Treatment with Optimal Dose Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers Has a Positive Effect on Long-Term Survival in Older Individuals (Aged >70 Years) and Octogenarians with Systolic Heart Failure

Heart failure with reduced ejection fraction (HFrEF) is a disease of older people, but the target doses of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) are unknown. To evaluate the association of ACEI/ARB dose level with long-term survival in stable older patients (aged >70 years) and octogenarian outpatients with HFrEF. A total of 138 outpatients aged >70 years (35.5 % > 80 years), with an LVEF <40 % and who were clinically stable on optimal therapy were followed up for 3 years. The ACEI/ARB doses were categorized as: none (0), low (1–50 % target dose), and high (50–100 % target dose). The Cox regression survival model was adjusted for age, ischemic etiology, and renal function. ACEIs/ARBs were prescribed to 91.3 % of patients, and 52.9 % received the high dose. Survival improved with increasing ACEI/ARB dose level in the total population (Hazard Ratio [HR] = 0.67; 95 % confidence interval [CI] 0.55–0.82; p < 0.001), older patients aged >70 years (HR = 0.65; 95 % CI 0.51–0.83; p < 0.001), and octogenarians (HR = 0.71; 95 % CI 0.51–0.99; p = 0.045). The low (HR = 0.35; 95 % CI 0.16–0.76; p = 0.008) and high doses (HR = 0.13; 95 % CI 0.06–0.32; p < 0.001) improved survival compared with not receiving ACEIs/ARBs. The high dose was associated with a better survival than the low dose in the total population (HR = 0.35; 95 % CI 0.19–0.67; p = 0.001) and in a propensity score-matched cohort (HR = 0.41; 95 % CI 0.16–1.02; p = 0.056). In octogenarians, all dose levels were associated with improved survival compared with not receiving ACEIs/ARBs, but there was no difference between ACEI/ARB doses. The achieved optimal dose of ACEIs/ARBs in ambulatory older people with HFrEF is associated with long-term survival.