Clinical characteristics, treatment and outcomes of acute heart failure patients over 65 years of age (analysis from the OP-AHF registry)

Abstract

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by a grant from the Institute of Medical Sciences, University of Opole, Poland. Introduction Acute heart failure (AHF) is one of the most common causes of hospitalizations and deaths in the developed countries. Advances in the diagnosis and treatment of heart diseases and the increase of life expectancy have resulted in the fact that we are increasingly hospitalizing elderly patients, often with multi-diseases, which is a significant challenge for health care. Purpose The aim of the study was to analyze the clinical characteristics, treatment and outcomes of patients with AHF over 65 years of age compared to the younger ones. Methods As part of the prospective Acute Heart Failure Registry (OP-AHF), data from 122 patients hospitalized in ICCU were collected from June 2019. Inclusion criteria were hospitalization for AHF and the use of at least one of: intravenous diuretics, catecholamines or mechanical circulatory support. All patients were then followed for 12 months. Results Patients older than 65 years constituted 64% of patients with AHF (78 out of 122 people). Compared to younger ones, they were more often males (36% vs 14%, p = 0.01), smokers (85% vs 55%, p <0.01) and had a significantly lower BMI (29 vs 32 kg / m2, p = 0.02). Older patients had more often history of renal failure (54% vs 44%, p <0.01), diabetes (58% vs 42%, p = 0.07) and arterial hypertension (47% vs 53%), p = 0, 02). Dyspnea was the dominant symptom in both groups (79% vs 94%, p = 0.04). Left ventricular ejection fraction LVEF was insignificantly lower in the elderly (40% vs 44%, p = 0.18). In both groups, NTpro-BNP was increased on admission (9722 vs 8221 pg / ml, p = 0.08) and then decreased on discharge (8057 vs 5377 pg / ml, p = 0.11). Significantly lower hemoglobin values were noted on admission in the group of patients over 65 years of age (12.5 vs 13.8 g%, p <0.01). Elderly patients had higher 12-month mortality (29% vs 14% in younger patients, p = 0.06; HR = 2.34 [95% CI = 0.95-5.76]; adjusted for age, sex, LVEF and NTpro-BNP HR = 2.64 [0.99-7.01], p = 0.05. There was no statistically significant difference in the rates of rehospitalizations within 12 months after hospital discharge (27% in both groups, corrected HR = 0.95 [0.45-1.99]). Conclusions Elderly patients >65 years of age have higher risk of death within 12 months after an episode of acute heart failure than younger ones. However, despite greater burden of comorbidities, they are not more often rehospitalized due to cardiovascular reasons. Fig. Actual and adjusted for age, sex, LVEF and NT-pro BNP 12- month survival of patient over 65 years of age