Introduction: The prevalence and incidence of heart failure (HF) in elderly patients are increasing worldwide. The management of HF with reduced left ventricular ejection fraction (HFREF) in over-80-year-old patients follows international guidelines despite the lack of a dedicated study. The question therefore remains: is there a benefit in optimising the management of HF with reduced LVEF in over-80-year-old?
Materials and methods: The HF80 pilot study is a prospective study. Over-80-year-old patients hospitalised for HFREF were randomised in an optimised group (optimised management) or a control group (usual care). Primary endpoint was quality of life (QoL) at 6 months (Minnesota Questionnaire).
Results: The trial was stopped prematurely, according to prespecified rules, after thirty-four patients were included (n = 17 in each group). There was no difference in QoL at baseline and at 6 months between the 2 groups (p = 0.14 and p = 0.64, respectively), although a significant improvement was observed between baseline and 6 months in the optimised group as opposed to the control group (−20.2 ± 25.2, p = 0.01 vs. −9.9 ± 19.0, p = 0.19). Mortality at 12 months was lower in the optimised group (17.7% vs. 47.1%, p = 0.047). There was no increase in acute renal failure, hyperkalaemia or falls in the optimised group (p = 0.49, p = 1, p = 1, respectively). Moreover, ACE inhibitors were significantly less reduced or halted (p = 0.04) while beta-blockers were further increased (p = 0.003) in this group.
Conclusions: Optimising the management of HFREF in over-80-year-old patients, according to the modalities of the HF80 Pilot Study, is both effective (improved QoL at 6 months and decreased mortality at 12 months) and safe (no observable increase in side-effects).