Heart failure in octogenarians with acute coronary syndrome: the EURHOBOP study in Portugal

Abstract

Introduction: Octogenarians with Acute Coronary Syndrome (ACS) are at risk of developing Heart Failure (HF). Our purpose was to identify clinical conditions that could predict HF development during hospitalization, and to evaluate its impact on in-hospital mortality. Methods: We studied a sample of 3009 cases of ACS from 10 Portuguese public hospitals, consecutively discharged within each hospital in 2009. The discharge notes and electronic/paper medical files were retrospectively reviewed by trained data extractors according to a standard protocol. For the present analysis patients were stratified according to age (< or ≥ 80 years) and compared regarding HF incidence (Killip2) as well as its predictors. Logistic regression analysis was performed to identify independent predictors of HF and, additionally, in-hospital death. Results: The very old group comprised 21.4% (n=645) of all ACS patients and 56.3% were women (versus 27.2% in the younger group; p<0.001) with a mean age of 84.7 years. This group was more likely to have an NSTEMI (59.3% vs 51.2%; p=0.003). During hospitalization, the very old group had more complications, namely new onset of atrial fibrillation (15.8% vs 7.5%; p<0.001) and cardiac (28.4% vs 17.1%; p<0.001) or renal failure (RF), (18.9% vs 6.4%; p<0.001). The very old group was more likely to have Left Ventricular Systolic Dysfunction (LVSD) (26.0% vs 19.7%; p=0.006) and to die in the hospital (16.7% vs 5.3%; p<0.001). In multivariate logistic regression, acute RF (OR 2.39; 95% CI 1.45-3.94, in comparison with no RF), LVSD (OR 2.37; 95% CI 1.47-3.81) as well as severe anemia (OR 1.97; 95% CI 1.16-3.35) were associated with higher in-hospital HF in the older. In the younger, the strongest determinants of developing HF were also RF (chronic: OR 1.40; 95% CI 1.04-1.87; acute: OR 3.00; 95% CI 2.01-4.48), LVSD (OR 4.94; 95% CI 3.77-6.48), severe anemia (OR 1.63; 95% CI 1.10-2.41) and atrial fibrillation (OR 1.92; 95% CI 1.33-2.78). In addition, the development of HF was associated with a higher in-hospital mortality only in younger group with STEMI, adjusted for sex, diabetes, previous coronary heart disease, acute and or chronic RF (OR 1.94; 95% CI 1.01-3.72). Conclusion: The very old group had a higher risk of HF. RF, LVSD and severe anemia were associated with HF at all ages. Atrial fibrillation had a strong effect on HF only in the younger. Higher mortality was associated with heart failure only in the younger group. HF after an ACS in the very old has a different clinical meaning than in younger patients and warrants a specific approach for improved.