Andrea Sonaglioni1, Chiara Lonati2, Lisa Tescaro3, Gian Luigi Nicolosi4, Marco Proietti5,6,7, Michele Lombardo1, Sergio Harari3,5. 1. Department of Cardiology, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy. 2. Internal Medicine Unit, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy. chiara.lonati@multimedica.it. 3. Internal Medicine Unit, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy. 4. Department of Cardiology, Policlinico San Giorgio, Pordenone, Italy. 5. Department of Clinical Sciences and Community Health, Università di Milano, Milan, Italy. 6. Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy. 7. Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK.
Abstract
BACKGROUND: Heart failure (HF) echocardiographic and hemodynamic categories are poorly characterized in the elderly. We aimed to evaluate the prevalence and clinical outcomes of echocardiographic and hemodynamic HF phenotypes in a consecutive series of hospitalized patients aged ≥ 70 years. METHODS: All consecutive patients ≥ 70 years old discharged from the Internal Medicine Unit of our Hospital with a diagnosis of HF, between January and November 2020, entered this retrospective study. All patients underwent physical examination, complete blood tests, chest X-ray and transthoracic echocardiography. At 1-year follow-up, we evaluated the occurrence of the composite outcome of all-cause mortality and re-hospitalization. RESULTS: Two hundred and sixty-one patients (86.3 ± 6.4 years, 60.9% women) were retrospectively analyzed. From the study group, 106 "old" (70-84 years) and 155 "oldest-old" (≥ 85 years) patients were separately analyzed. A total of 169 (64.7%) patients reported the composite outcome during follow-up: 41 (15.7%) died and 128 (49.0%) were re-hospitalized. At 1-year follow-up, survival analysis did not show any statistically significant difference between age groups (p = 0.31) and between HF echocardiographic categories (p = 0.34), whereas HF patients with "cold-dry" phenotype had significantly poorer survival compared to the other hemodynamic subtypes (p < 0.001). Male sex (HR 1.44, 95% CI 1.04-1.98), "cold-dry" phenotype (HR 3.90, 95% CI 1.73-8.77), high sodium level (HR 1.03, 95% CI 1.01-1.04) and low estimated glomerular filtration rate (eGFR) (HR 0.98, 95% CI 0.97-0.99) were independently associated with the outcome occurrence. CONCLUSIONS: Male sex, "cold-dry" phenotype, high sodium level and low eGFR are the main adverse prognostic indicators over a mid-term follow-up in hospitalized patients aged ≥ 70 years.
BACKGROUND: Heart failure (HF) echocardiographic and hemodynamic categories are poorly characterized in the elderly. We aimed to evaluate the prevalence and clinical outcomes of echocardiographic and hemodynamic HF phenotypes in a consecutive series of hospitalized patients aged ≥ 70 years. METHODS: All consecutive patients ≥ 70 years old discharged from the Internal Medicine Unit of our Hospital with a diagnosis of HF, between January and November 2020, entered this retrospective study. All patients underwent physical examination, complete blood tests, chest X-ray and transthoracic echocardiography. At 1-year follow-up, we evaluated the occurrence of the composite outcome of all-cause mortality and re-hospitalization. RESULTS: Two hundred and sixty-one patients (86.3 ± 6.4 years, 60.9% women) were retrospectively analyzed. From the study group, 106 "old" (70-84 years) and 155 "oldest-old" (≥ 85 years) patients were separately analyzed. A total of 169 (64.7%) patients reported the composite outcome during follow-up: 41 (15.7%) died and 128 (49.0%) were re-hospitalized. At 1-year follow-up, survival analysis did not show any statistically significant difference between age groups (p = 0.31) and between HF echocardiographic categories (p = 0.34), whereas HF patients with "cold-dry" phenotype had significantly poorer survival compared to the other hemodynamic subtypes (p < 0.001). Male sex (HR 1.44, 95% CI 1.04-1.98), "cold-dry" phenotype (HR 3.90, 95% CI 1.73-8.77), high sodium level (HR 1.03, 95% CI 1.01-1.04) and low estimated glomerular filtration rate (eGFR) (HR 0.98, 95% CI 0.97-0.99) were independently associated with the outcome occurrence. CONCLUSIONS: Male sex, "cold-dry" phenotype, high sodium level and low eGFR are the main adverse prognostic indicators over a mid-term follow-up in hospitalized patients aged ≥ 70 years.
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