학술논문
The interaction between physical frailty and prognostic impact of heart failure medication in elderly patients
Document Type
Report
Author
Abe, Takuro; Jujo, Kentaro; Maeda, Daichi; Saito, Katsumi; Ogasahara, Yuki; Saito, Kazuya; Saito, Hiroshi; Iwata, Kentaro; Konishi, Masaaki; Kitai, Takeshi; Kasai, Takatoshi; Wada, Hiroshi; Momomura, Shin‐Ichi; Kagiyama, Nobuyuki; Kamiya, Kentaro; Yamashita, Masashi; Hamazaki, Nobuaki; Nozaki, Kohei; Maekawa, Emi; Ako, Junya; Matsue, Yuya
Source
ESC Heart Failure. June 2023, Vol. 10 Issue 3, p1698, 8 p.
Subject
Language
English
Abstract
Introduction Heart failure (HF) is an expanding global public health problem associated with a high mortality rate.[sup.1] The number of elderly patients with HF has been increasing, particularly in countries [...]
: Aims: Frailty is highly prevalent and associated with poor prognoses in elderly patients with heart failure (HF). However, the potential effects of physical frailty on the benefits of HF medications in elderly patients with HF are unclear. We aimed to determine the influence of physical frailty on the prognosis of HF medications in elderly patients with HF with reduced and mildly reduced ejection fraction (HFr/mrEF). Methods and results: From the combined HF database of the FRAGILE‐HF and Kitasato cohorts, hospitalized HF patients with a left ventricular ejection fraction < 50% and age ≥ 65 years were analysed. Patients treated with or without renin‐angiotensin‐aldosterone system inhibitors (RAASi) and beta‐blockers at discharge were compared. Physical frailty was defined by the presence of ≥3 items on the Japanese version of the Cardiovascular Health Study criteria. The primary endpoint was all‐cause mortality rate. Among the 1021 enrolled patients, 604 patients (59%) received both RAASi and beta‐blockers, and 604 patients (59%) were diagnosed as physically frail. Patients receiving both RAASi and beta‐blockers showed a significantly lower 1 year mortality than those not receiving either, even after adjusting for covariates (hazard ratio: 0.50, 95% confidence interval: 0.34–0.75). This beneficial effect of both medications on 1 year mortality was comparable between patients with and without physical frailty (hazard ratio: 0.53 and 0.51, respectively; P for interaction = 0.77). Conclusions: The presence of physical frailty did not interact with the beneficial prognostic impact of RAASi and beta‐blocker combination therapy in elderly patients with HFr/mrEF.
: Aims: Frailty is highly prevalent and associated with poor prognoses in elderly patients with heart failure (HF). However, the potential effects of physical frailty on the benefits of HF medications in elderly patients with HF are unclear. We aimed to determine the influence of physical frailty on the prognosis of HF medications in elderly patients with HF with reduced and mildly reduced ejection fraction (HFr/mrEF). Methods and results: From the combined HF database of the FRAGILE‐HF and Kitasato cohorts, hospitalized HF patients with a left ventricular ejection fraction < 50% and age ≥ 65 years were analysed. Patients treated with or without renin‐angiotensin‐aldosterone system inhibitors (RAASi) and beta‐blockers at discharge were compared. Physical frailty was defined by the presence of ≥3 items on the Japanese version of the Cardiovascular Health Study criteria. The primary endpoint was all‐cause mortality rate. Among the 1021 enrolled patients, 604 patients (59%) received both RAASi and beta‐blockers, and 604 patients (59%) were diagnosed as physically frail. Patients receiving both RAASi and beta‐blockers showed a significantly lower 1 year mortality than those not receiving either, even after adjusting for covariates (hazard ratio: 0.50, 95% confidence interval: 0.34–0.75). This beneficial effect of both medications on 1 year mortality was comparable between patients with and without physical frailty (hazard ratio: 0.53 and 0.51, respectively; P for interaction = 0.77). Conclusions: The presence of physical frailty did not interact with the beneficial prognostic impact of RAASi and beta‐blocker combination therapy in elderly patients with HFr/mrEF.