The edition · Geriatrics
Heart failure drugs were associated with 31% lower mortality after 65 — yet frail patients are the least likely to get them
A 92,916-patient meta-analysis argues against withholding guideline therapy on age, one older inpatient in four leaves hospital less able than they arrived, and an AD8 score now separates MCI from dementia.
The edition in brief
A meta-analysis of 34 studies and 92,916 patients aged 65 and over with heart failure and reduced ejection fraction found guideline-directed medical therapy associated with lower mortality (HR 0.69), with no excess hypotension, kidney injury or hypoglycaemia; beta-blockers raised the risk of bradycardia. Frail patients were 37% less likely to receive treatment. Age and frailty are reasons to titrate carefully, not to withhold. A meta-analysis of 46 studies (439,406 older inpatients) put hospitalisation-associated disability at 27%, with a wide range; recording pre-admission function on arrival is the first step to preventing it. A crosswalk between two informant questionnaires set AD8 cut-offs of 2 for mild cognitive impairment and 4 for dementia in hospitalised older adults, useful when delirium prevents direct testing. Cardiologists' eyeball judgement of frailty before angiography ruled it out well (sensitivity 93.9%, negative predictive value 98.5%) but needed a formal test to confirm it. The Keep-On-Keep-Up digital programme improved Berg balance scores by 6.35 points at 12 weeks in 202 community-dwelling older adults.
About one older inpatient in four leaves hospital with new disability
Document pre-admission function for every older inpatient and measure discharge function against it.
AD8 cut-offs of 2 and 4 now separate MCI from dementia when patients cannot be tested
Ask a family member the AD8 on admission: 2 suggests MCI, 4 suggests dementia.
A clinician's eyeball can rule out frailty before angiography, but not rule it in
Trust a "not frail" impression; confirm a "frail" impression with a formal tool before it changes management.
A digital strength and balance programme improved balance in older adults at 12 weeks
Digital strength and balance programmes improve balance in older adults; they complement, not replace, falls services.
Ask about function two weeks before the illness, not today
Record pre-illness function on admission so that any loss can be seen and treated.
Guideline heart failure drugs were associated with 31% lower mortality in patients over 65
Do not withhold guideline heart failure therapy on age or frailty alone; titrate carefully instead.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this one is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for geriatrics, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free