P6321Therapeutic optimization and inclusion in rehabilitation and education programs depend on age in chronic heart failure. A report of the French survey OFICSel
Authors: Broussier A , Berthelot E , Kharoubi M , Barnabas G , Bonnefous L , Beauvais F , Pezel T , Bauer F , Raitiere O , Taieb C , Benedyga V , Bastuji Garin S , David J P , Audureau E , Damy T 
Published: October 2019

Abstract

Background
Heart Failure (HF) is a major public health problem resulting in high rates of hospitalization and mortality. Frequency of HF increase due to the aging of population and improvement of treatments. Therefore, we hypothetized that elderly is a factor that might limit access to appropriate HF Care.

Purpose and methods
Our aim was to analyzed the optimization therapy and participation in rehabilitation and education programs depending according to classes of age (<40 years, 40–50; 50–60; 60–70; 70–80 and >80) in a large French HF population (out and in-patients, de novo/chronique/acute; consultation/hospitalization/rehabilitation; all LVEF classes and any type of cardiologist practice). Data were analized according to age groups

Results
A total of 2729 HF patients from 79 French departments were included of whom 36% were out patients, 53% were in-patients and 11% were in rehabilitation center. 16% were de novo Chronic HF and 31% were in Acute HF. Elderly patients were more frequently included in acute HF. Main data according on classes of age are presented in the table. Ischemic etiology and valvular diseases increased with age (p<0.0001). Cardiovascular risk factors (HTA, hypercholesterolemia) and atrial fibrillation were more frequent with ageing (p<0.0001).
Beta-blockers, angiotensin converting enzyme inhibitors, and anti-aldosterone, were less prescribed after 60 years old (p<0.0001) as therapeutic education or rehabilitation programs (p<0.0001). Modern means of communication (e-mail, smartphone and internet) were less used by elderly patients.(p<0.0001).
Main data according on classes of age Characteristics All (n=2729) <40 (n=91) 40–50 (n=197) 50–60 (n=447) 60–70 (n=706) 70–80 (n=715) >80 (n=573) p SBP 120±21 107±15 117±21 117±21 118±21 122±20 126±22 <0.0001 NYHA Class <0.0001   I 339 (13.8) 16 (19.3) 42 (23.5) 87 (21.4) 103 (16.1) 57 (8.8) 34 (6.7)   II 1187 (48.2) 45 (54.2) 95 (53.1) 213 (52.3) 311 (48.5) 314 (48.4) 209 (41.3)   III 763 (31.0) 20 (24.1) 34 (19.0) 97 (23.8) 199 (31.0) 206 (31.7) 207 (40.9)   IV 176 (7.1) 2 (2.4) 8 (4.5) 10 (2.5) 28 (4.4) 72 (11.1) 56 (11.1) LVEF 36 (29–50) 33 (26–44) 35 (25–45) 35 (25–42) 35 (25–45) 40 (30–50) 44 (32–55) <0.0001 NTproBNP 1808 (690–4323) 1176 (569–2434) 737 (294–1945) 1072 (346–2611) 1480 (619–3597) 2287 (1015–5689) 3275 (1500–6240) <0.0001 Plus-minus values are means ± SD, n (%) median (IQR).
Origin of patients according on classes

Conclusion
Elderly patients receive less Chronic HF treatment, and are less included in patient education and rehabilitation program despite having more comorbidities and cardiovascular risk factors. Thus, to improve outcome, the health care system needs to be adapt to the patients'age.

Acknowledgement/Funding
SFC, CNCF, CNCH, FFC, Alliance du coeur, GERS, SNSMCV