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Influence of Age on the Management of Heart Failure: Findings from Get With the Guidelines-HF 40 DE Forman, CP Cannon, AF Hernandez, L Liang, CW Yancy, GC Fonarow Brigham and Women’s Hospital, Boston, MA 30 20 10 Background Warfari Lipid Low Rx ASA Nitrates evidence-based therapy for the 5 standardized GWTG-HF measures that were indicated • Admission medications, In-hospital procedures 6 20 3 2 10 1 0 <0.0001 Discharged on Beta Blocker with LVSD (%) 88.8 Discharge Instructions (%) 77.1 77.5 77.8 76.6 75.9 0.0063 Smoking Cessation Counseling (%) 87.1 88.7 86.3 84.0 74.4 <0.0001 90.9 88.4 88.0 82.7 <0.0001 Composite Performance Measure 84.7 (26.7) 85.7 (24.5) 85.0 (25.7) 84.8 (27.0) 82.7 (30.6) 0.2201 69.1 67.2 68.1 70.3 71.0 <0.0001 3.3 1.6 3.1 3.8 5.3 LOS •Median 5.0 Days 5.0 5.0 5.0 5.0 Pt Died (%) <.0001 Limitations • Data from medical chart review • Voluntary participation in GWTG so may not be generalizable • No socioeconomic assessment component • Lack of post-discharge follow-up data Dialysis 79.0 p Value R Hrt Cath 81.8 Age >85 Conclusions Age 76-85 IABP 84.3 Age76-85 Age 66-75 ICD 88.6 Age 66-77 Age<=65 Pacemaker 84.7 Age < 65 Bi-Pace Discharged on ACE or ARB with LVSD (%) Tot Pop CABG • Multivariable regression analysis used to assess the influence of age on therapeutic decisions and in-hospital mortality, independent of common confounders Mortality and LOS PCI <0.0001 Univariate analysis shows age-related declines in therapy. Multivariate regression analyses shows Age>85 66-77 Age persistent ageAge<=65 effects onAge treatment and 76-85 mortality even after accounting for confounding variables. 0 Cath 89.4 Warfarin 92.8 Lipid Low Rx 93.1 ASA 93.8 Nitrates p Value Diuretic Age>85 N=10,860 4 Digoxin Age-76-85 N= 18,398 5 Aldos Block Age 66-77 N=12,488 30 ARB Age < 65 N=16245 Age<=65 Age 66-75 Age 76-85 Age>85 7 40 defect-free composite measure: 100% of 92.6 Composite Performance Measure for 100% Compliance (%) Diuretic Documentation of LV function (%) during the HF hospitalization Composite Performance Measure [Mean % (SD)] 50 therapeutic interventions/circumstances interventions indicated Selected GWTG Performance and Quality Measures • Variables in the model included gender, race, admission BMI, admission BP, anemia, CVA/TIA, diabetes, HTN, hyperlipidemia, atrial fibrillation/flutter, PVD, CRI, depression, smoking, HF etiology, insurance, and hospital DISCLOSURE INFORMATION The following relationships exist related to this presentation: characteristics. GWTG-HF is an American Heart Association Program sponsored program supported in part by GlaxoSmithKline 9 opportunity composite measure: # • Documented contraindications or intolerance were used to exclude ineligible patients as determined by providers, facilitating analysis of only eligible HF patients. • Generalized Estimating Equations (GEE) method employed to account for within-hospital clustering. Digoxin GWTG Quality of Care Performance Measures Total Population N=57,937 Hospital Procedures Meds at Admission 8 • LOS, in-hospital death • Assessment of HF patients at admission, during the course of HF hospitalizations, and at discharge. 10 ACE Inhib Methods • GWTG indices: (a) Performance; (b) Quality; (c) composite scores: •Patient characteristics and management collected at admission and discharge, and stratified by age. •Prespecified GWTG performance and quality indices. 60 Aldos Block The objectives of this study are to assess the characteristics, treatment, quality of care, and outcomes for patients hospitalized with HF as a function of patient age. •57,937 admissions from 1/05-4/07 from 257 hospitals participating in the AHA’s Get With the Guidelines-HF Program. General Patterns of Management in Relation to Age 0 ARB While patient complexities relating to age may sometimes steer decisions to omit specific guidelines-based therapies, in other instances omissions may constitute deficiencies of care. Measures ACE Inhib Heart failure (HF) in older adults is associated with high morbidity and mortality. Underutilization of evidence-based medications for older adults has been reported previously. Components Age>85 •Older age is associated with lower rates of guideline recommended therapies even when confounders and contraindications are considered. •However, compared to prior studies, rates of evidence-based therapies are now higher in the very old in GWTG-HF hospitals. •Rising use of evidence-based therapy suggests there may be fundamental changes in caregiver attitudes regarding importance and efficacy of guidelines recommended therapy for older HF patients. - GWTG-HF may have catalyzed greater utilization of evidence-based treatments, even for those very old and with many comorbidites.