Patients with reduced EF: guideline-directed medical therapy

Guideline-directed medical therapy (GDMT), which includes treatment using SGLT2 inhibitors and angiotensin receptor-neprilysin inhibitor (ARNI), has been proven to significantly reduce mortality and morbidity in patients with heart failure with reduced ejection fraction (HFrEF). The latest guideline recommends these drugs for all patients with HFrEF, with no upper age limit. However, many large scale trials which have indicated GDMT’s efficacy for treating HFrEF have simultaneously excluded heart failure (HF) patients over 80 years old.

The aim of this cross-sectional study was to investigate the clinical characteristics of patients without GDMT, as well as the association between the prescription of GDMT at discharge and physical frailty in patients with acute decompensated heart failure. In this study, GDMT included a combination of AS inhibitors and beta-blockers.

Key learnings:

Physical frailty was associated with a lack of prescription of GDMT at discharge in elderly patients with HFrEF. These patients were significantly older than those with GDMT, and a larger proportion of patients without GDMT suffered from severe renal impairment, cognitive decline and physical frailty (including anaemia). Physical frailty may thus interfere with GDMT implementation at discharge in a population of mainly elderly patients with HF.