セキグチ　ハルキ   SEKIGUCHI Haruki   関口　治樹    所属   医学部 医学科（東京女子医科大学病院）    職種   准教授
言語種別	英語
発表タイトル	Differences by Age in Efficacy of Guidelinerecommended Medication on Long-term Outcomes in Patients with Acute Heart Failure
会議名	The 83rd Annual Scientific Meeting of the Japanese Circulation Society (JCS2019)
主催者	Japanese Circulation Society
学会区分	全国規模の学会
発表形式	口頭
講演区分	一般
発表者・共同発表者	◎ABE Takuro, JUJO Kentaro, MINAMI Yuichiro, KAMETANI Motoko, YOSHIKAWA Masafumi, MIZOBUCHI Keiko, ISHIDA Issei, AKASHI Madoka, TANAKA Kazuki, HARUKI Shintaro, SEKIGUCHI Haruki, HAGIWARA Nobuhisa
発表年月日	2019/03/30
開催地 （都市, 国名）	Yokohama, JAPAN
概要	*Oral Presentation (English) 23 Heart Failure (Pharmacology) Introduction: Octogenarian acute heart failure (AHF) patients with reduced left ventricular ejection fraction (LVEF) are commonly encountered in clinical practice; however, the prognostic impact of guideline-recommended medical therapy (GRMT) in this population is yet to be validated. Hypothesis: We hypothesized that GRMT including beta-blocker (BB), angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker (ACEi/ARB), and mineralocorticoid-receptor antagonist (MRA) exerted different therapeutic effects by age.Methods: This study initially included 1,286 consecutive AHF patients who were urgently hospitalized and discharged alive. After the exclusion of patients with regular hemodialysis and with preserved LVEF (>50%), 226 patients ≥80 years (Older group) and 598 patients < 80 years (Younger group) with reduced LVEF were ultimately analyzed. The primary endpoint was any death.Results: Kaplan-Meier analysis in the Older group showed patients with MRA at discharge had a significant lower mortality than those without (Log-rank test, p=0.030); however, BB or ACEi/ARB did not affect it. Conversely, in the Younger group, patients with BB or ACEi/ARB had a significant lower mortality than those without (p<0.001, p=0.015, respectively); however, patients with MRA did not show a significant better outcome than those without (p=0.06). Even after the adjustment with multiple covariants, BB and ACEi/ARB were associated with lower mortality in the Younger group (HR: 0.19 [95% CI: 0.08-0.45]; HR: 0.36 [95%CI: 0.15-0.90], respectively). However, in the Older group, MRA did not retain the significance in all-cause mortality.Conclusion: In AHF patients with reduced LVEF, patients <80 years who received BB and/or ACEi/ARB had better outcomes than those without. However, GRMT did not affect mortality in patients ≥80 years.