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Adherence to Guideline-Directed Medical Therapy in Hospitalized Older People with Heart Failure at Discharge and

Renee C M A Raijmann1,2, Melanie Haverkamp1, Manon G van der Meer3

  • 1Department of Geriatrics, UMC Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands.

Journal of Clinical Medicine
|October 16, 2025
PubMed

Insights

Adherence to guideline-directed medical therapy (GDMT) for heart failure in older adults is low. Physicians must individualize treatment, balancing guidelines with patient-specific factors like life expectancy and care goals.

Area of Science:

  • Cardiology
  • Geriatrics
  • Pharmacology

Background:

  • Heart failure is a major cause of hospitalization in older adults.
  • Guideline-directed medical therapy (GDMT) improves outcomes but is difficult to implement in this population.
  • The 2021 ESC heart failure guideline provides recommendations for managing heart failure.

Purpose of the Study:

  • To evaluate adherence to the 2021 ESC heart failure guideline in older patients (70+ years).
  • To explore reasons for deviations from GDMT in this demographic.
  • To analyze factors associated with GDMT non-adherence.

Main Methods:

  • Retrospective cohort study of 60 patients (≥70 years) with decompensated heart failure (ejection fraction <50%).
  • Data collected at discharge and 3 months post-discharge on GDMT use, dosage, and reasons for deviations.
  • Analysis of associations between GDMT adherence and age, frailty, comorbidities, and admission specialty.

Main Results:

  • Only 15% of patients received all four GDMT drugs at discharge, increasing to 26% at follow-up; only 3% achieved target doses.
  • Older patients (>80 years) received GDMT less frequently at discharge (4% vs. 26%, p=0.03), though this normalized at follow-up.
  • Common reasons for non-adherence included adverse effects, contraindications, reduced life expectancy, and treatment postponement.

Conclusions:

  • Adherence to GDMT in older heart failure patients is suboptimal.
  • Physicians need to carefully weigh guideline recommendations against individual patient factors, including life expectancy and personal care objectives.
  • Individualized care is crucial for optimizing heart failure management in the elderly.

Keywords:
agedguideline directed medical therapyheart failureoptimal drug dosage

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