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Title <p>Guideline-Directed Medical Therapy in Older Adults with Heart Failure; Are There Differences Across Age Groups?</p> Background <p>Older adults remain underrepresented in heart failure (HF) studies evaluating guideline-directed medical therapy (GDMT). This study aimed to assess clinical characteristics, HF GDMT pillars use, and outcomes across age groups of older adults with HF.</p> Methods <p>This retrospective, multicentre sub-analysis of the Sarawak Heart Failure Registry included patients aged ≥ 65 years. Participants were stratified into youngest-old (65–70 years), middle-old (71–75 years), and oldest-old (&gt; 75 years). GDMT use, dosing, and clinical outcomes, including all-cause mortality and HF readmission, were evaluated at baseline, 3 and 6 months. Multivariable regression analyses were performed to identify factors associated with outcomes and GDMT optimisation.</p> Results <p>A total of 176 patients were included. Comorbidity burden increased with age, whereas coronary artery disease was more prevalent in the youngest-old group. HF GDMT pillars use declined with increasing age, particularly for renin–angiotensin system inhibitors and SGLT2 inhibitors, while beta-blocker use remained consistently high. At 6 months, 50% of the oldest-old achieved three GDMT pillars, although fewer achieved four compared with younger groups. LVEF improved in all age groups, most notably in the youngest-old. NYHA functional class improvement was greater in younger patients. Mortality at 6 months was numerically higher in the youngest-old (16.0%), while HF readmission was slightly higher in the oldest-old (12.5%), without statistical significance. In multivariable analyses, age, comorbidities, and LVEF were not independent predictors of outcomes.</p> Conclusion <p>Older adults with HF demonstrated consistent structural and functional improvement across age groups despite differences in GDMT use. Outcome variation was not independently explained by age or comorbidity burden, suggesting that disease phenotype and physiological reserve may play a greater role. These findings provide real-world evidence from a multiethnic Asian population and support individualized, multidisciplinary care strategies for older adults with HF.</p>

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Guideline-directed medical therapy in older adults with heart failure; Are there differences across age group?

  • 期刊论文

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  • 发表日期：

    2026年5月7日

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  • Schee Li Kwa,
  • Bui Khiong Chung,
  • Zhun Foo Tan,
  • Janice Kee Wei Wong,
  • Zi Yang Lian,
  • Kok Choon Cheah,
  • Ka-Shing Tan,
  • Chun-Hau Lam,
  • Mae Jane Khaw,
  • Siew Yap Chai,
  • Melvinder Singh A/L Jasbinder,
  • Lee Yee Ting,
  • Jordan Ching Bing Hoo,
  • Chelfi Zhi Fei Chua,
  • Min Ting Wong,
  • Pey Woei Ting,
  • Jun Xun Ng,
  • Qing Wei Lim,
  • Ching Hua Chai,
  • Wei Ming Cho,
  • Alex Zhi Yang Koh,
  • Tze Cheng Wong,
  • Weng Kee Ho,
  • Wun Khang Chong,
  • Rebecca Su Li Chew,
  • Jothiswaran Namasoo,
  • Ing Chiew Yew,
  • Hwei Sung Ling

摘要

Title

Guideline-Directed Medical Therapy in Older Adults with Heart Failure; Are There Differences Across Age Groups?

Background

Older adults remain underrepresented in heart failure (HF) studies evaluating guideline-directed medical therapy (GDMT). This study aimed to assess clinical characteristics, HF GDMT pillars use, and outcomes across age groups of older adults with HF.

Methods

This retrospective, multicentre sub-analysis of the Sarawak Heart Failure Registry included patients aged ≥ 65 years. Participants were stratified into youngest-old (65–70 years), middle-old (71–75 years), and oldest-old (> 75 years). GDMT use, dosing, and clinical outcomes, including all-cause mortality and HF readmission, were evaluated at baseline, 3 and 6 months. Multivariable regression analyses were performed to identify factors associated with outcomes and GDMT optimisation.

Results

A total of 176 patients were included. Comorbidity burden increased with age, whereas coronary artery disease was more prevalent in the youngest-old group. HF GDMT pillars use declined with increasing age, particularly for renin–angiotensin system inhibitors and SGLT2 inhibitors, while beta-blocker use remained consistently high. At 6 months, 50% of the oldest-old achieved three GDMT pillars, although fewer achieved four compared with younger groups. LVEF improved in all age groups, most notably in the youngest-old. NYHA functional class improvement was greater in younger patients. Mortality at 6 months was numerically higher in the youngest-old (16.0%), while HF readmission was slightly higher in the oldest-old (12.5%), without statistical significance. In multivariable analyses, age, comorbidities, and LVEF were not independent predictors of outcomes.

Conclusion

Older adults with HF demonstrated consistent structural and functional improvement across age groups despite differences in GDMT use. Outcome variation was not independently explained by age or comorbidity burden, suggesting that disease phenotype and physiological reserve may play a greater role. These findings provide real-world evidence from a multiethnic Asian population and support individualized, multidisciplinary care strategies for older adults with HF.