Differential characteristics of acute heart failure in very elderly patients: the prospective RICA study
Por:
Huerta-Preciado, J, Franco, J, Formiga, F, Iborra, P, Epelde, F, Franco, A, Ormaechea, G, Manzano, L, Cepeda-Rodrigo, J, Montero-Perez-Barquero, M, Rocha, P, Anarte, L, Arevalo-Lorido, J, Cabanes, Y, Carrascosa, S, Izquierdo, M, Cepeda, J, Cerqueiro, J, Martel, A, Epelde, F, Formiga, F, Vanegas, J, Escriva, D, Franco, A, Leon, A, Llacer, P, Lopez-Castellanos, G, Furio, O, Manzano, L, Montero-Perez-Barquero, M, Ormaechea, G, Perez-Silvestre, J, Ortega, R, Suarez-Pedreira, I and Aid RICA Investigators Grp
Publicada:
1 sep 2020
Ahead of Print:
1 oct 2019
Resumen:
Introduction Acute heart failure (AHF) is a frequent epidemic in geriatrics. The main aim of this study was to evaluate the clinical and prognostic differences of very elderly patients with AHF compared to the rest, and evaluate the factors associated with 90-day mortality. Methods We analyzed 3828 patients hospitalized for AHF with an age of >= 70 years. The population was divided into three groups: 70-79, 80-89 and >= 90 years old (nonagenarians). The baseline characteristics of patients nonagenarians were compared with the rest. In the group of nonagenarians, their clinical characteristics were analyzed according to the left ventricular ejection fraction (LVEF) and the factors associated with mortality at 90 days of follow-up. Results Nonagenarians showed higher comorbidity and cognitive deterioration, worse basal functional status, and preserved LVEF. Alternatively, they presented a lower rate of diabetes mellitus, lower incidence of de novo AHF, and lower prescription of angiotensin-converting-enzyme inhibitors, aldosterone blockers, anticoagulants, and statins at hospital discharge. Of the total, 334 patients (9.3%) had died by 90 days. The 90-day mortality rate was highest in nonagenarians (7.1% vs 9.8% vs 17%; p = 0.001). Multivariate analysis showed that renal failure, New York Heart Association (NYHA) functional classifications of III-IV, and a more advanced functional deterioration at baseline are predictors of mortality within 90 days. Conclusions The AHF in patients nonagenarians has a different clinical profile compared to younger patients and a higher mortality. In this subgroup of patients having a worse baseline functional status, higher NYHA classification (III-IV), and renal failure are predictors of 90-day mortality.
Filiaciones:
Huerta-Preciado, J:
Hosp Univ Quiron Dexeus, Dept Internal Med, Barcelona, Spain
Franco, J:
Hosp Univ Quiron Dexeus, Dept Internal Med, Barcelona, Spain
Formiga, F:
Hosp Univ Bellvitge, Dept Internal Med, Barcelona, Spain
Iborra, P:
Hosp Manises, Dept Internal Med, Manises, Spain
Epelde, F:
Hosp Univ Parc Tauli, Short Stay Unit, Sabadell, Spain
Franco, A:
Hosp Univ Cent Asturias, Dept Internal Med, Oviedo, Spain
Ormaechea, G:
Hosp Clin Dr Manuel Quintela, Multidisciplinary Unit Heart Failure, Montevideo, Uruguay
Manzano, L:
Univ Alcala De Henares, IRYCIS, Hosp Univ Ramon y Cajal, Dept Internal Med, Madrid, Spain
:
Hosp Vega Baja, Dept Internal Med, Orihuela, Spain
Montero-Perez-Barquero, M:
Univ Cordoba, IMIBIC Hosp Univ Reina Sofia, Dept Internal Med, Cordoba, Spain
Epelde, F:
Hosp Univ Parc Tauli, Short Stay Unit, Sabadell, Spain
Formiga, F:
Hosp Univ Bellvitge, Dept Internal Med, Barcelona, Spain
Manzano, L:
Univ Alcala De Henares, IRYCIS, Hosp Univ Ramon y Cajal, Dept Internal Med, Madrid, Spain
Montero-Perez-Barquero, M:
Univ Cordoba, IMIBIC Hosp Univ Reina Sofia, Dept Internal Med, Cordoba, Spain
Ormaechea, G:
Hosp Clin Dr Manuel Quintela, Multidisciplinary Unit Heart Failure, Montevideo, Uruguay
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