所属 医学部 医学科（東京女子医科大学病院） 職種 講師
|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|
|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|
|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.