ArticleJournal of the American Geriatrics Society2023
Frailty and uptake of angiotensin receptor neprilysin inhibitor for heart failure with reduced ejection fraction.
Article in Journal of the American Geriatrics Society, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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The trial behind it
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Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it, 18 citations in OpenAlex.
- Frailty as an Effect Modifier in Randomized Controlled Trials: A Systematic Review.Journal of general internal medicine · 2024Pooled it
- Optimizing cardiovascular pharmacotherapy in older adults with frailty.Nature reviews. Cardiology · 2026Review
- Interaction Between Frailty and Renal Function in Patients with Heart Failure.Life (Basel, Switzerland) · 2025Article
- Maximum tolerated medication dose and other predictors of mortality in heart failure with reduced ejection fraction: retrospective cohort study.BMC cardiovascular disorders · 2025Article
- Adherence to Guideline-Directed Medical Therapy in Hospitalized Older People with Heart Failure at Discharge and 3-Month Follow-Up.Journal of clinical medicine · 2025Article
- Heart Failure in Older Patients: An Update.Journal of clinical medicine · 2025Review
- Deprescribing strategies in older patients with heart failure.Internal and emergency medicine · 2025Review
- Diuretic resistance in cardiorenal syndrome: mechanisms, monitoring and phenotype-tailored management.Frontiers in cardiovascular medicine · 2025Review
- Unleashing frailty from laboratory into real world: A critical step toward frailty-guided clinical care of older adults.Journal of the American Geriatrics Society · 2024Article
- Assessing the Benefits and Harms of Pharmacotherapy in Older Adults with Frailty: Insights from Pharmacoepidemiologic Studies of Routine Health Care Data.Drugs & aging · 2024Review
- Prescribing trends of SGLT2 inhibitors among HFrEF and HFpEF patients with and without T2DM, 2013-2021.BMC cardiovascular disorders · 2024Article
- Impact of the COVID-19 pandemic on implementation of novel guideline-directed medical therapies for heart failure in Germany: a nationwide retrospective analysis.The Lancet regional health. Europe · 2023Article
Corrections and comments
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Authors and funding
8 authors at 4 institutions in 2 countries.
Funding
Abstract
backgroundFrail older adults may be less likely to receive guideline-directed medical therapy (GDMT)-renin-angiotensin blockers, beta-blockers, and mineralocorticoid receptor antagonists-for heart failure with reduced ejection fraction (HFrEF). We aimed to examine the uptake of angiotensin receptor neprilysin inhibitor (ARNI) and GDMT in frail older adults with HFrEF.
methodsUsing 2015-2019 Medicare data, we estimated the proportion of beneficiaries with HFrEF receiving ARNI and GDMT each year by frailty status, defined by a claims-based frailty index. Logistic regression was used to identify clinical characteristics associated with ARNI initiation. Cox proportional hazards regression was used to examine the association of GDMT use in 2015 and death or heart failure hospitalization in 2016-2019.
resultsAmong 147,506-180,386 beneficiaries with HFrEF (mean age: 77 years; 27% women; 42.6-49.1% frail) in 2015-2019, the proportion of patients receiving ARNI increased in both non-frail (0.4%-16.4%) and frail (0.3%-13.7%) patients (p for yearly-trend-by-frailty = 0.970). Among those not receiving a renin-angiotensin system blocker, patients with age ≥ 85 years (odds ratio [95% CI], 0.89 [0.80-0.99]), dementia (0.88 [0.81-0.96]), and frailty (0.87 [0.81-0.94]) were less likely to initiate ARNI. The proportion of patients receiving all 3 GDMT classes increased in non-frail patients (22.0%-27.0%) but changed minimally in frail patients (19.6%-21.8%). Regardless of frailty status, treatment with at least 1 class of GDMT was associated with lower death or heart failure hospitalization than no GDMT medications (hazard ratio [95% CI], 0.94 [0.91-0.97], 0.92 [0.89-0.94], 0.94 [0.91-0.97] for 1, 2, and 3 classes, respectively).
conclusionsOur results suggest an evidence-practice gap in the use of ARNI and GDMT in Medicare beneficiaries with HFrEF, particularly those with frailty. Efforts to narrow this gap are needed to reduce the burden of HFrEF in older adults.
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