Do Elderly Patients with Heart Failure and Reduced Ejection Fraction Benefit from Pharmacological Strategies for Prevention of Arrhythmic Events?

• Published in: Cardiology Vol. 148; no. 3; p. 195
• Main Authors: Díez-Villanueva, Pablo, Jimenez-Mendez, Cesar, Pérez, Ángel, Esteban-Fernández, Alberto, Datino, Tomás, Martínez-Sellés, Manuel, Ayesta, Ana
• Format: Journal Article
• Language: English
• Published: Switzerland 01.07.2023
• Subjects: Aged; Angiotensin Receptor Antagonists - pharmacology; Angiotensin Receptor Antagonists - therapeutic use; Arrhythmias, Cardiac - chemically induced; Arrhythmias, Cardiac - drug therapy; Arrhythmias, Cardiac - prevention & control; Biphenyl Compounds - therapeutic use; Death, Sudden, Cardiac - etiology; Death, Sudden, Cardiac - prevention & control; Drug Combinations; Heart Failure - complications; Heart Failure - drug therapy; Humans; Prognosis; Stroke Volume; Tetrazoles - therapeutic use; Valsartan - pharmacology; Cardiac arrhythmia; Reduced left ventricular ejection fraction; Heart failure with reduced ejection fraction; Sudden cardiac death; Elderly; Mortality
• DOI: 10.1159/000530424

Heart failure is associated with aging. It is one of the leading causes of morbidity and mortality in Western countries and constitutes the main cause of hospitalization among elderly patients. The pharmacological therapy of patients with heart failure with reduced ejection fraction (HFrEF) has greatly improved during the last years. However, elderly patients less frequently receive recommended medical treatment. The quadruple therapy (sacubitril/valsartan, beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter 2 inhibitors) is nowadays the cornerstone of medical treatment since it associates lower risk of heart failure hospitalizations and mortality (also of arrhythmic origin). Cardiac arrhythmias, including sudden cardiac death, are common in patients with HFrEF, entailing worse prognosis. Previous studies addressing the role of blocking the renin-angiotensin-aldosterone system and beta-adrenergic receptors in HFrEF have suggested different beneficial effects on arrhythmia mechanisms. Therefore, the lower mortality associated with the use of the four pillars of HFrEF therapy depends, in part, on lower sudden (mostly arrhythmic) cardiac death. In this review, we highlight and assess the role of the four pharmacological groups that constitute the central axis of the medical treatment of patients with HFrEF in clinical prognosis and prevention of arrhythmic events, with special focus on the elderly patient, since evidence supports that most benefits provided are irrespective of age, but elderly patients receive less often guideline-recommended medical treatment.