Evidence-based Therapy in Older Patients with Heart Failure with Reduced Ejection Fraction
Older patients are becoming prevalent among people with heart failure (HF) as the overall population ages. However, older patients are largely under-represented, or even excluded, from randomised controlled trials on HF with reduced ejection fraction, limiting the generalisability of trial results i...
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| Format: | Article |
| Language: | English |
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Radcliffe Medical Media
2022-04-01
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| Series: | Cardiac Failure Review |
| Online Access: | https://www.cfrjournal.com/articleindex/cfr.2021.34 |
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| _version_ | 1849220273404903424 |
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| author | Davide Stolfo Gianfranco Sinagra Gianluigi Savarese |
| author_facet | Davide Stolfo Gianfranco Sinagra Gianluigi Savarese |
| author_sort | Davide Stolfo |
| collection | DOAJ |
| description | Older patients are becoming prevalent among people with heart failure (HF) as the overall population ages. However, older patients are largely under-represented, or even excluded, from randomised controlled trials on HF with reduced ejection fraction, limiting the generalisability of trial results in the real world and leading to weaker evidence supporting the use and titration of guideline-directed medical therapy (GDMT) in older patients with HF with reduced ejection fraction. This, in combination with other factors limiting the application of guideline recommendations, including a fear of poor tolerability or adverse effects, the heavy burden of comorbidities and the need for multiple therapies, classically leads to lower adherence to GDMT in older patients. Although there are no data supporting the under-use and under-dosing of HF medications in older patients, large registry-based studies have confirmed age as one of the major obstacles to treatment optimisation. In this review, the authors provide an overview of the contemporary state of implementation of GDMT in older groups and the reasons for the lower use of treatments, and discuss some measures that may help improve adherence to evidence-based recommendations in older age groups. |
| format | Article |
| id | doaj-art-7bd4eafbddba47f6bb7dbd46d0a35ec1 |
| institution | Kabale University |
| issn | 2057-7540 2057-7559 |
| language | English |
| publishDate | 2022-04-01 |
| publisher | Radcliffe Medical Media |
| record_format | Article |
| series | Cardiac Failure Review |
| spelling | doaj-art-7bd4eafbddba47f6bb7dbd46d0a35ec12024-12-14T16:03:36ZengRadcliffe Medical MediaCardiac Failure Review2057-75402057-75592022-04-01810.15420/cfr.2021.34Evidence-based Therapy in Older Patients with Heart Failure with Reduced Ejection FractionDavide Stolfo0Gianfranco Sinagra1Gianluigi Savarese2Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University Hospital of Trieste, Trieste, ItalyCardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University Hospital of Trieste, Trieste, ItalyDivision of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Heart and Vascular Theme, Karolinska University Hospital, Stockholm, SwedenOlder patients are becoming prevalent among people with heart failure (HF) as the overall population ages. However, older patients are largely under-represented, or even excluded, from randomised controlled trials on HF with reduced ejection fraction, limiting the generalisability of trial results in the real world and leading to weaker evidence supporting the use and titration of guideline-directed medical therapy (GDMT) in older patients with HF with reduced ejection fraction. This, in combination with other factors limiting the application of guideline recommendations, including a fear of poor tolerability or adverse effects, the heavy burden of comorbidities and the need for multiple therapies, classically leads to lower adherence to GDMT in older patients. Although there are no data supporting the under-use and under-dosing of HF medications in older patients, large registry-based studies have confirmed age as one of the major obstacles to treatment optimisation. In this review, the authors provide an overview of the contemporary state of implementation of GDMT in older groups and the reasons for the lower use of treatments, and discuss some measures that may help improve adherence to evidence-based recommendations in older age groups.https://www.cfrjournal.com/articleindex/cfr.2021.34 |
| spellingShingle | Davide Stolfo Gianfranco Sinagra Gianluigi Savarese Evidence-based Therapy in Older Patients with Heart Failure with Reduced Ejection Fraction Cardiac Failure Review |
| title | Evidence-based Therapy in Older Patients with Heart Failure with Reduced Ejection Fraction |
| title_full | Evidence-based Therapy in Older Patients with Heart Failure with Reduced Ejection Fraction |
| title_fullStr | Evidence-based Therapy in Older Patients with Heart Failure with Reduced Ejection Fraction |
| title_full_unstemmed | Evidence-based Therapy in Older Patients with Heart Failure with Reduced Ejection Fraction |
| title_short | Evidence-based Therapy in Older Patients with Heart Failure with Reduced Ejection Fraction |
| title_sort | evidence based therapy in older patients with heart failure with reduced ejection fraction |
| url | https://www.cfrjournal.com/articleindex/cfr.2021.34 |
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