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Relationship Between Medical Therapy, Long-Term Care Insurance, and Comorbidity in Elderly Patients With Heart

Mayumi Kase1, Shinya Fujiki1, Takeshi Kashimura1

  • 1Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences.

Circulation Journal : Official Journal of the Japanese Circulation Society
|March 17, 2023
PubMed

Insights

Guideline-directed medical therapy (GDMT) is underutilized in elderly heart failure patients, especially those with long-term care insurance (LTCI). LTCI certification is linked to lower GDMT prescription rates, highlighting care disparities.

Area of Science:

  • Cardiology
  • Geriatrics
  • Pharmacology

Background:

  • Guideline-directed medical therapy (GDMT) improves outcomes in heart failure with reduced (HFrEF) and mildly reduced (HFmrEF) ejection fraction.
  • Despite proven benefits, GDMT is often inadequately prescribed to patients with HFrEF and HFmrEF.
  • Elderly patients with HFrEF/HFmrEF and frailty (indicated by long-term care insurance certification) may face unique treatment challenges.

Purpose of the Study:

  • To investigate GDMT prescription patterns in elderly patients with HFrEF and HFmrEF.
  • To examine the association between long-term care insurance (LTCI) certification and GDMT use in this population.
  • To identify characteristics of elderly heart failure patients with LTCI certification.

Main Methods:

  • Retrospective cross-sectional study of 1,296 elderly patients with symptomatic HFrEF/HFmrEF using diuretics.
  • Analysis of prescription rates for beta-blockers, ACE inhibitors (ACEi)/angiotensin receptor blockers (ARBs), and mineralocorticoid receptor antagonists (MRAs).
  • Assessment of the independent association between LTCI certification and GDMT prescription, controlling for other factors.

Main Results:

  • GDMT prescription rates were suboptimal: ACEi/ARBs (27.0%/30.1%), beta-blockers (54.1%), and MRAs (41.9%).
  • LTCI certification was significantly associated with reduced prescription of ACEi/ARBs (OR 0.591), beta-blockers (OR 0.698), and MRAs (OR 0.743).
  • Patients with LTCI certification exhibited high rates of polypharmacy and diuretic use.

Conclusions:

  • Vulnerable elderly patients with LTCI certification represent a significant barrier to implementing GDMT.
  • Improved communication and tailored care strategies are essential for optimizing heart failure management in frail elderly patients.
  • Addressing disparities in GDMT prescription is crucial for improving outcomes in this population.
Abstract

Keywords:
ComorbidityDisease managementHeart failureLong-term care insurancePolypharmacy

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