Adherence and discontinuation of optimal heart failure therapies according to age: a Danish nationwide study

Garred, C. H. et al. (2022) Adherence and discontinuation of optimal heart failure therapies according to age: a Danish nationwide study. Journal of the American Heart Association, 11(19), e026187. (doi: 10.1161/JAHA.122.026187) (PMID:36172925)

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Background: Guideline‐recommended disease‐modifying pharmacological therapies for heart failure (HF) with reduced ejection fraction are underutilized, particularly among elderly patients. We studied the association of age in adherence and discontinuation of angiotensin‐converting enzyme inhibitors/angiotensin‐II receptor blockers (ACEi/ARB), β‐blockers (BB), and mineralocorticoid receptor antagonists. Methods and Results: Patients with a first heart failure diagnosis who had initiated ACEi/ARB and BB within 120 days of presentation were included from nationwide registries and divided into 3 age groups: <65 years (reference), 65 to 79, and ≥80. One‐year median proportions of daily target doses were calculated. Adherence was estimated by the proportion of days covered. The 5‐year risk of discontinuation was assessed with the Aalen‐Johansen estimator. Discontinuation rates were evaluated using Multivariable Cox regression. Twenty‐nine thousand four hundred eighty‐two patients were included. Advancing age was associated with lower median proportions of daily target doses and adherence (ACEi/ARB 79.1%, 77.5%, and 69.4%; BB 79.1%, 78.6%, and 73.8%), in the <65, 65 to 79, and ≥80 age groups, respectively. Age ≥80 was associated with higher discontinuation rates (cumulative incidence, ACEi/ARB 41%, 44%, and 51%; BB 38%, 35%, and 39%; hazard ratio, ACEi/ARB 1.60 [95% CI, 1.51–1.69]; BB 1.33 [95% CI, 1.25–1.41]). The risk of mineralocorticoid receptor antagonists discontinuation differed little with age (50%, 54%, and 56%), although mineralocorticoid receptor antagonists initiation in the most elderly was less frequent (33%, 33%, and 22%). Conclusions: In a nationwide cohort of patients with heart failure, advanced age was associated with lower proportions of daily target doses, lower adherence, and higher discontinuation rates of ACEi/ARB and BBs. Focus on treatment adherence and optimal dosages among elderly patients with heart failure could improve outcomes.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Butt, Mr Jawad and Kober, Professor Lars and McMurray, Professor John and Petrie, Professor Mark
Authors: Garred, C. H., Zahir, D., Butt, J. H., Ravn, P. B., Bruhn, J., Gislason, G. H., Fosbøl, E. L., Torp‐Pedersen, C., Petrie, M. C., McMurray, J. J.V., Køber, L., and Schou, M.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:Journal of the American Heart Association
Publisher:American Heart Association
ISSN (Online):2047-9980
Published Online:29 September 2022
Copyright Holders:Copyright © 2022 The Authors
First Published:First published in Journal of the American Heart Association 11(19): e026187
Publisher Policy:Reproduced under a Creative Commons License

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