097 Patterns of acute heart failure in nonagenarians

Abstract

Since heart failure (HF) often occurs in subjects >70y old and the population of Western countries is getting older, the incidence of HF is expected to dramatically increase in the future. However, limited information is available on HF in the extreme elderly. We retrospectively studied patients >90y old patients admitted to our hospital for acute HF between 2007 and March 2010. Patients with incomplete clinical records were excluded. Main foci were: epidemiological data, initial presentation, results of routine biological and imaging tests and clinical outcome. 56 patients (mean age 94 [range 91–97], 60% female) were included. Cardiovascular risk factors were hypertension (75%), hypercholesterolemia (16%) and diabetes (7%). 56% of patients had no underlying cardiomyopathy while 16% had coronary artery disease, 13% had valve disease, 5% had hypertension and 10% had cardiomyopathy due to multiple factors. On presentation, mean creatinine was 163 mmol/L [79–317], hemoglobin was 11,5 g/dL [9,9–12,4], and BNP was 2617 pg/mL [128–14.574]. Mean ejection fraction was 46% [34–58]. The 3 main precipitating factors of acute HF were hypertension (23%), infection (23%) and acute coronary syndrome (20%). In 15% of patients, no reason for acute decompensation could be identified. More than 50% of patients were admitted to the ICU, 30% required breathing assistance and 5% required inotropic drugs. Average hospital stay was 6 days [2.9–9.5]. 63% of patients were discharged home; hospital mortality was 20%. Medical treatment at discharge included diuretics (90%), ACE inhibitors (60%) and beta-blockers (45%). Acute HF in nonagenarians is associated with poor prognosis. Main characteristics are a preserved ejection fraction, no obvious underlying cardiomyopathy and infection and hypertension as precipitating factors.