Optimized management of heart failure patients aged 80 years or more improves outcomes versus usual care: The HF80 randomized trial☆

Summary Background The prevalence and incidence of heart failure (HF) in elderly patients are increasing worldwide. Management of HF with reduced ejection fraction (HF-REF) in patients aged 80 years or more follows international guidelines, despite the lack of a dedicated study in this frail population. Aims To determine whether optimized management of HF-REF in patients aged 80 years or more can improve quality of life at 6 months. Methods Patients aged 80 years or more hospitalized for acute HF-REF were randomized prospectively into an optimized group or a control group (usual care). All patients benefitted from the same in-hospital management. Optimized group patients were also managed at 3, 6 and 9 weeks, and 3, 6, 9 and 12 months after initial hospitalization, to optimize HF-REF treatment. The primary endpoint was quality of life at 6 months. Results The trial was stopped prematurely, according to prespecified rules and an independent data monitoring board, after 34 patients were included ( n  = 17 in each group). There was no difference in quality of life at baseline and at 6 months between the two groups ( P  = 0.14 and 0.64, respectively), although a significant improvement was observed between baseline and 6 months in the optimized group compared with the control group: −20.2 ± 25.2 ( P  = 0.01) versus −9.9 ± 19.0 ( P  = 0.19). Mortality at 12 months was lower in the optimized group (17.7% vs 47.1%; P  = 0.03). There was no increase in acute renal failure, hyperkalaemia or falls in the optimized group ( P  = 0.49, 1 and 1, respectively). Conclusions Optimizing the management of HF-REF in patients aged 80 years or more, according to the modalities of the HF80 study, seems to be both effective and safe.