy

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic disorder resulting in fibrofatty replacement of the myocardium. Genetic mutations in genes encoding for desmosome proteins result in a ventricular myocardium prone to arrhythmias and heart failure. Although ARVC is known for a few decades, most of the outcomes in pregnancy are reported recently. Pregnancy leads to significant physiological changes with excess mechanical stress on the myocardium. All the retrospective studies suggest that pregnancy is well tolerated in these patients despite the high risk of arrhythmias and heart failure. Our review focuses on the most up-to-date evidence on the management of ARVC patients during the antepartum and postpartum period.

Heart failure in Acute Coronary Syndrome: predictors and prognosis

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
M Santos ◽  
H Santos ◽  
I Almeida ◽  
H Miranda ◽  
C Sa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Artery Bypass ◽  
Study Data ◽  
Multivessel Disease ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Coronary Syndrome ◽  
Funding Sources ◽  
Previous Stroke ◽  
St Elevation

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf on behalf of the Investigators of " Portuguese Registry of ACS " Introduction Heart failure (HF) is a frequent complication of acute coronary syndromes (ACS). Therefore, it is important to access its impact on prognosis and identify patients (pts) with higher risk of HF. Objective To evaluate predictors and prognosis of HF in the setting of ACS. Methods Based on a multicenter retrospective study, data collected from admissions between 1/10/2010 and 4/09/2019. Pts without data on cardiovascular history or uncompleted clinical data were excluded. Pts were divided in 2 groups (G): GA – pts without HF; GB - pts with HF during hospitalization. Results HF occurred in 4003 (15.6%) out of 25718 pts with ACS. GB was older (74 ± 12 vs 65 ± 13, p < 0.001), had more females (36.3% vs 26.2%, p < 0.001), had higher rates of arterial hypertension (78.4% vs 69.3%, p < 0.001), dyslipidaemia (64.4% vs 61.1%. p < 0.001), previous ACS (25.6% vs 19.7%, p < 0.001,), previous HF (16.4% vs 4.1%, p < 0.001), previous stroke (11.9% vs 6.4%, p < 0.001), chronic kidney disease (CKD) (17.1% vs 5.5%, p < 0.001), chronic obstructive pulmonary disease (COPD) (7.8% vs 3.8%, p < 0.001) and longer times from first symptoms to admission (268min vs 238min, p < 0.001). GA had higher rate of smokers (28.4% vs 16.2%, p < 0.001) and higher rate of non-ST-elevation myocardial infarction (MI) (46.5% vs 43.0%, p < 0.001). GB had higher rates of ST-elevation MI (STEMI) (49.2% vs 41.1%, p < 0.001), namely anterior STEMI (58.1% vs 44.9%, p < 0.001). GB had lower blood pressure (130 ± 32 vs 140 ± 28, p < 0.001), higher heart rate (86 ± 23 vs 76 ± 18, p < 0.001), Killip-Kimball class (KKC) ≥2 (63.2% vs 6.7%, p < 0.001), atrial fibrillation (AF) (15.4% vs 5.7%, p < 0.001), left bundle branch block (7.5% vs 3.1%, p < 0.001) and were previously treated with diuretics (39.1% vs 22.1%, p < 0.001), amiodarone (2.2% vs 1.4%, p < 0.001) and digoxin (2.8% vs 0.7%, p < 0.001). GB had higher rates of multivessel disease (66.0% vs 49.5%, p < 0.001) and planned coronary artery bypass grafting (7.3% vs 6.0%, p < 0.001), reduced left ventricle function (72.3% vs 33.4%, p < 0.001) and needed more frequently mechanical ventilation (8.2% vs 0.9%, p < 0.001), non-invasive ventilation (8.7% vs 0.5%, p < 0.001) and provisory pacemaker (4.5% vs 1.0%, p < 0.001). Logistic regression confirmed females (p < 0.001, OR 1.42, CI 1.29-1.58), diabetes (p < 0.001, OR 1.43, CI 1.30-1.58), previous ACS (p < 0.001, OR 1.27, CI 1.10-1.47), previous stroke (p < 0.001, OR 1.35, CI 1.16-1.57), CKD (p < 0.001, OR 1.76, CI 1.50-2.05), COPD (p < 0.001, OR 2.15, CI 1.82-2.54), previous usage of amiodarone (p = 0.041, OR 1.35, CI 1.01-1.81) and digoxin (p < 0.001, OR 2.30, CI 1.70-3.16), and multivessel disease (p < 0.001, OR 1.64, CI 1.67-2.32) were predictors of HF in the setting of ACS. Event-free survival was higher in GA than GB (79.5% vs 58.1%, OR 2.3, p < 0.001, CI 2.09-2.56). Conclusion As expected, HF in the setting of ACS is associated with poorer prognosis. Several features may help predict the HF occurrence during hospitalizations, allowing an earlier treatment.

