Characteristics of acute heart failure in very elderly patients - EVE study (EAHFE very elderly).
Eur J Intern Med. 2014 May 15;
Authors: Herrero-Puente P, Marino-Genicio R, Martín-Sánchez FJ, Vázquez-Alvarez J, Jacob J, Bermudez M, Llorens P, Miró O, Pérez-Durá MJ, Gil V, Alonso-Morilla A, representing the members of the ICA-SEMES group (Annex 1)
OBJECTIVES: To determine the characteristics and prognostic factors of early death in the very elderly with acute heart failure (AHF).
PATIENTS AND METHODS: We performed a prospective, observational study of AHF patients attended in Emergency Departments (ED), analyzing 45 variables collected in ED and studying troponin, natriuretic peptides and echocardiographies, not always available in the ED. The patients were divided into 2 groups: nonagenarian (age ≥90years) and controls (age <90years). The study variables were mortality and death or reconsultation to the ED for AHF within 30days after inclusion.
RESULTS: We included 4700 patients (nonagenarians: 520, 11.1%). The 30-day mortality was 21.5% and 8.7% (p<0.01), respectively with a combined event of 33.3% and 26.7% (p=0.001). Age ≥90years was maintained in all the models associated with death (OR: 1.94, CI 95%: 1.40-2.70). In nonagenarians, chronic kidney insufficiency (OR: 2.07, CI95%: 1.16-3.69), severe functional dependence (OR: 2.18, CI95%; 1.30-3.64) and basal oxygen saturation <90% (OR: 1.97, CI95%: 1.17-3.32) and hyponatremia <135mEq/L (OR: 1.89, CI95%: 1.05-3.42) were predictive variables of mortality. We observed an association between elevated troponin levels and natriuretic peptide values >5180pg/mL and mortality (OR: 4.26, CI95%: 1.83-9.89; and OR: 3.51, CI95%: 1.45-8.48; respectively).
CONCLUSIONS: The profile of nonagenarians with AHF differs from that of younger patients. Although very advanced age is an independent prognostic factor of mortality, these patients have fewer predictive factors of mortality, being only functional deterioration, basal kidney disease, hyponatremia and respiratory insufficiency on arrival at the ED and probably troponin values and elevated natriuretic peptides.
PMID: 24837751 [PubMed - as supplied by publisher]