Real-World Data on Post-Discharge Prognosis of Elderly and Frail Hospitalized Patients with Heart Failure Reflecting the Latest Guideline-Directed Medical Therapy in Japan

Abstract

The West Tokyo Heart Failure (WET-HF) registry has recently reported that the post-discharge prognosis for hospitalized patients with heart failure (HF) between 2011 and 2021 has been improving over time and that there has been an upward trend in the use of guideline-directed medical therapy (GDMT). However, there are few post-discharge prognostic data for elderly and frail hospitalized patients with HF. A total of 738 consecutive patients with HF hospitalized at the Konan Medical Center between April 2020 and March 2024 were retrospectively studied. The primary endpoint was cardiovascular death or HF hospitalization. The mean age and clinical frailty scale were 83.4 ± 11.0 years and 4.8 ± 2.3, respectively. The average prescription rates of GDMT at discharge over the 4-year period were 71.0% for beta-blockers, 23.4% for angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB), 42.7% for angiotensin receptor neprilysin inhibitor (ARNI), 56.1% for mineralocorticoid receptor antagonists (MRA), and 23.2% for sodium-glucose cotransporter 2 (SGLT2) inhibitors. Although, there has been an upward trend in the use of GDMT, the Kaplan-Meier curve showed no improvement in prognosis over time. Multivariate analyses showed that none of the beta-blockers, ACE-I, ARB, ARNI, MRA, or SGLT2-inhibitors at discharge reduced the primary endpoint for hospitalized patients with HF. GDMT alone may not be sufficient to improve the prognosis of elderly and frail hospitalized patients with HF. In addition to GDMT, comprehensive management by a multidisciplinary team may be vital, since currently there seems to be no one-size-fits-all approach for these patients.