scholarly journals Comparison of adaptive versions of the Hong Kong-specific criteria and 2015 Beers criteria for assessing potentially inappropriate medication use in Hong Kong older patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Huanyu ZHANG ◽  
Eliza L. Y. WONG ◽  
Samuel Y. S. WONG ◽  
Patsy Y. K. CHAU ◽  
Benjamin H. K. YIP ◽  
...  
Keyword(s):  
Older Adults ◽  
Hong Kong ◽  
Older Patients ◽  
Inappropriate Medication ◽  
Female Gender ◽  
Potentially Inappropriate Medication ◽  
Multivariable Logistic Regression Analysis ◽  
Beers Criteria ◽  
Medical Conditions ◽  
Cross Sectional

Abstract Background The Hong Kong-specific criteria have been established in 2019 to assess potentially inappropriate medication (PIM) use in older adults and improve the local prescribing quality. The aim of this study was to compare the adaptive versions of the Hong Kong-specific criteria and 2015 Beers criteria for assessing the prevalence and correlates of PIM use in Hong Kong older patients. Methods A cross-sectional study was performed from January 1, 2014 to December 31, 2014 using the Hospital Authority (HA) database. A total of 489,301 older patients aged 65 years and older visiting general outpatient clinics (GOPCs) during the study period were included in the study. Two categories of PIM use included in the Hong Kong-specific criteria and 2015 Beers criteria, i.e. PIMs independent of diagnoses and PIMs considering specific medical conditions, were adapted to assess the prevalence of PIM use among the study sample. Characteristics of PIM users and the most frequently prescribed PIMs were investigated for each set of the criteria. Factors associated with PIM use were identified using the stepwise multivariable logistic regression analysis. Results The adaptive Hong Kong-specific criteria could detect a higher prevalence of patients exposed to at least one PIM than that assessed by the adaptive Beers criteria (49.5% vs 47.5%). Meanwhile, the adaptive Hong Kong-specific criteria could identify a higher rate of patients exposed to PIMs independent of diagnoses (48.1% vs 46.8%) and PIMs considering specific medical conditions (7.3% vs 4.9%) compared with that of the adaptive Beers criteria. The most frequently prescribed PIMs detected by the adaptive Beers criteria were all included in the adaptive Hong Kong-specific criteria. The strongest factor associated with PIM use was number of different medications prescribed. Patients with female gender, aged 65 ~ 74 years, a larger number of GOPC visits, and more than six diagnoses were associated with greater risk of PIM use, whereas advancing age was associated with lower risk of PIM use. Conclusions The adaptive Hong Kong-specific criteria could detect a higher prevalence of PIM use than the adaptive Beers criteria in older adults visiting GOPCs in Hong Kong. It is necessary to update the prevalence and correlates of PIM use regularly in older adults to monitor the burden of PIM use and identify vulnerable patients who need further interventions.

scholarly journals Effect of frailty on treatment, hospitalisation and death in patients with chronic heart failure

2021 ◽  
Author(s):  
S. Sze ◽  
P. Pellicori ◽  
J. Zhang ◽  
J. Weston ◽  
I. B. Squire ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Clinical Frailty Scale ◽  
Mineralocorticoid Receptor Antagonist ◽  
Reduced Ejection Fraction ◽  
Frail Patients ◽  
History Of ◽  
Poor Outcomes ◽  
To Receive

Abstract Background Frailty is common in patients with chronic heart failure (CHF) and is associated with poor outcomes. The natural history of frail patients with CHF is unknown. Methods Frailty was assessed using the clinical frailty scale (CFS) in 467 consecutive patients with CHF (67% male, median age 76 years, median NT-proBNP 1156 ng/L) attending a routine follow-up visit. Those with CFS > 4 were classified as frail. We investigated the relation between frailty and treatments, hospitalisation and death in patients with CHF. Results 206 patients (44%) were frail. Of 291 patients with HF with reduced ejection fraction (HeFREF), those who were frail (N = 117; 40%) were less likely to receive optimal treatment, with many not receiving a renin–angiotensin–aldosterone system inhibitor (frail: 25% vs. non-frail: 4%), a beta-blocker (16% vs. 8%) or a mineralocorticoid receptor antagonist (50% vs 41%). By 1 year, there were 56 deaths and 322 hospitalisations, of which 25 (45%) and 198 (61%), respectively, were due to non-cardiovascular (non-CV) causes. Most deaths (N = 46, 82%) and hospitalisations (N = 215, 67%) occurred in frail patients. Amongst frail patients, 43% of deaths and 64% of hospitalisations were for non-CV causes; 58% of cardiovascular (CV) deaths were due to advancing HF. Among non-frail patients, 50% of deaths and 57% of hospitalisations were for non-CV causes; all CV deaths were due to advancing HF. Conclusion Frailty in patients with HeFREF is associated with sub-optimal medical treatment. Frail patients are more likely to die or be admitted to hospital, but whether frail or not, many events are non-CV. Graphical abstract

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