Background: Data from the German hospital report 2019 show that in 2017 heart failure (HF) (I50, ICD-10) was the most common diagnosis among inpatients. Prevalence of HF increases with age. In 2021 around 24% of inpatients at the Geriatric Department of University Medical Center of the Johannes Gutenberg University Mainz had HF, 13% with symptoms under mild or severe strain (ICD I50.12 + I50.13). It is assumed that geriatric patients are more likely to receive treatment that does not conform to the guidelines because of frequent comorbidities such as chronic renal disease and pre-existing polypharmacy.

Methods: Data of the MyoVasc study (N=3,289), a prospective cohort study on chronic HF (NCT04064450), were analyzed. Participants underwent a 5 hour highly standardized examination at a dedicated study center including assessment of medication with subsequent categorization according to the anatomical therapeutic chemical (ATC) coding system. Study participants were categorized as geriatric patients aged ≥ 70 years and subsequently compared to non-geriatric patients regarding frequency of medication intake. Poisson regression with robust standard errors with adjustment for age, sex, cardiovascular risk factors, co-morbidities and kidney function was used to analyze the frequency of medication intake by geriatric status in subjects with HF stages C/D.

Results: The analysis sample comprised 1281 geriatric (mean age: 75.4±3.6 years) and 2008 non-geriatric patients (mean age: 57.7±8.5 years). A total of 68,5% (n=878) of the geriatric patients presented with HF stage C/D, compared to 43% (n=863) in non-geriatric patients. On average, geriatric patients took 6.53 (standard deviation (SD) ±3.14) drugs as compared to non-geriatric subjects taking 4.65 (SD ±3.45) drugs, regardless of the severity of HF. Regression analysis demonstrated that geriatric patients receive aldosterone antagonists less frequently (PR: 0.64, 95%CI 0.54; 0.77, p<0.0001). This effect persisted even after additional adjustment for kidney function (PR: 0.53, 95%CI 0.44; 0.63, p<0.0001). Beta-blockers, on the other hand, were used far less in geriatric patients as compared to non-geriatric individuals (PR: 0.93, 95%CI 0.88; 0.99, p=0.016). In contrast, calcium channel blockers were taken significantly more frequently in the group of geriatric patients (PR: 1.22, 95%CI 1.01; 1.48, p=0.035). In contrast, geriatric patients with impaired renal function received fewer loop diuretics (PR: 0.88, 95%CI 0.78; 0.99, p=0.033).

Conclusion: In the present study, a difference in medication of HF patients could be shown. This effect persisted even after adaptation to renal function. The data indicates a potential underuse of guideline-base medical therapy for HF in geriatric patients suffering from HF.