Optimized management of heart failure patients aged 80 years or more improves outcomes versus usual care: The HF80 randomized trial.
BACKGROUND
The prevalence and incidence of heart failure (HF) in elderly patients are increasing worldwide. Management of HF with reduced ejection fraction (HF-REF) in patients aged 80 years or more follows international guidelines, despite the lack of a dedicated study in this frail population.


OBJECTIVE
To determine whether optimized management of HF-REF in patients aged 80 years or more can improve quality of life at 6 months.


METHODS
Patients aged 80 years or more hospitalized for acute HF-REF were randomized prospectively into an optimized group or a control group (usual care). All patients benefitted from the same in-hospital management. Optimized group patients were also managed at 3, 6 and 9 weeks, and 3, 6, 9 and 12 months after initial hospitalization, to optimize HF-REF treatment. The primary endpoint was quality of life at 6 months.


RESULTS
The trial was stopped prematurely, according to prespecified rules and an independent data monitoring board, after 34 patients were included (n=17 in each group). There was no difference in quality of life at baseline and at 6 months between the two groups (P=0.14 and 0.64, respectively), although a significant improvement was observed between baseline and 6 months in the optimized group compared with the control group: -20.2±25.2 (P=0.01) versus -9.9±19.0 (P=0.19). Mortality at 12 months was lower in the optimized group (17.7% vs 47.1%; P=0.03). There was no increase in acute renal failure, hyperkalaemia or falls in the optimized group (P=0.49, 1 and 1, respectively).


CONCLUSIONS
Optimizing the management of HF-REF in patients aged 80 years or more, according to the modalities of the HF80 study, seems to be both effective and safe.
Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France; Clermont Université, ISIT-CaVITI, BP 10448, Clermont-Ferrand, France.
Charles
C
Vorilhon
Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France.
Frédéric
F
Jean
Biostatistics Unit (Clinical Research and Innovation Direction), CHU Clermont-Ferrand, Clermont-Ferrand, France.
Aurélien
A
Mulliez
Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France; Clermont Université, ISIT-CaVITI, BP 10448, Clermont-Ferrand, France.
Guillaume
G
Clerfond
Biostatistics Unit (Clinical Research and Innovation Direction), CHU Clermont-Ferrand, Clermont-Ferrand, France.
Bruno
B
Pereira
Department of Biochemistry, CHU Clermont-Ferrand, Clermont-Ferrand, France.
Vincent
V
Sapin
Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France; Clermont Université, ISIT-CaVITI, BP 10448, Clermont-Ferrand, France.
Géraud
G
Souteyrand
Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France.
Bernard
B
Citron
Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France; Clermont Université, ISIT-CaVITI, BP 10448, Clermont-Ferrand, France.
Pascal
P
Motreff
Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France; Clermont Université, ISIT-CaVITI, BP 10448, Clermont-Ferrand, France.
Jean-René
JR
Lusson
Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France; Clermont Université, ISIT-CaVITI, BP 10448, Clermont-Ferrand, France; INI-CRCT F-CRIN, Nancy, France. Electronic address: reschalier@chu-clermontferrand.fr.
Romain
R
Eschalier
D000369:Aged, 80 and over; D002423:Cause of Death / Q000639:trends; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006333:Heart Failure / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D009017:Morbidity / Q000639:trends; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D018570:Risk Assessment / Q000379:methods*; D013318:Stroke Volume / Q000502:physiology*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016277:Ventricular Function, Left / Q000502:physiology*
Aged 80 years or more; Heart failure; Insuffisance cardiaque; Mortality; Mortalité; Personnes âgées de 80 ans ou plus; Quality of life; Qualité de vie