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Management and Prognosis of Heart Failure in Octogenarians: Final Report from the KorAHF Registry

Authors
 Gyu Chul Oh  ;  Hyun-Jai Cho  ;  Sang Eun Lee  ;  Min-Seok Kim  ;  Jae-Joong Kim  ;  Jin-Oh Choi  ;  Eun-Seok Jeon  ;  Kyung-Kuk Hwang  ;  Shung Chull Chae  ;  Sang Hong Baek  ;  Seok-Min Kang  ;  Byung-Su Yoo  ;  Dong-Ju Choi  ;  Youngkeun Ahn  ;  Kye Hun Kim  ;  Myeong-Chan Cho  ;  Byung-Hee Oh  ;  Hae-Young Lee 
Citation
 JOURNAL OF CLINICAL MEDICINE, Vol.9(2) : 501, 2020-02 
Journal Title
JOURNAL OF CLINICAL MEDICINE
Issue Date
2020-02
Keywords
J-curve ; guideline-directed medical therapy ; heart failure ; mortality ; octogenarians ; sex difference
Abstract
Treatment of heart failure (HF) in the elderly face many difficulties due to lack of robust evidence. We analyzed the outcome of HF in octogenarians using a nationwide HF registry. Among 5625 patients from the Korean Acute Heart Failure (KorAHF) registry, prognosis of octogenarian HF and the association of guideline-directed medical therapy (GDMT) with mortality and readmissions were analyzed. Octogenarian patients (1185, 22.4%) showed a higher mortality, and males were especially at increased risk (HR (hazard ratio) 1.19, 95% CI 1.01-1.40). A J-curve association between blood pressure (BP) and mortality was observed regardless of age, but the nadir value was lower in octogenarians (123.8 vs. 127.9 mmHg for systolic blood pressure (SBP); 67.1 vs. 73.9 mmHg for diastolic blood pressure (DBP), p < 0.001). Use of GDMT in octogenarian patients with HF and reduced ejection fraction (EF) were inadequate (74.3%, 47.1%, and 46.1% in octogenarians vs. 78.4%, 59.8%, and 55.2% in non-elderly for renin-angiotensin system inhibitors, beta-blockers, and aldosterone antagonists, respectively; all p < 0.05). However, those on medications had a significant reduction in 6 month mortality. For octogenarians with HF and preserved EF, angiotensin receptor blocker use reduced hospitalizations for HF in men (HR 0.19, 95% CI 0.04-0.87), but not in women (p-interaction = 0.037). HF in octogenarians were found to have different characteristics compared with the non-elderly. However, adequate use of GDMT was still associated with improved survival, and more attention should be given to prescribing medications with clinical benefits.
Files in This Item:
T202006800.pdf Download
DOI
10.3390/jcm9020501
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Seok Min(강석민) ORCID logo https://orcid.org/0000-0001-9856-9227
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/182754
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