{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T12:19:57Z","timestamp":1770898797394,"version":"3.50.1"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2022,4,1]],"date-time":"2022-04-01T00:00:00Z","timestamp":1648771200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>A gap in evidence exists concerning the survival-benefit of neurohormonal blockade in older patients with chronic heart failure (HF). The purpose of our study was to investigate the neurohormonal modulation therapy in older HF patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We retrospectively analysed data on chronic HF patients with systolic dysfunction from January 2012 to May 2018 at a central tertiary academic hospital in Porto, Portugal. Very old (VO) patients were those \u226580\u00a0years. Endpoint under analysis: all-cause mortality; patients were followed until January 2021. The prognostic impact of beta-blockers (BBs) and renin-angiotensin system inhibitors (RASi) use was assessed with a Cox-regression analysis adjusting for confounders.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We studied 934 patients, 65.5% male; 45.3% had ischemic HF. BBs were used in 92.2% and RASi in 83.5%; 255 (27.3%) were VO patients. VO more often presented co-morbidities, were more symptomatic, presented worse renal function and higher BNP levels. BB prescription was similar in VO and non-VO patients, however RASi were less used in VO: 74.9% versus 86.7%, respectively. During a median follow-up of 47 months, 479 (51.3%) patients died: 71.4% among VO versus 43.7% in non-VO. BBs increased survival both in non-VO and VO\u2014multivariate adjusted HRs of 0.57 (95% CI: 0.38\u20130.85) and 0.59 (0.36\u20130.97), respectively. A survival-benefit was also observed with RASi\u2014adjusted HR of 0.71 (0.50\u20131.01) and 0.59 (0.42\u20130.83) in non-VO and VO.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>VO patients with chronic HF with systolic dysfunction have a very ominous outcome. Neurohormonal modulation therapy appears to portend survival-benefit also in this particularly vulnerable subgroup of patients.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ageing\/afac076","type":"journal-article","created":{"date-parts":[[2022,3,8]],"date-time":"2022-03-08T20:10:29Z","timestamp":1646770229000},"source":"Crossref","is-referenced-by-count":3,"title":["Prognostic impact of neurohormonal modulation in very old patients with chronic heart failure"],"prefix":"10.1093","volume":"51","author":[{"given":"Jo\u00e3o Enes","family":"Silva","sequence":"first","affiliation":[{"name":"Internal Medicine Department, Centro Hospitalar de S\u00e3o Jo\u00e3o, Porto, Portugal"},{"name":"Heart Failure Clinic of the Internal Medicine Department, Centro Hospitalar de S\u00e3o Jo\u00e3o, Porto, Portugal"}]},{"given":"Nuno","family":"Melo","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Centro Hospitalar de S\u00e3o Jo\u00e3o, Porto, Portugal"},{"name":"Heart Failure Clinic of the Internal Medicine Department, Centro Hospitalar de S\u00e3o Jo\u00e3o, Porto, Portugal"}]},{"given":"Ana Isabel","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Centro Hospitalar de S\u00e3o Jo\u00e3o, Porto, Portugal"},{"name":"Heart Failure Clinic of the Internal Medicine Department, Centro Hospitalar de S\u00e3o Jo\u00e3o, Porto, Portugal"}]},{"given":"Clara","family":"Silva","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Centro Hospitalar de S\u00e3o Jo\u00e3o, Porto, Portugal"},{"name":"Heart Failure Clinic of the Internal Medicine Department, Centro Hospitalar de S\u00e3o Jo\u00e3o, Porto, Portugal"}]},{"given":"Diana","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Centro Hospitalar de S\u00e3o Jo\u00e3o, Porto, Portugal"},{"name":"Heart Failure Clinic of the Internal Medicine Department, Centro Hospitalar de S\u00e3o Jo\u00e3o, Porto, Portugal"}]},{"given":"Maria Jo\u00e3o","family":"Lume","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Centro Hospitalar de S\u00e3o Jo\u00e3o, Porto, Portugal"},{"name":"Heart Failure Clinic of the Internal Medicine Department, Centro Hospitalar de S\u00e3o Jo\u00e3o, Porto, Portugal"}]},{"given":"Joana","family":"Pereira","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Centro Hospitalar de S\u00e3o Jo\u00e3o, Porto, Portugal"},{"name":"Heart Failure Clinic of the Internal Medicine Department, Centro Hospitalar de S\u00e3o Jo\u00e3o, Porto, Portugal"}]},{"given":"Jos\u00e9 Paulo","family":"Ara\u00fajo","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Centro Hospitalar de S\u00e3o Jo\u00e3o, Porto, Portugal"},{"name":"Heart Failure Clinic of the Internal Medicine Department, Centro Hospitalar de S\u00e3o Jo\u00e3o, Porto, Portugal"},{"name":"Porto Cardiovascular I&D Unit (UnIC), Faculdade de Medicina da Universidade do Porto, Porto, Portugal"}]},{"given":"Patr\u00edcia","family":"Louren\u00e7o","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Centro Hospitalar de S\u00e3o Jo\u00e3o, Porto, Portugal"},{"name":"Heart Failure Clinic of the Internal Medicine Department, Centro Hospitalar de S\u00e3o Jo\u00e3o, Porto, Portugal"},{"name":"Porto Cardiovascular I&D Unit (UnIC), Faculdade de Medicina da Universidade do Porto, Porto, Portugal"}]}],"member":"286","published-online":{"date-parts":[[2022,4,1]]},"reference":[{"key":"2022040112013117300_ref1","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1093\/eurjhf\/hft028","article-title":"Heart failure in elderly patients: distinctive features and unresolved issues","volume":"15","author":"Lazzarini","year":"2013","journal-title":"Eur J Heart Fail"},{"key":"2022040112013117300_ref2","doi-asserted-by":"crossref","first-page":"2725","DOI":"10.1093\/eurheartj\/ehl193","article-title":"EuroHeart Failure Survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population","volume":"27","author":"Nieminen","year":"2006","journal-title":"Eur Heart J"},{"key":"2022040112013117300_ref3","doi-asserted-by":"crossref","first-page":"2057","DOI":"10.1161\/CIRCULATIONAHA.108.784215","article-title":"Long-term trends in the incidence of heart failure after myocardial infarction","volume":"118","author":"Velagaleti","year":"2008","journal-title":"Circulation"},{"key":"2022040112013117300_ref4","doi-asserted-by":"crossref","first-page":"1614","DOI":"10.1016\/j.ehj.2004.06.038","article-title":"Quantifying the heart failure epidemic: prevalence, incidence rate, lifetime risk and prognosis of heart failure - 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