Les résultats de cette thèse ont plusieurs implications pour la pratique clinique. Premièrement, nous avons démontré que les ainés sont peu exposés au traitement standard de l’insuffisance cardiaque et que la proportion de patients exposés ne s’améliorait que peu durant le suivi. Puisque ce traitement est recommandé par les lignes directrices chez tous les patients souffrant d’insuffisance cardiaque avec diminution de la fraction d’éjection du ventricule gauche et ce, dès le diagnostic, nous pouvons nous demander, devant cette sous- exposition, si les cliniciens connaissent les lignes directrices du traitement de l’insuffisance cardiaque. Nos résultats suggèrent qu’une amélioration de la pratique clinique est nécessaire et nos résultats peuvent conscientiser les cliniciens à l’ampleur de la sous- exposition au traitement standard retrouvée chez les ainés. Par contre, il est aussi possible que les cliniciens connaissent ces lignes directrices, mais qu’ils ne croient pas qu’elles s’appliquent aux ainés soit parce qu’ils trouvent qu’il n’y a pas assez de preuve du bénéfice dans ce groupe d’âge ou soit parce qu’ils ne croient pas les patients assez robustes pour bénéficier de l’exposition au traitement de l’insuffisance cardiaque. Ainsi, des interventions sont nécessaires afin de diffuser les preuves démontrant le bénéfice de l’exposition des ainés au traitement standard.
Deuxièmement, nous avons identifié plusieurs facteurs associés à une diminution de la probabilité d’initiation ou à une augmentation de la probabilité d’arrêt des β-bloqueurs. Bien que ces différents facteurs ne soient pas modifiables (par exemple, l’âge et le sexe), ils permettent de cibler les patients à risque de sous-exposition aux β-bloqueurs. Par contre, il est nécessaire de poursuivre les recherches afin de mieux comprendre les raisons de la sous- initiation et de l’arrêt des β-bloqueurs. Sont-ils dus à des croyances de fausse bienveillance ou à des attitudes âgistes des cliniciens? Est-ce qu’ils sont dus à un manque de connaissance de la part des prescripteurs? Est-ce que des enjeux reliés au système de santé sont en cause? Il est nécessaire de répondre à ces questions afin de développer des interventions pertinentes et efficaces pour améliorer l’exposition des ainés à un traitement de qualité de l’insuffisance cardiaque.
Troisièmement, nous avons démontré que les ainés bénéficient de l’exposition aux β-bloqueurs suite à un premier diagnostic d’insuffisance cardiaque. En effet, nos résultats
suggèrent que l’exposition aux β-bloqueurs est associée à une diminution du risque de mortalité et d’hospitalisation. Nos résultats suggèrent que l’exposition aux β-bloqueurs, tel que recommandé dans les lignes directrices, peut être généralisée aux ainés et même aux plus âgés parmi les ainés. Comme la qualité de vie est un résultat de santé primordial chez les ainés, il est important que d’autres études aient lieu afin de déterminer si cette diminution des hospitalisations se traduit aussi en une augmentation de la qualité de vie. Finalement, nous avons démontré que les expositions récentes aux AINS, aux thiazolidinediones et aux bloqueurs de canaux calciques non-dihydropyridines chez les ainés souffrant d’insuffisance cardiaque sont associés à une augmentation du risque d’hospitalisation. Il est important de sensibiliser les cliniciens à ces résultats afin qu’ils soient en mesure de mettre en perspective les risques et les bénéfices associés à l’exposition aux médicaments potentiellement inappropriés chez les ainés souffrant d’insuffisance cardiaque. Cependant, même si ces médicaments sont potentiellement inappropriés chez les patients souffrant d’insuffisance cardiaque, il se peut que certains patients ne puissent recourir à d’autres options thérapeutiques pour le contrôle de leur condition médicale. Puisque, dans les bases de données administratives, nous n’avons pas accès aux justifications de l’exposition aux traitements potentiellement inappropriés, une étude utilisant des données provenant de dossiers médicaux serait nécessaire afin de bien estimer les risques et les bénéfices associés à l’exposition à ces traitements.
En conclusion, nos résultats suggèrent que les ainés sont sous-exposés au traitement de l’insuffisance cardiaque suggéré par les lignes directrices. Par contre, comme ils bénéficient, tout comme les adultes plus jeunes, de l’exposition à un traitement de qualité de l’insuffisance cardiaque pour diminuer tant la morbidité que la mortalité. Étant donné l’augmentation du poids démographique des ainés prévue dans les prochaines années (et donc l’augmentation de la prévalence de l’insuffisance cardiaque), il est important que les lignes directrices recommandent l’exposition au traitement de qualité (et que les cliniciens adhèrent à ces lignes directrices) afin de minimiser les répercussions sur le système de santé.
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