Influence of Age on the Management of Heart Failure: Findings from Get With the Guidelines-HF

1. Influence of Age on the Management of Heart Failure: Findings from Get With the Guidelines-HF DE Forman, CP Cannon, AF Hernandez, L Liang, CW Yancy, GC Fonarow Brigham and Women’s Hospital, Boston, MA Background Components Measures General Patterns of Management in Relation to Age • 57,937 admissions from 1/05-4/07 from 257 hospitals participating in the AHA’s Get With the Guidelines-HF Program. • Patient characteristics and management collected at admission and discharge, and stratified by age. • Prespecified GWTG performance and quality indices. • GWTG indices: (a) Performance; (b) Quality; (c) composite scores: • opportunity composite measure: # therapeutic interventions/circumstances interventions indicated • defect-free composite measure: 100% of evidence-based therapy for the 5 standardized GWTG-HF measures that were indicated • Admission medications, In-hospital procedures • LOS, in-hospital death Hospital Procedures Meds at Admission 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. 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. 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. Methods GWTG Quality of Care Performance Measures Univariate analysis shows age-related declines in therapy. Multivariate regression analyses shows persistent age effects on treatment and mortality even after accounting for confounding variables. Conclusions • Assessment of HF patients at admission, during the course of HF hospitalizations, and at discharge. • Documented contraindications or intolerance were used to exclude ineligible patients as determined by providers, facilitating analysis of only eligible HF patients. • Multivariable regression analysis used to assess the influence of age on therapeutic decisions and in-hospital mortality, independent of common confounders • Generalized Estimating Equations (GEE) method employed to account for within-hospital clustering. • 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 characteristics. • 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. Mortality and LOS 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 DISCLOSURE INFORMATION The following relationships exist related to this presentation: GWTG-HF is an American Heart Association Program sponsored program supported in part by GlaxoSmithKline