Masayuki Mizuno1, Katsuya Kajimoto2, Naoki Sato3, Dai Yumino4, Yuichiro Minami4, Koji Murai5, Ryo Munakata5, Kuniya Asai6, Takehiko Keida7, Yasushi Sakata8, Nobuhisa Hagiwara4, Teruo Takano5. 1. Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan. Electronic address: masa07010@gmail.com. 2. Department of Cardiology, Sekikawa Hospital, Tokyo, Japan. 3. Department of Cardiology, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan. 4. Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan. 5. Intensive and Cardiac Care Unit, Nippon Medical School, Tokyo, Japan. 6. Division of Cardiology, Hepatology, Geriatrics, and Integrated Medicine, Nippon Medical School, Tokyo, Japan. 7. Department of Cardiology, Edogawa Hospital, Tokyo, Japan. 8. Department of Cardiology, Osaka University, Osaka, Japan.
Abstract
BACKGROUND: Acute decompensated heart failure (ADHF) is a leading cause of hospitalization among the elderly. Discussion of optimal management of ADHF in older patients is a growing health care priority. The aim of this study was to examine the clinical profile, management, and mortality in patients admitted with ADHF according to age. METHODS: We analyzed 4824 patients enrolled in the Acute Decompensated Heart Failure Syndromes registry from April 2007 to December 2011. Patient characteristics, management, and in-hospital outcomes were compared among four age groups (<65, 65-74, 75-84, and ≥85 years). RESULTS: The mean age of the overall population was 73 years; approximately 20% were aged ≥85 years. Older patients were more likely to be women and have preserved left ventricular ejection fraction (LVEF) and decreased renal function. Intravenous treatments were well administered in both young and elderly patients irrespective of LVEF. Invasive procedures were less frequently performed in the eldest group. The median length of hospital stay was 21 days, and in-hospital cardiac death in the eldest group was four-fold higher than that in the youngest group (2.2% vs. 8.9%, P<0.001). CONCLUSIONS: Clinical characteristics of ADHF differ considerably with age, and cardiac death increases linearly with age. Despite a higher rate of preserved systolic function in very-elderly individuals aged ≥85 years, in-hospital mortality was higher, suggesting that more suitable treatments for the elderly might be needed.
BACKGROUND: Acute decompensated heart failure (ADHF) is a leading cause of hospitalization among the elderly. Discussion of optimal management of ADHF in older patients is a growing health care priority. The aim of this study was to examine the clinical profile, management, and mortality in patients admitted with ADHF according to age. METHODS: We analyzed 4824 patients enrolled in the Acute Decompensated Heart Failure Syndromes registry from April 2007 to December 2011. Patient characteristics, management, and in-hospital outcomes were compared among four age groups (<65, 65-74, 75-84, and ≥85 years). RESULTS: The mean age of the overall population was 73 years; approximately 20% were aged ≥85 years. Older patients were more likely to be women and have preserved left ventricular ejection fraction (LVEF) and decreased renal function. Intravenous treatments were well administered in both young and elderly patients irrespective of LVEF. Invasive procedures were less frequently performed in the eldest group. The median length of hospital stay was 21 days, and in-hospital cardiac death in the eldest group was four-fold higher than that in the youngest group (2.2% vs. 8.9%, P<0.001). CONCLUSIONS: Clinical characteristics of ADHF differ considerably with age, and cardiac death increases linearly with age. Despite a higher rate of preserved systolic function in very-elderly individuals aged ≥85 years, in-hospital mortality was higher, suggesting that more suitable treatments for the elderly might be needed.
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