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Age-Related Implications in Guideline-Directed Medical Therapy Up-Titration for Heart Failure with Reduced Ejection Fraction: A Retrospective Single-Center Study
Session:
Sessão de Posters 39 - Insuficiência cardíaca: abordagem a longo prazo
Speaker:
Inês Caldeira Araújo
Congress:
CPC 2024
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.6 Chronic Heart Failure - Clinical
Session Type:
Cartazes
FP Number:
---
Authors:
Inês Caldeira Araújo; Catarina Gregório; Diogo Ferreira; Ana Francês; Fátima Salazar; Nuno Lousada; Joana Rigueira; Rafael Santos; Doroteia Silva; Fausto J. Pinto; Dulce Brito; João Agostinho
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Introduction: According to the STRONG-HF study, the initiation and rapid up-titration of oral heart failure therapy is recommended to reduce heart failure (HF) hospital admissions and all-cause mortality. Up-titration can be challenging due to the complexity of HF patients (pts), however age is not highlighted enough as a contributing factor for this difficulty. </span></span></span></p> <p> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Aim: To evaluate the impact of age on guideline-directed medical therapy (GDMT) up-titration in pts with HF with reduced or mildly reduced ejection fraction (HFrEF).</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Methods: Single-center retrospective study of pts with HFrEF followed in a HF unit. Pts were divided into 3 groups based on age terciles (T): 1</span></span></span><span style="font-size:6.999999999999999pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>st</sup></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> T included pts below 60 years (52 pts), 2</span></span></span><span style="font-size:6.999999999999999pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>nd</sup></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> T, between 60 and 70 years (51 pts) and 3</span></span></span><span style="font-size:6.999999999999999pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>rd</sup></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> T, pts above 70 years (51 pts). Demographic, clinical, therapeutic, and echocardiographic data were recorded. For statistical analysis Chi-square test and Kaplan-Meier survival analysis were used.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Results: We included 154 patients, 76% males, median age of 64.3±14.2 years, with 62.5% of pts in NYHA class II. HF etiology was ischemic heart disease in 46.7% of pts and dilated cardiomyopathy in 41.7%. At baseline, groups were comparable regarding age, HF etiology, NYHA class, NT-proBNP and creatinine. The group of pts older than 70 years had a significantly higher left ventricular EF (p=0.001; Table 1).</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Significant differences were found in the maximum achieved doses of GDMT between groups. Pts above 70 years tended to achieve lower therapeutic doses of ARNI (1</span></span></span><span style="font-size:6.999999999999999pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>st</sup></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> T: 126.5±81.7mg; 2</span></span></span><span style="font-size:6.999999999999999pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>nd</sup></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> T: 132.6±75.5mg; 3</span></span></span><span style="font-size:6.999999999999999pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>rd</sup></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> T: 76.8±69.4 mg, p<0.001), B-blocker (1</span></span></span><span style="font-size:6.999999999999999pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>st</sup></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> T: 5.5±2.7; 2</span></span></span><span style="font-size:6.999999999999999pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>nd</sup></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> T: 5.95±2.6; 3</span></span></span><span style="font-size:6.999999999999999pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>rd</sup></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> T: 4±2.5mg, p<0.001), and MRA (1</span></span></span><span style="font-size:6.999999999999999pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>st</sup></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> T: 29.8±13.5, 2</span></span></span><span style="font-size:6.999999999999999pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>nd</sup></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> T: 27.3±16.2, 3</span></span></span><span style="font-size:6.999999999999999pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>rd</sup></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> T: 22.1±11.4, p=0.009), with no differences regarding iSGLT2 (p=0.17). Regarding renin angiotensin aldosterone system inhibitors, ACEi was preferred to ARNI as the starting drug in patients above 70 years-old; this was not so evident in younger age groups (pts that were started on ACEi instead of ARNI: 1</span></span></span><span style="font-size:6.999999999999999pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>st</sup></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">T – 26 pts (50%), 2</span></span></span><span style="font-size:6.999999999999999pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>nd</sup></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">T - 21 pts (41%), 3</span></span></span><span style="font-size:6.999999999999999pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>rd</sup></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">T - 42 pts (82%), p=0.03. Hypotension or eGFR did not appear to have influenced this decision as they were not statistically different between groups (p=0.049, p= 0.09, respectively). Consequently, one may speculate that non-quantified characteristics like clinical frailty may have impact when deciding which drug to start. During a follow-up of 3 years, EF significantly improved in with no significant differences between groups (1</span></span></span><span style="font-size:6.999999999999999pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>st</sup></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> T: 42.5±14%, 2</span></span></span><span style="font-size:6.999999999999999pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>nd</sup></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> T: 39.9±12%, 3</span></span></span><span style="font-size:6.999999999999999pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>rd</sup></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> T: 41.5±12%, p=0.66). Despite differences in GDMT, the rate of HF hospitalizations or death was similar between groups (LogRank 1.48, p=0.48).</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Conclusion: In the studied population, pts with HFrEF or HFmrEF and age above 70 years achieved lower doses of GMDT, specially regarding ARNI. The older population also seems to present non-quantified and characteristics that impact GDMT initiation and up-titration.</span></span></span></p>
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