Medical Therapy No Help

March 11, 2011 by admin  
Filed under Western Treatment

Patients in their 80s appeared to get no benefit from commonly used cardiac drugs when they have heart failure with preserved ejection fraction, data from a small retrospective study suggest. Action Points

Explain to patients that this study found no benefits from medical treatment of patients older than 80 with heart failure and preserved ejection fraction.

Note that the findings were based on a retrospective subgroup analysis of a larger study and involved a relatively small number of patients, which may have limited the ability to identify significant differences.
Antihypertensives, vasodilators, and statins all failed to make an impact on survival during five years of follow-up, Ernst R. Schwarz, M.D., Ph.D., of Cedars-Sinai Medical Center here, and colleagues reported online in the American Journal of Cardiology.

In fact, the only significant difference in medication use between patients who died and those who survived five years went in the wrong direction.

“The benefits of statins and other common cardiac medications in patients older than 80 with heart failure and preserved left ventricular ejection fraction should be vigorously and specifically studied in this patient population with the intention of showing both a validated therapy and insights into novel mechanisms of disease and disease modification,” the authors concluded.

The American College of Cardiology/American Heart Association guidelines for management of chronic heart failure emphasize treatment of hypertension, atrial fibrillation, and clinical symptoms in patients with preserved ejection fraction.

Medication classes suggested in the guidelines include beta-blockers, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, and diuretics, the authors noted. Statins also have been studied in patients with heart failure and preserved ejection fraction.

However, the benefits of these commonly used medications in heart failure patients older than 80 had not been established, the authors said.

To examine the issue, they performed a subgroup analysis of a larger study involving patients of any age with heart failure and preserved ejection fraction.

The authors identified 142 study participants who were older than 80. Complete records were available for medical history and medication use.

During the five years of follow-up, 98 patients (69%) died. The authors could identify no significant differences between survivors and those who died.

Comparison of patients who died or survived revealed no statistically significant impact on survival from use of:

  • ACE inhibitors or ARBs, P=0.912
  • Beta-blockers, P=0.891
  • Calcium-channel blockers, P=0.690
  • Diuretics, P=0.303
  • Digoxin, P=0.233
  • Statins, P=0.321

“Furthermore, no medication use showed a decrease in adjusted all-cause or cardiac rehospitalization,” the authors said.

“However,” they noted, “patients using calcium-channel blockers had a statistically significant increase in annual cardiac rehospitalization.”

Also noting an increased risk of adverse drug effects in older patients, the authors called for more judicious use of medications in that patient population.

“There was no proven benefit for pharmacologic therapy, and yet there were costs, both financial and physiologic,” the authors said. “Despite the lack of proven benefit, there was still moderate use of many common cardiovascular medications in this patient population.”

The authors noted that “the present study was limited by its small retrospective nature. The limited sample size of this pilot study led to a lack of statistical signiļ¬cance in multiple trends in mortality with various medications.”

They also noted that effects of different agents within drug class and different dosages of different agents were not assessed.

The authors reported no disclosures.

By Charles Bankhead, Staff Writer, MedPage Today

Published: March 13, 2009
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine.

Primary source: American Journal of Cardiology
Source reference:
Tehrani F, et al “Value of medical therapy in patients >80 years of age with heart failure and preserved ejection fraction” Am J Cardiol 2009; epub.

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