Age-dependent association of discharge heart-failure medications with clinical outcomes in a super-aged society
Aims: Real-world evidence about heart failure (HF) medical care for elderly patients is limited. The aim of this study was to clarify the age-dependent associations of HF medications at discharge with clinical outcomes in a super-aged society using a real-world big database. Methods and results: Pat...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-11-01
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| Series: | Biomedicine & Pharmacotherapy |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0753332222011507 |
| _version_ | 1798030942783143936 |
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| author | Michikazu Nakai Yoshitaka Iwanaga Koshiro Kanaoka Yoko Sumita Yuichi Nishioka Tomoya Myojin Shinichiro Kubo Katsuki Okada Tsunenari Soeda Tatsuya Noda Yasushi Sakata Tomoaki Imamura Yoshihiko Saito Satoshi Yasuda Yoshihiro Miyamoto |
| author_facet | Michikazu Nakai Yoshitaka Iwanaga Koshiro Kanaoka Yoko Sumita Yuichi Nishioka Tomoya Myojin Shinichiro Kubo Katsuki Okada Tsunenari Soeda Tatsuya Noda Yasushi Sakata Tomoaki Imamura Yoshihiko Saito Satoshi Yasuda Yoshihiro Miyamoto |
| author_sort | Michikazu Nakai |
| collection | DOAJ |
| description | Aims: Real-world evidence about heart failure (HF) medical care for elderly patients is limited. The aim of this study was to clarify the age-dependent associations of HF medications at discharge with clinical outcomes in a super-aged society using a real-world big database. Methods and results: Patients hospitalized with a first episode of acute HF in 2013–2019 were identified in a nationwide claims database in Japan and were analyzed based on the HF medications at discharge. Hazard ratios (HRs) and 95 % confidence intervals (95 % CIs) for clinical outcomes were calculated after adjustment. Among 325,468 patients from 4351 hospitals, 130,230 (40.0 %) were aged ≥ 85 years. All-cause mortality and HF readmission rate within 1 year were 14 % and 23 %, respectively. β-Blockers and angiotensin-converting-enzyme inhibitors or angiotensin II receptor blockers (ACEI/ARB) uses were associated with lower mortality (HR [95 %CI]: 0.84 [0.83,0.86] and 0.73 [0.71,0.74], respectively) and HF readmission (0.98 [0.97,0.99] and 0.89 [0.88,0.90], respectively). The associations were attenuated as the age increased and, in β-blockers use, the favorable associations with mortality and HF readmission were not observed in patients with ≥ 95 years and ≥ 80 years, respectively. In contrast, mineralocorticoid receptor antagonists (MRA) use was associated only with lower HF readmission (0.83 [0.82,0.84]), which was not attenuated with increased age. Conclusions: The favorable associations of β-blockers and ACEI/ARB uses with mortality and HF readmission were age-dependently attenuated in patients across a broad spectrum of HF in a super-aged society. In contrast, positive impact of MRA use on HF readmission was not attenuated with aging. |
| first_indexed | 2024-04-11T19:49:26Z |
| format | Article |
| id | doaj.art-8db918d800f64bf28e09a69a59576a88 |
| institution | Directory Open Access Journal |
| issn | 0753-3322 |
| language | English |
| last_indexed | 2024-04-11T19:49:26Z |
| publishDate | 2022-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Biomedicine & Pharmacotherapy |
| spelling | doaj.art-8db918d800f64bf28e09a69a59576a882022-12-22T04:06:22ZengElsevierBiomedicine & Pharmacotherapy0753-33222022-11-01155113761Age-dependent association of discharge heart-failure medications with clinical outcomes in a super-aged societyMichikazu Nakai0Yoshitaka Iwanaga1Koshiro Kanaoka2Yoko Sumita3Yuichi Nishioka4Tomoya Myojin5Shinichiro Kubo6Katsuki Okada7Tsunenari Soeda8Tatsuya Noda9Yasushi Sakata10Tomoaki Imamura11Yoshihiko Saito12Satoshi Yasuda13Yoshihiro Miyamoto14Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Japan; Department of Biostatistics, National Cerebral and Cardiovascular Center, JapanDepartment of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Japan; Correspondence to: Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, 6-1 Kishibeshimmachi, Suita, Osaka 564-8565, Japan.Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, JapanDepartment of Medical and Health Information Management, National Cerebral and Cardiovascular Center, JapanDepartment of Public Health, Health Management and Policy, Nara Medical University, JapanDepartment of Public Health, Health Management and Policy, Nara Medical University, JapanDepartment of Public Health, Health Management and Policy, Nara Medical University, JapanDepartment of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Japan; Department of Transformative System for Medical Information, Osaka University Graduate School of Medicine, JapanDepartment of Cardiovascular Medicine, Nara Medical University, JapanDepartment of Public Health, Health Management and Policy, Nara Medical University, JapanDepartment of Cardiovascular Medicine, Osaka University Graduate School of Medicine, JapanDepartment of Public Health, Health Management and Policy, Nara Medical University, JapanDepartment of Cardiovascular Medicine, Nara Medical University, JapanDepartment of Cardiovascular Medicine, Tohoku University Hospital, Tohoku University Graduate School of Medicine, JapanOpen Innovation Center, National Cerebral and Cardiovascular Center, JapanAims: Real-world evidence about heart failure (HF) medical care for elderly patients is limited. The aim of this study was to clarify the age-dependent associations of HF medications at discharge with clinical outcomes in a super-aged society using a real-world big database. Methods and results: Patients hospitalized with a first episode of acute HF in 2013–2019 were identified in a nationwide claims database in Japan and were analyzed based on the HF medications at discharge. Hazard ratios (HRs) and 95 % confidence intervals (95 % CIs) for clinical outcomes were calculated after adjustment. Among 325,468 patients from 4351 hospitals, 130,230 (40.0 %) were aged ≥ 85 years. All-cause mortality and HF readmission rate within 1 year were 14 % and 23 %, respectively. β-Blockers and angiotensin-converting-enzyme inhibitors or angiotensin II receptor blockers (ACEI/ARB) uses were associated with lower mortality (HR [95 %CI]: 0.84 [0.83,0.86] and 0.73 [0.71,0.74], respectively) and HF readmission (0.98 [0.97,0.99] and 0.89 [0.88,0.90], respectively). The associations were attenuated as the age increased and, in β-blockers use, the favorable associations with mortality and HF readmission were not observed in patients with ≥ 95 years and ≥ 80 years, respectively. In contrast, mineralocorticoid receptor antagonists (MRA) use was associated only with lower HF readmission (0.83 [0.82,0.84]), which was not attenuated with increased age. Conclusions: The favorable associations of β-blockers and ACEI/ARB uses with mortality and HF readmission were age-dependently attenuated in patients across a broad spectrum of HF in a super-aged society. In contrast, positive impact of MRA use on HF readmission was not attenuated with aging.http://www.sciencedirect.com/science/article/pii/S0753332222011507AgeHeart failure medicationNationwide claims database1-year prognosisSuper-aged society |
| spellingShingle | Michikazu Nakai Yoshitaka Iwanaga Koshiro Kanaoka Yoko Sumita Yuichi Nishioka Tomoya Myojin Shinichiro Kubo Katsuki Okada Tsunenari Soeda Tatsuya Noda Yasushi Sakata Tomoaki Imamura Yoshihiko Saito Satoshi Yasuda Yoshihiro Miyamoto Age-dependent association of discharge heart-failure medications with clinical outcomes in a super-aged society Biomedicine & Pharmacotherapy Age Heart failure medication Nationwide claims database 1-year prognosis Super-aged society |
| title | Age-dependent association of discharge heart-failure medications with clinical outcomes in a super-aged society |
| title_full | Age-dependent association of discharge heart-failure medications with clinical outcomes in a super-aged society |
| title_fullStr | Age-dependent association of discharge heart-failure medications with clinical outcomes in a super-aged society |
| title_full_unstemmed | Age-dependent association of discharge heart-failure medications with clinical outcomes in a super-aged society |
| title_short | Age-dependent association of discharge heart-failure medications with clinical outcomes in a super-aged society |
| title_sort | age dependent association of discharge heart failure medications with clinical outcomes in a super aged society |
| topic | Age Heart failure medication Nationwide claims database 1-year prognosis Super-aged society |
| url | http://www.sciencedirect.com/science/article/pii/S0753332222011507 |
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