European Heart Journal Advance Access published online on December 23, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn539
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Contemporary management of octogenarians hospitalized for heart failure in Europe: Euro Heart Failure Survey II
1 AP-HP, Department of Cardiology, Pitie Salpetriere Hospital, University Pierre et Marie Curie-Paris 6, 47/83, boulevard de l’Hôpital, Paris 75013, France
2 AP-HP, Department of Geriatrics, Broca Hospital, University Paris-Descartes-Paris 5, Paris, France
3 Stiftung Institut für Herzinfarktforschung an der Universität Heidelberg, Ludwigshafen am Rhein, Germany
4 Department of Cardiology, University Hospital La Paz, Paseo de la Castellana, 261 Madrid, Spain
5 Department of Cardiology, University Hospital, Zurich, Switzerland
6 Klinika Kardiologi, Wojskowy Szpital Kliniczny z Poliklinika, Wroclaw, Poland
7 Department of Medicine, University Hospital, Helsinki, Finland
8 Zentrum Innere Medizin Med. Hochschule, Hannover, Germany
9 Cardiology Division, Stavanger University Hospital, University of Bergen 4011, Stavanger, Norway
10 Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
Received 27 May 2008; revised 3 November 2008; accepted 6 November 2008.
* Corresponding author. Tel: +33 1 42 16 30 03, Fax: +33 1 42 16 30 20, Email: michel.komajda{at}psl.aphp.fr
Aims: International guidelines are frequently not implemented in the elderly population with heart failure (HF). This study determined the management of octogenarians with HF enrolled in Euro Heart Failure Survey II (EHFS II) (2004–05).
Methods and results: We compared the clinical profile, 12 month outcomes, and management modalities between 741 octogenarians (median age 83.7 years) and 2836 younger patients (median age 68.4 years) hospitalized for acute/decompensated HF. Management modalities were also compared with those observed in EHFS I (2000–01). Female gender, new onset HF (de novo), hypertension, atrial fibrillation, co-morbidities, disabilities, and low quality of life were more common in the elderly (all P < 0.001). Mortality rates during hospital stay and during 12 months after discharge were increased in octogenarians (10.7 vs. 5.6% and 28.4 vs. 18.5%, P < 0.001). Underuse and underdosage of medications recommended for HF were observed in the elderly. However, a significant improvement was observed when compared with EHFS I both in the overall HF octogenarian population and in the subgroup with ejection fraction 
45% for prescription rates of ACE-I/ARBs, beta-blockers, and aldosterone antagonists at discharge (82 vs. 71%; 56 vs. 29%; 54 vs. 18.5%, respectively, all P < 0.01), as well as for recommended combinations and dosage. Prescription rates remained stable for 12 months after discharge in survivors.
Conclusion: Our study confirms that the contemporary management of very elderly patients with HF remains suboptimal but that the situation is improving.
Key Words: Heart failure • Very elderly • Octogenarians • Treatment • Guidelines • Management • Mortality
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