Meta-Analysis Comparing Neurohumoral Antagonist Use in Patients ≥75 Years Versus <75 Years Receiving Cardiac
Ahmed AlTurki1, Riccardo Proietti2, Hasan Alturki3
1Division of Cardiology, McGill University Health Center, Quebec, Canada.
Insights
Older adults (≥75 years) receiving cardiac resynchronization therapy (CRT) are less likely to use essential neurohumoral antagonists. This study highlights potential underuse of these heart failure medications in the elderly population undergoing CRT.
Area of Science:
- Cardiology
- Geriatric Medicine
- Pharmacology
Background:
- Neurohumoral antagonists are crucial for managing heart failure with reduced ejection fraction.
- Cardiac resynchronization therapy (CRT) improves outcomes in eligible heart failure patients.
- The use of these therapies in elderly patients (≥75 years) requires specific evaluation.
Purpose of the Study:
- To compare the utilization of neurohumoral antagonists in patients aged ≥75 years versus those <75 years undergoing CRT.
- To identify potential disparities in guideline-directed medical therapy for older adults receiving CRT.
Main Methods:
- A systematic review and meta-analysis of studies published up to December 20, 2016.
- Inclusion of 12 studies (1 randomized trial, 11 observational) with 5,728 patients ≥75 years and 9,549 patients <75 years.
- Analysis of medication use, including angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), mineralocorticoid receptor antagonists (MRAs), and beta-blockers.
Main Results:
- Significantly lower use of ACEIs/ARBs in patients ≥75 years (OR 0.59, p<0.0001) and MRAs (OR 0.48, p<0.0001) compared to younger patients.
- Beta-blocker use was nonsignificantly lower in the older group (OR 0.70, p=0.07).
- Overall, neurohumoral antagonist use was lower in elderly patients receiving CRT.
Conclusions:
- Neurohumoral antagonists are underutilized in patients ≥75 years undergoing CRT.
- Increased consideration for neurohumoral antagonism is warranted in elderly patients referred for CRT.
- Optimizing medical therapy in older heart failure patients receiving CRT is essential for improved outcomes.
Abstract:
Neurohumoral antagonists are the foundation of heart failure therapy in patients with reduced left ventricular ejection fraction. Cardiac resynchronization therapy (CRT) has also been associated with improved outcomes in these patients. We aimed to evaluate the use of neurohumoral antagonists in patients ≥75 years compared with <75 years of age receiving CRT. We searched electronic databases, up to December 20, 2016 for all studies reporting medication use in patients ≥75 years and <75 years of age who received CRT. We used random-effects meta-analysis models to summarize the studies. We retained 12 studies (1 randomized trial and 11 observational studies) enrolling 5,728 ≥75 years old and 9,549 patients of <75 years old. There were lower use of angiotensin converting enzyme inhibitors or angiotensin receptor blockers in patients ≥75 years compared with patients <75 years (odds ratio [OR] 0.59, 95% confidence interval [CI] 0.47 to 0.74, p < 0.0001). In addition, there were lower use of mineralocorticoid receptor antagonists in patients ≥75 years compared with patients <75 years (OR 0.48, 95% CI 0.40 to 0.57, p < 0.0001). The use of β blockers was nonsignificantly lower in patients ≥75 years compared with patients <75 years (OR 0.70, 95% CI 0.47 to 1.03, p = 0.07). In conclusion, neurohumoral antagonists appeared to be underused in patients ≥75 years compared with patients <75 years receiving CRT. Consideration should be given to increase neurohumoral antagonism in patients ≥75 years referred for CRT.
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