Heart failure & cardiomyopathiesMeta-analysis
Survival benefit of guideline-directed medical therapy in older patients with heart failure: a systematic review and meta-analysis
- systematic review and meta-analysis
Authors' conclusion
The use of GDMT in older patients with LV systolic dysfunction was associated with a survival benefit. However, the presence of frailty may limit the successful implementation and tolerability of these therapies. High-quality studies are urgently needed to guide the development of novel strategies aimed at optimising the management of older, frail patients with LV systolic function.
Study context
- Population
- Patients aged ≥65 years old with heart failure with reduced ejection fraction (HFrEF)34 studies, 1994 to 2024
- Participants
- 92,916 patients
- Comparison
- Guideline-directed medical therapy (GDMT) vs no GDMT
Pooled result
As reported in the abstract
Survival in older patients receiving four classes of GDMT
- There were no reported data on the survival benefits of older patients receiving four classes of GDMT
Further pooled results
| Outcome | HR (CI) | P value | |
|---|---|---|---|
| Survival in older patients with LV systolic dysfunction · Tau 2 0.03, I 2 71%; survival benefit of GDMT | 0.69 (0.64–0.74) | P < 0.001 | |
| 0.512Hazard ratio (log scale) |
Receipt of GDMT in frail older patients
- Frail older patients were less likely to receive GDMT, RR
- 0.63 (0.45-0.89)
- I2
- 50%
- p
- P = 0.009
Safety
Bradycardia with beta-blockers
- Older patients receiving beta-blockers were more likely to develop bradycardia, RR
- 3.98 (2.72-5.82)
- p
- P < 0.001
- I2
- 0%
Hypotension, acute renal impairment and hypoglycaemia
- No difference between the GDMT and control group
Original publication
Survival benefit of guideline-directed medical therapy in older patients with heart failure: a systematic review and meta-analysis. Heart. Published 11 February 2026. doi:10.1136/heartjnl-2025-326305
Summarised from the published abstract; every number is checked against it