Contemporary management of octogenarians hospitalized for heart failure in Europe: Euro Heart Failure Survey II.
OBJECTIVE
International guidelines are frequently not implemented in the elderly population with heart failure (HF). This study determined the management of octogenarians with HF enrolled in Euro Heart Failure Survey II (EHFS II) (2004-05).


RESULTS
We compared the clinical profile, 12 month outcomes, and management modalities between 741 octogenarians (median age 83.7 years) and 2836 younger patients (median age 68.4 years) hospitalized for acute/decompensated HF. Management modalities were also compared with those observed in EHFS I (2000-01). Female gender, new onset HF (de novo), hypertension, atrial fibrillation, co-morbidities, disabilities, and low quality of life were more common in the elderly (all P < 0.001). Mortality rates during hospital stay and during 12 months after discharge were increased in octogenarians (10.7 vs. 5.6% and 28.4 vs. 18.5%, P < 0.001). Underuse and underdosage of medications recommended for HF were observed in the elderly. However, a significant improvement was observed when compared with EHFS I both in the overall HF octogenarian population and in the subgroup with ejection fraction < or =45% for prescription rates of ACE-I/ARBs, beta-blockers, and aldosterone antagonists at discharge (82 vs. 71%; 56 vs. 29%; 54 vs. 18.5%, respectively, all P < 0.01), as well as for recommended combinations and dosage. Prescription rates remained stable for 12 months after discharge in survivors.


CONCLUSIONS
Our study confirms that the contemporary management of very elderly patients with HF remains suboptimal but that the situation is improving.
Komajda
Michel
M
AP-HP, Department of Cardiology, Pitie Salpetriere Hospital, University Pierre et Marie Curie-Paris 6, Paris, France. michel.komajda@psl.aphp.fr
Hanon
Olivier
O
Hochadel
Matthias
M
Lopez-Sendon
Jose Luis
JL
Follath
Ferenc
F
Ponikowski
Piotr
P
Harjola
Veli-Pekka
VP
Drexler
Helmut
H
Dickstein
Kenneth
K
Tavazzi
Luigi
L
Nieminen
Markku
M
D000203:Activities of Daily Living / Q000523:psychology; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D015331:Cohort Studies; D004232:Diuretics / Q000627:therapeutic use; D005060:Europe / Q000453:epidemiology; D005260:Female; D006299:Health Services for the Aged / Q000592:standards*; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011379:Prognosis; D016896:Treatment Outcome
D002121:Calcium Channel Blockers; D004232:Diuretics; D000451:Mineralocorticoid Receptor Antagonists