Highlights
- •Frequency of preserved left ventricular function increased with advancing age.
- •Coronary risk factors excluding hypertension were lowest in very-elderly patients.
- •Diuretics and vasodilators were administered well in older patients.
- •However, very-elderly patients had worst cardiac mortality.
- •Further, very-elderly patients were at high risk for cardiac death even though it was their first episode.
Abstract
Background
Acute decompensated heart failure (ADHF) is a leading cause of hospitalization among
the elderly. Discussion of optimal management of ADHF in older patients is a growing
health care priority. The aim of this study was to examine the clinical profile, management,
and mortality in patients admitted with ADHF according to age.
Methods
We analyzed 4824 patients enrolled in the Acute Decompensated Heart Failure Syndromes
registry from April 2007 to December 2011. Patient characteristics, management, and
in-hospital outcomes were compared among four age groups (<65, 65–74, 75–84, and ≥85 years).
Results
The mean age of the overall population was 73 years; approximately 20% were aged ≥85 years. Older patients were more likely to be women and have preserved left ventricular
ejection fraction (LVEF) and decreased renal function. Intravenous treatments were
well administered in both young and elderly patients irrespective of LVEF. Invasive
procedures were less frequently performed in the eldest group. The median length of
hospital stay was 21 days, and in-hospital cardiac death in the eldest group was four-fold higher than
that in the youngest group (2.2% vs. 8.9%, P < 0.001).
Conclusions
Clinical characteristics of ADHF differ considerably with age, and cardiac death increases
linearly with age. Despite a higher rate of preserved systolic function in very-elderly
individuals aged ≥85 years, in-hospital mortality was higher, suggesting that more suitable treatments
for the elderly might be needed.
Keywords
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Article info
Publication history
Published online: September 18, 2015
Accepted:
August 27,
2015
Received in revised form:
August 26,
2015
Received:
February 17,
2015
Identification
Copyright
© 2015 European Federation of Internal Medicine. Published by Elsevier Inc. All rights reserved.
