Adherence and Discontinuation of Optimal Heart Failure Therapies According to Age: A Danish Nationwide Study

Research output: Contribution to journalJournal articleResearchpeer-review


  • Fulltext

    Final published version, 2.08 MB, PDF document

BACKGROUND: Guideline-recommended disease-modifying pharmacological therapies for heart failure (HF) with reduced ejection fraction are underutilized, particularly among elderly patients. We studied the association of age in adherence and discontinuation of angiotensin-converting enzyme inhibitors/angiotensin-II receptor blockers (ACEi/ARB), β-blockers (BB), and mineralocorticoid receptor antagonists. METHODS AND RESULTS: Patients with a first heart failure diagnosis who had initiated ACEi/ARB and BB within 120 days of presentation were included from nationwide registries and divided into 3 age groups: <65 years (reference), 65 to 79, and ≥80. One-year median proportions of daily target doses were calculated. Adherence was estimated by the proportion of days covered. The 5-year risk of discontinuation was assessed with the Aalen-Johansen estimator. Discontinuation rates were evaluated using Multivariable Cox regression. Twenty-nine thousand four hundred eighty-two patients were included. Advancing age was associated with lower median proportions of daily target doses and adherence (ACEi/ARB 79.1%, 77.5%, and 69.4%; BB 79.1%, 78.6%, and 73.8%), in the <65, 65 to 79, and ≥80 age groups, respectively. Age ≥80 was associated with higher discontinuation rates (cumulative incidence, ACEi/ARB 41%, 44%, and 51%; BB 38%, 35%, and 39%; hazard ratio, ACEi/ARB 1.60 [95% CI, 1.51–1.69]; BB 1.33 [95% CI, 1.25–1.41]). The risk of mineralocorticoid receptor antagonists discontinuation differed little with age (50%, 54%, and 56%), although mineralocorticoid receptor antagonists initiation in the most elderly was less frequent (33%, 33%, and 22%). CONCLUSIONS: In a nationwide cohort of patients with heart failure, advanced age was associated with lower proportions of daily target doses, lower adherence, and higher discontinuation rates of ACEi/ARB and BBs. Focus on treatment adherence and optimal dosages among elderly patients with heart failure could improve outcomes.

Original languageEnglish
Article numbere026187
JournalJournal of the American Heart Association
Issue number19
Number of pages19
Publication statusPublished - 2022

Bibliographical note

Funding Information:
Garred reports lecture fees from Astra Zeneca. Dr Butt reports advisory board honoraria from Bayer, outside the submitted work. Dr Petri and Dr McMurray are supported by a British Heart Foundation Centre of Research Excellence Grant (RE/18/6/34217). Dr Schou reports lecture fees from Novartis, Astra Zeneca, Novo Nordisk, and Boehringer Ingelheim.

    Research areas

  • adherence, age, discontinuation, heart failure, pharmacotherapy

ID: 324821544