The prevalence of heart failure (HF) is approximately 1–2% of the adult population rising to ≥10% among people ˃70 years of age. In most trials investigating drug treatment of HF, older patients are not adequately represented. Elderly patients with HF with reduced ejection fraction (HFrEF) often do not benefit from an optimized medical treatment.

By using NAtional TUnisian REgistry of Heart Failure (NATURE HF), we aim to study the influence of patient's age on delivery of guideline-recommended heart failure (HF) therapies.

NATURE HF is a multicenter registry collecting exhaustive data in both acute and chronic HF (NCT03262675). Patient management was stratified by age groups <65, 65–75 and >75 years.

We analyzed 2040 HF patients from October 2017 through November 2018 in hospitals participating in NATURE HF. In total, 958 patients had HFrEF. 17.5% were >75 years of age. Prescriptions of most HF therapies were relatively reduced with age but still remained high overall (Table 1). Elderly patients were significantly less likely to receive beta-blockers and aldosterone inhibitors.

HFrEF therapies including angiotensine converting enzyme inhibitor, beta-blockers and aldosterone inhibitors are relatively underprescribed in elderly patients.