Original article
Clinical characteristics and one-year survival in heart failure patients more than 85 years of age compared with younger

https://doi.org/10.1016/j.ejim.2013.01.005Get rights and content

Abstract

Background

Heart failure (HF) is frequent in elderly patients, but few studies have focused on patients older than 84 years. The aim of this study was to evaluate major comorbidities and 1-year survival in HF patients aged ≥ 85 years compared with younger age groups.

Methods

Patients included in a prospective national registry of HF (RICA) were evaluated. Sociodemographic data, Charlson comorbidity index, cognitive status, basal functional status, body mass index, NYHA functional class, and left ventricle ejection fraction (LVEF) were recorded. Patients aged ≥ 85 years were compared with the rest using the Cox regression model to detect independent predictive factors of 1-year survival.

Results

Of the 1172 patients included, 224 (19%) were aged over 84 years-old, mostly women, with hypertensive heart disease (46%, p < 0.001) and preserved LVEF (68.7%; p < 0.001). Diabetes (p < 0.001), dyslipidemia (p = 0.03) and obesity (p < 0.001) were less prevalent in this group of patients. One-year mortality in the oldest old patients was 26.3%, which was higher than the rest (p < 0.001). By multivariable analysis, a higher NYHA functional class (p = 0.038), anemia (p = 0.037), absence of obesity (p = 0.002), and a worse functional status (p = 0.049) were related to a worse 1-year survival in the oldest HF patients.

Conclusions

The oldest old HF patients have differential characteristics with lower prevalence of diabetes, dyslipidemia and obesity and a lower 1-year survival. Independent factors related to a worse 1-year survival in the oldest age group were a higher NYHA class, a worse functional status, presence of anemia and absence of obesity.

Introduction

Heart failure (HF) causes considerable morbidity and mortality and is responsible for an important burden on the health care system in developed countries. The ageing of the population and improved survival following acute cardiac events have led to an increased prevalence of HF, especially in the elderly [1] with the highest rates occurring in those aged > 80 years [2]. The oldest old patients constitute the most rapidly expanding segment of the population in western countries, and, especially for this reason, it is expected that the number of new cases of HF will rise over the next few years [1].

Due to changes in physiology related to ageing and the presence of multiple comorbidities, many important clinical features of HF differ in the elderly population [3]. Comorbidity is one of the most important characteristics of elderly patients. Several authors suggest that the high mortality for HF among this age group is due, at least in part, to the presence of multiple comorbid conditions [4], [5]. However, some comorbidities may be less prevalent in the oldest patients. On the other hand, the prognostic value of functional status has not always been considered in studies regarding older patients with HF and only a few studies have evaluated the value of functional status as a predictor of mortality [6], [7], [8], [9], [10]. There are few data regarding independent predictors of mortality in elderly HF patients and the differences in prognostic risk factors between older and younger acute HF patients.

The objective of this study was to analyze clinical characteristics, major comorbidities and 1-year survival in heart failure patients more than 85 years of age compared with younger age groups. We tested the hypothesis that the oldest HF patients have different clinical characteristics and a worse prognosis (1-year survival) than younger patients.

Section snippets

Methods

Patients were recruited through the National registry of Heart Failure (RICA), supported by the Heart Failure-Working Group of the Spanish Society of Internal Medicine (SEMI-IC). The RICA Registry is an ongoing multicenter, prospective, cohort study that has been described elsewhere [11], [12]. This registry includes patients with HF, according to the criteria of the European Society of Cardiology [13], admitted to Internal Medicine units in public and private hospitals in Spain. This study

Results

The cohort of this study included 1172 patients who were discharged after hospitalization due to acute or acute decompensated HF. The mean age was 77 (± 8.6) years old, and 528 patients (45%) were male. Baseline characteristics in relation to the four age-groups are presented in Table 1 and considering only two age groups: ≥ 85 years and < 85 years in Table 2.

Two-hundred-and-twenty-four (19%) patients were older than 84-years old. Female gender was less common among the youngest patients (33%), but

Discussion

The present study represents a ‘real-world’ picture of patients hospitalized for HF in Internal Medicine departments. The oldest elderly subjects were an important percentage of HF patients, more frequently women, with preserved ejection fraction, hypertensive etiology and poorer mental and functional status.

The proportion of women in our cohort increased with age reaching 65% in the oldest group. This figure is comparable to the percentages described in the literature for elderly HF patients

Conclusion

The most elderly heart failure patients present differential characteristics with lower prevalence of cardiovascular comorbidities, including diabetes, dyslipidemia and obesity and a lower 1-year survival. Independent factors related to a worse 1-year survival in the oldest age group were a higher NYHA class, a worse functional status, anemia and the absence of obesity. In the younger group a higher NYHA class, a worse functional status, a higher age and a worse renal function were

Learning points

  • The Heart Failure (HF) patients aged ≥ 85 years old have differential characteristics compared with younger age groups with lower prevalence of several cardiovascular comorbidities including diabetes, dyslipidemia and obesity.

  • The oldest old patients have a worse prognosis (1-year survival) than younger patients.

  • Independent factors related to a worse 1-year survival in the oldest age group were a higher NYHA class, a worse functional status, presence of anemia and absence of obesity.

Grant support

Laboratorios Menarini SA supported the RICA Registry (Spanish National Registry of Heart Failure) with an unrestricted educational grant.

Conflict of interests

All authors declare no conflict of interest related to this manuscript.

Acknowledgments

The authors thank all the researchers of RICA Registry and the Registry Coordinating Center, S&H Medical Science Service, for their quality control, logistic and administrative support.

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    • Basal functional status predicts one-year mortality after a heart failure hospitalization in elderly patients — The RICA prospective study

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      A subject's independent basic functional status can be defined as its ability to perform without help from others the everyday behaviors known as the basic activities of the daily life (ADL) [10]. HF sustains a bidirectional relationship with remaining independent for ADL: HF symptoms may render a patient unable to perform some basic ADL [11] and AHF episodes may impair a patient's ability to keep performing at least some of them [12,13], but on the other hand a poor functional status (dependence for basic ADL or even for the more advanced instrumental ADL) has been identified as a risk factor for developing adverse outcomes both in chronic HF [14–16] and AHF [17–21]. Our group has previously identified that elderly AHF patients with severe preadmission dependence for basic ADL present a significantly higher 3-month all-cause mortality risk after hospital discharge, irrespective of other variables classically influencing short-term survival [22].

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