An Observational Study of Evidence-Based Therapies in Older Patients with Heart Failure with Reduced Ejection Fraction: Insights from a Dedicated Heart Failure Clinic

Background/Objectives: Despite significant advances in the management of heart failure with reduced ejection fraction (HFrEF), data concerning older patients remain limited. The purpose of this study was to evaluate the implementation of guideline-directed medical therapy (GDMT) in older patients with HFrEF along with cardiac events and variation in clinical and echocardiographic parameters during follow-up in a heart failure (HF) clinic. Methods: We conducted a retrospective observational analysis of patients with HFrEF aged ≥ 80 years who attended an HF clinic between March 2022 and February 2023. The primary outcome was a composite of the first episode of worsening HF or cardiovascular death. All-cause death was also recorded. Results: We included 110 patients (30.9% females; mean age 82.9 years). After a median follow-up of 25.5 months, left ventricular ejection fraction (LVEF) improved (mean difference 12.5% (p < 0.001)). New York Heart Association class improved in 37% of patients, and N-terminal pro-B-type natriuretic peptide levels decreased (3091 (158-53354) to 1802 (145-19509), p < 0.001). The primary outcome occurred in 34 patients (30.9%). Patients without the primary outcome were more likely to receive sodium-glucose co-transporter-2 inhibitors (SGLT2i) (23.5% versus 67.1%, p < 0.001) and angiotensin receptor-neprilysin inhibitors, angiotensin-converting enzyme inhibitors, or angiotensin-receptor blockers (67.6% versus 84.2%, p < 0.05). These patients also received a greater number of GDMT medications (2 (0-4) versus 3 (1-4), p < 0.01) and demonstrated a higher LVEF at the last visit (41.2 ± 10.2% versus 47.1 ± 9.4%, p < 0.05). Survival analysis demonstrated a significant association between LVEF recovery (hazard ratio (HR) 0.35, p < 0.01), treatment with two or more GDMT medications (HR 0.29, p < 0.01), vasodilator use (HR 0.36, p < 0.01), and SGLT2i prescription (HR 0.17, p < 0.001) and a reduced risk of the primary endpoint. Conclusions: The optimization of HF treatment is achievable in older patients and may be associated with a reduction in cardiac events.