AJC: Common heart meds no benefit to older patients with diastolic heart failure

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People over 80 years of age suffering from a certain type of heart failure do not appear to benefit from most commonly prescribed heart medications, according to a study published in the March 15 issue of the American Journal of Cardiology.

"The American population continues to live longer lives, often surviving with heart failure and other chronic conditions, but patients in this age range are typically excluded from medical research. Our review of 142 patient cases found that medications had little if any beneficial effect on five-year survival or rehospitalization for heart problems among elderly patients who have heart failure but an ejection fraction of at least 50 percent," said the study's senior author Ernst R. Schwarz, MD, PhD, a cardiologist at Cedars-Sinai Heart Institute in Los Angeles.

Diastolic heart failure is more prominent than other forms among the elderly, women and obese people but, like other types of heart failure, it typically has a poor prognosis and a very high mortality rate.

The authors noted that while the study found no proven benefit for drug therapy in this group of patients, cardiovascular medications are often prescribed, at both financial and physiologic cost. They urged special caution in prescribing digoxin and diuretics--drugs often used to treat congestive heart failure and other cardiac conditions--because the study showed a trend toward increased mortality.

The average age of patients in this study was 87 years at the time of initial hospitalization with heart failure; 31 percent of the subjects were men.

The researchers reported that 69 percent of the patients died during the five-year follow-up, and none of the drug therapies-statins, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, beta blockers, diuretics, calcium channel blockers, nitrates and digoxin-appeared to make a significant difference in which patients survived and which did not.

"The risk of adverse drug effects in the geriatric population is high. Because older patients may be taking multiple medications for a variety of medical conditions, and because drugs may affect older people differently than they do younger people, it is important for physicians to prescribe heart medications judiciously and account for a different and often more severe side effect spectrum" said Schwarz, professor of medicine at Cedars-Sinai Medical Center, medical director of the cardiac support program and co-director of the heart transplant program at the Cedars-Sinai.

The authors also pointed out that more research is needed to evaluate the effects of therapies among the very elderly patients with heart failure.