Influence of age on the management of heart failure: Findings from Get With the Guidelines–Heart Failure (GWTG-HF)
Received 15 December 2008; accepted 4 March 2009. published online 27 April 2009.
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 ≤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 ≤65 years of age with left ventricular systolic dysfunction were prescribed angiotensin-converting enzyme inhibitor or angiotensin receptor blocker and 90.9% were prescribed β-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 β-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.
aCardiovascular Division, Brigham and Women's Hospital, Boston, MA
ABSTRACT