Komajda M et al. (2007) Management of octogenarians hospitalized for heart failure in Euro Heart Failure Survey I. Eur Heart J 28: 1310–1318

Very elderly patients are often unrepresented in randomized controlled trials, and consequently do not always receive evidence-based therapies. Komajda and co-workers have analyzed data from the Euro Heart Failure Survey I, obtained at 115 centers in 24 countries, to assess the management of heart failure in patients aged ≥80 years. In total, 2,780 octogenarians (median age 85.3 years) were compared with 7,912 younger patients (median age 69.0 years).

Both in-hospital and 12-week follow-up mortality were higher in the older patients than in the younger group (13.2% vs 5.3%, and 11.7% vs 6.1%, respectively; P <0.001 for both). Octogenarians were significantly more likely than younger patients to have preserved left ventricular function, although fewer patients aged ≥80 years had undergone echocardiography. The age-related differences in mortality were apparent in both patients with epressed and those with preserved systolic function. Comorbidities were more common in the older patient group, with only 13.1% of octogenarians free from comorbid conditions, compared with 22.4% of the patients aged <80 years (P <0.001). Together with the presence of acute conditions, comorbidities were predictive of increased mortality, whereas use of angiotensin-converting-enzyme inhibitors, angiotensin-receptor blockers, antiplatelet agents or β-blockers was associated with improved outcomes. Importantly, the investigators found that angiotensin-converting-enzyme inhibitors and β-blockers were underused in octogenarians, suggesting that patient age might be deterring physicians from adhering to guidelines for prescription of these agents. By contrast, use of diuretics, digitalis and nitrates was more common in older than in younger patients.