Adherence to Guideline-Directed Medical Therapy in Hospitalized Older People with Heart Failure at Discharge and 3-Month Follow-Up

Objectives: Heart failure is one of the leading causes of hospitalization in older adults. Guideline-directed medical therapy (GDMT) reduces the risk of decompensation and hospitalization, though it is challenging to implement GDMT in this group. Therefore, this study evaluated adherence to the 2021 ESC heart failure guideline in older patients and explored reasons for guideline deviations. Methods: A retrospective cohort study was performed in older patients (70+ years) with decompensated heart failure (ejection fraction < 50%) admitted to the cardiology or geriatrics department at a tertiary hospital (May 2022-September 2023). Data on GDMT-drug use, dosage, and reasons for guideline deviations were collected at discharge and three months post-discharge. Additionally, associations between GDMT non-adherence and factors such as age, frailty, comorbidities, and admission specialty were analyzed. Results: A total of 60 patients were included (mean age 79 years, 40% women, median EF 34%). The four GDMT drugs were prescribed to 15% of patients at discharge and 26% at follow-up, and 3% of the patients received the target dose for all drugs. Older patients (>80 years) received GDMT less frequently at discharge compared to younger patients (4% vs. 26%, p = 0.03). Though this difference was resolved at follow-up. The other studied factors were not significantly associated with GDMT adherence. Common reasons for guideline deviations were adverse effects, contraindications, reduced life expectancy, and postponed treatment. Conclusions: Adherence to GDMT in older heart failure patients is low due to several reasons, such as relevant contraindications. Physicians should carefully balance the risks and benefits of the guideline versus individual benefit, considering life expectancy and individual care goals.