Cutajar, Anthony (2022). Heart Failure with Reduced Left Ventricular Ejection Fraction in Patients Aged 70 Years or Older in Malta:Epidemiology and Treatment Outcome of ACE Inhibitors and Angiotensin Receptor Blockers. PHD thesis, Aston University.
Abstract
Approximately 80% of patients suffering from heart failure (HF) with reduced ejection fraction are elderly aged ≥70 years. Yet, patients aged over 70 years are under-represented in clinical trials that shaped current treatment. Results from large observational studies that followed are now used to extrapolate the same expected benefit on the present patient population. However, suitable representation of the real world remains problematic with longer survival and wider, multimodal treatment. This single-centre, retrospective research evaluated current and predicted burden of disease in the Maltese population and re-examined two key effectiveness aspects of renin angiotensin system (RAS) blockade with a focus on patients aged ≥70 years at incident diagnosis. First, are angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) effective at reducing all-cause mortality and HF hospitalisation? Second, are ARB effective as ACEI in this population? Incidence rates from 2007 to 2017 demonstrated fast rising trends of incident diagnosis accompanied by similar trends for related mortality with a sex gap where males fared worse. ACEI were prevalent in males while ARB were preferred in females. Treatment decreased with age and females experienced earlier treatment denial. Survival analysis revealed significant mortality reduction with ACEI and ARB that compared with younger patients, persisted for at least 3 years post incident diagnosis, and remained incremental with background treatment despite additional comorbidity. The sex disparity in preferential treatment was irrelevant because ARB were comparable to ACEI at reducing mortality. These findings were demonstrated by cohorts of patients aged ≥70 years at incident diagnosis. The influence of treatment on HF hospitalisation was heavily confounded by selection bias that precluded any conclusions. Nonetheless, if treatment is maintained the positive benefit of both RAS inhibitors of reduced mortality in elderly patients has a beneficial impact on the predicted disease burden that shall keep rising until 2040.
Divisions: | College of Health & Life Sciences > Aston Pharmacy School |
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Additional Information: | Copyright © Anthony Cutajar, 2022. Anthony Cutajar asserts his moral right to be identified as the author of this thesis. This copy of the thesis has been supplied on condition that anyone who consults it is understood to recognise that its copyright rests with its author and that no quotation from the thesis and no information derived from it may be published without appropriate permission or acknowledgement. If you have discovered material in Aston Publications Explorer which is unlawful e.g. breaches copyright, (either yours or that of a third party) or any other law, including but not limited to those relating to patent, trademark, confidentiality, data protection, obscenity, defamation, libel, then please read our Takedown Policy and contact the service immediately. |
Institution: | Aston University |
Uncontrolled Keywords: | Heart failure,elderly patients,ejection fraction,ACEI,ARB,hospitalisation,mortality,effectiveness |
Last Modified: | 28 Jun 2024 08:22 |
Date Deposited: | 22 Dec 2023 17:29 |
Completed Date: | 2022-08 |
Authors: |
Cutajar, Anthony
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