Response by Butt et al to Letter Regarding Article, “Efficacy and Safety of Dapagliflozin According to Frailty in Patients With Heart Failure: A Prespecified Analysis of the DELIVER Trial”
Year: 2023
Type: article
Abstract: In Response:Drs Wong and Demers are of course correct that there is an association between frailty and age, but it is also well recognized that frailty can develop at any age.The frailty-associated gradient in age in any specific population likely reflects many different factors, including the disease in question, sex distribution, and the extent of comorbidity.Among patients with heart failure, all of these vary by ejection fraction phenotype.Many of these factors also vary by geographic region, and clinical trials may include patients from up to 50 countries.How frailty is assessed may also be relevant.Although it is interesting that the age gradient appeared greater in patients with reduced ejection fraction compared with preserved ejection fraction, in the trial publication mentioned by the authors 1 (and in a second article 1 ), this was not the case in another heart failure with reduced ejection fraction trial. 2 In 2 recent studies of "real-world" as opposed to trial patients, the age gradient related to frailty was small and similar to that observed in our analysis of the DELIVER trial. 3,4We do not agree that trials include few elderly patients.The proportion of patients ≥80 years of age in PARAGON-HF was 22.4%, and in DELIVER, it was 21.4%.The median age among patients from North America in each of these trials was 75 years, not so different from similar patients in the Get With the Guidelines-Heart Failure Registry (median age, 76 years). 5We see no reason not to apply the findings of trials to older patients because the benefits of treatment are generally consistent across the range of age in both heart failure with reduced ejection fraction and heart failure with midrange ejection fraction/heart failure with preserved ejection fraction.Indeed, what the studies of frailty and older age emphasize is the large absolute benefits of treatment in these vulnerable patients who are often needlessly denied therapy.
Source: Circulation
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4362522396