Abstract
Background: The prevalence and prognostic value of heart failure (HF) stages among elderly hospitalized patients is unclear.Methods: We conducted a prospective, observational, multi-center, cohort study, including hospitalized patients with the sample size of 1,068; patients were age 65 years or more, able to cooperate with the assessment and to complete the echocardiogram. Two cardiologists classified all participants in various HF stages according to 2013 ACC/AHA HF staging guidelines. The outcome was rate of 1-year major adverse cardiovascular events (MACE). The Kaplan–Meier method and Cox proportional hazards models were used for survival analyses. Survival classification and regression tree analysis were used to determine the optimal cutoff of N-terminal pro-brain natriuretic peptide (NT-proBNP) to predict MACE.Results: Participants' mean age was 75.3 ± 6.88 years. Of them, 4.7% were healthy and without HF risk factors, 21.0% were stage A, 58.7% were stage B, and 15.6% were stage C/D. HF stages were associated with worsening 1-year survival without MACE (log-rank χ2 = 69.62, P < 0.001). Deterioration from stage B to C/D was related to significant increases in HR (3.636, 95% CI, 2.174–6.098, P < 0.001). Patients with NT-proBNP levels over 280.45 pg/mL in stage B (HR 2; 95% CI 1.112–3.597; P = 0.021) and 11,111.5 pg/ml in stage C/D (HR 2.603, 95% CI 1.014–6.682; P = 0.047) experienced a high incidence of MACE adjusted for age, sex, and glomerular filtration rate.Conclusions : HF stage B, rather than stage A, was most common in elderly inpatients. NT-proBNP may help predict MACE in stage B.Trial Registration: ChiCTR1800017204; 07/18/2018.
Highlights
Deterioration from stage B to C/D was related to significant increases in hazard ratios (HR) (3.636, 95% confidence intervals (CIs), 2.174–6.098, P < 0.001)
Patients with NT-proBNP levels over 280.45 pg/mL in stage B (HR 2; 95% CI 1.112–3.597; P = 0.021) and 11,111.5 pg/ml in stage C/D (HR 2.603, 95% CI 1.014–6.682; P = 0.047) experienced a high incidence of major adverse cardiovascular events (MACE) adjusted for age, sex, and glomerular filtration rate
Cardiac parameters measured by echocardiogram change with age; these changes include smaller left ventricular (LV) size, higher LV ejection fraction (LVEF), and lower early diastolic mitral annular velocity (e′) [6, 7]; there are few data on elderly Asian populations with Heart failure (HF) confirmed by echocardiography
Summary
Once HF progresses, patients seldom return to lower stages [1]. HF stages A and B were found to be more common in the elderly (83.4%) than in young adults (58.7%) in the community [5]. The risk of HF was higher in the hospital than in the community; there are few data on the prevalence of HF stages among older hospitalized adults. Cardiac parameters measured by echocardiogram change with age; these changes include smaller left ventricular (LV) size, higher LV ejection fraction (LVEF), and lower early diastolic mitral annular velocity (e′) [6, 7]; there are few data on elderly Asian populations with HF confirmed by echocardiography. The prevalence and prognostic value of heart failure (HF) stages among elderly hospitalized patients is unclear
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