Abstract 12903: Frailty Did Not Diminish the Prognostic Advantage of Guideline-Directed Medical Therapy in Elderly Patients With Heart Failure (Multicentral Cohort Study)

• Published in: Circulation (New York, N.Y.) N.Y.), 2021-11, Vol.144 (Suppl_1), p.A12903-A12903
• Main Authors: Abe, Takuro, Jujo, Kentaro, Saito, Katsumi, Kazuya, Saito, Saito, Hiroshi, Kentaro, Iwata, Konishi, Masaaki, Kitai, Takeshi, Kasai, Takatoshi, Wada, Hiroshi, Momomura, Shinichi, Kagiyama, Nobuyuki, Kamiya, Kentaro, Masashi, Yamashita, Hamazaki, Nobuaki, Kohei, Nozaki, Maekawa, Emi, Ako, Junya, Matsue, Yuya
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.144.suppl_1.12903

IntroductionNumerous previous trials revealed that the effectiveness of guideline-directed medical therapy (GDMT) including beta-blockers (BB) and renin-angiotensin system inhibitors (RASi) in patients with heart failure (HF) with reduced/mildly reduced ejection fraction (HFr/mrEF). Although frailty is world-wide concern in HF patients, the impact of physical frailty on the prognostic effect of GDMT in geriatric patients with HFr/mrEF remains unclear. HypothesisThe prognostic impact of GDMT in HF patients depends on whether they exhibit physical frailty or not. MethodsFrom the combined HF database of FRAGILE-HF and Kitasato cohort, 1,054 hospitalized HFr/mrEF patients >65 year-old were analyzed. Of them, 715 patients (32%) were on the full GDMT (both BB and RASi) at discharge, and 604 patients (57%) were diagnosed as physically frail. The primary endpoint was death from any cause. ResultsIn the whole population, patients on GDMT at discharge showed a significantly lower 1-year mortality than those without GDMT in Kaplan-Meier analysis (Log-rank, p=0.0014). In multivariable Cox regression analysis including GWTG-HF risk score, log-transformed BNP, left ventricular ejection fraction, anemia and NYHA class, the superiority of GDMT was confirmed (HR 0.53, 95%CI0.36-0.78). The rate of risk reduction for 1-year mortality by receiving GDMT was comparable between patients with and without physical frailty after adjusting covariates (HR0.57 and 0.59, respectively). Additionally, the prognostic advantages of GDMT were not significantly interacted by the presence or absence of physical frailty (P for interaction=0.77). ConclusionsGDMT was associated with the improved prognosis in geriatric hospitalized HFr/mrEF patients regardless of the frailty. We should not hesitate the administration of GDMT in elderly patients even if they are physically frail.