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Beta-blockers (BB) and renin angiotensin system inhibitors (RASi) are foundational for the treatment of heart failure with reduced ejection fraction (HFrEF). However, given the increased risk of side effects in older patients, uncertainly remains as to whether, on net, older patients benefit as much as the younger patients studied in trials.Using the GWTG-HF registry linked with Medicare data, overlap propensity weighted Cox proportional hazard models were used to examine the association between BB and RASi use at hospital discharge 30-day and 1-year outcomes among patients with HFrEF.Among the 48,711 patients (age ≥65 years) hospitalized with HFrEF, there were significant associations between BB and/or RASi use at discharge and lower rates of 30-day and 1-year mortality, including those over age 85 (30-day HR=0.56 [95% CI 0.45, 0.70]; 1-year HR=0.69 [95% CI 0.61, 0.78]). In addition, the magnitude of benefit associated with BB and/or RASi use after discharge did not decrease with increasing age. Even among the oldest patients, those over age 85, with hypotension, renal insufficiency or frailty, BB and/or RASi at discharge was still associated with lower 1-year mortality or readmission.Among older patients hospitalized with HFrEF, BB and/or RASi use at discharge is associated with lower rates of 30-day and 1-year mortality across all age groups and the magnitude of this benefit does not appear to decrease with increasing age. These data suggest that, absent a clinical contraindication, BB and RASi should be considered in all patients hospitalized with HFrEF before or at hospital discharge, regardless of age. |
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