Clinical features and outcomes of elderly outpatients with heart failure followed up in hospital cardiology units: Data from a large nationwide cardiology database (IN-CHF Registry)

Pulignano, Giovanni; Sindaco, Donatella Del; Tavazzi, Luigi; Lucci, Donata; Gorini, Marco; Leggio, F; Porcu, Maurizio; Scherillo, Marino; Opasich, Cristina; Lenarda, Andrea Di; Senni, Michele; Maggioni, Aldo P.

doi:10.1067/mhj.2002.119608

Cited by 161 publications

(129 citation statements)

References 62 publications

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“…As expected, age represented an independent predictor of outcome in our elderly patients, in accordance with previous reports [9,22]. Interestingly, reduced EF was identified as an independent predictor of poorer outcome in octogenarians although there is growing evidence in favour of similar outcomes for HFPEF and HF with reduced EF [25].…”

Section: Survival and Predictors Of Outcomesupporting

confidence: 79%

Long‐term survival in patients older than 80 years hospitalised for heart failure. A 5‐year prospective study

Mahjoub

Ruşinaru

Soulière

et al. 2008

European J of Heart Fail

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Background: Although heart failure (HF) is frequent in elderly patients, few studies have focused on patients older than 80 years. Aims: To evaluate the clinical features, treatment and long-term prognosis of HF in patients older than 80 years. Methods and results: Consecutive patients hospitalised for a first HF episode in the Somme Department (France) during 2000 were prospectively included. Of the 799 included patients, 305 (38%) were aged over 80 years. The elderly patients were mostly women with a high prevalence of atrial fibrillation, ischaemic and hypertensive heart disease. Ejection fraction (EF) was assessed in 68.5% of elderly patients and 61% had EF z 50%. Angiotensin-converting enzyme inhibitors, beta-blockers, oral anticoagulants and statins were prescribed less frequently in elderly patients. The 5-year survival in elderly patients was 19%, dramatically lower than the survival of age-and sexmatched general population (48%). Cardiovascular causes were recorded in over 60% of deaths. On multivariable analysis, cancer, renal insufficiency, old myocardial infarction, diabetes, hyponatraemia and age were predictors of mortality in elderly patients. Reduced EF was a potent predictor of death (HR 1.72, 95%CI 1.24-2.37, p = 0.001) in elderly patients. Conclusion: Long-term prognosis in HF patients older than 80 years is poor, with a dramatic excess mortality compared to the elderly general population. Life-saving drugs are largely underused in elderly HF patients.

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Section: Survival and Predictors Of Outcomesupporting

confidence: 79%

Long‐term survival in patients older than 80 years hospitalised for heart failure. A 5‐year prospective study

Mahjoub

Ruşinaru

Soulière

et al. 2008

European J of Heart Fail

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“…7 Until a few years ago epidemiological data on CHF came from observational or registry studies in settings of Cardiology Departments. [8][9][10][11] The characteristics of these patients in many ways are similar to those of the HF trials designed for younger subjects without comorbidities. 12,13N o n -c o m m e r c i a l u s e o n l y sible to ascertain that they are similar to the so-called real world, i.e., old or very old patients, most often frail, with multiple comorbidities.…”

Section: Introductionmentioning

confidence: 89%

The heart failure in Internal Medicine in Tuscany: the SMIT Study

Verdiani

Panigada²,

Fortini³

et al. 2015

Ital J Med

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The incidence and prevalence associated with the growing age of population have made heart failure (HF) a new epidemic. In Italy most of HF patients are admitted to Internal Medicine Departments (IMD). We conducted a 30-day cross-sectional study involving patients with HF admitted to IMD of Tuscany. The aim of the study was to provide an updated snapshot of in-hospital management of HF in Tuscany and to analyze the differences in relation to the most recent guidelines. We have recruited 770 patients (M=45.4%) with a mean age of 82.5±8.9 years. Only 16.1% had a de novo HF. Most of them were re-admitted for decompensated HF. Hypertension and ischemic disease are the prevailing etiologies. HF alone was in less than 2%. 71.5% of patients had more than two comorbidities and 40.6% more than three concomitant diseases. The mean hospital stay (overall 8.6±5.5 days) correlated with the number of comorbidity. About 25% of patients had a creatinine clearance <30 mL/min. Nearly 50% of patients had atrial fibrillation but only the half was anti-coagulated. b-blockers, angiotensin converting enzyme-inhibitors (ACE-I) or angiotensin receptor blockers (ARB) were prescribed in about two-thirds of the subjects. Echocardiography was performed in 64.1% of patients. BNP or NT-pro BNP was tested in 67% at the hospital admission and in 18.3% at the discharge. At the discharge 50.1% of patients had loss of autonomy, 57% a polypharmacy prescription (≥8 classes of medicines) and 21.2% needed domiciliary oxygen therapy, but despite these critical points only 8% of the patients were transferred to long-term/intermediate care settings. In conclusion, the main characteristics of patients with HF admitted to IMD in Tuscany are the advanced age (the patients are old and very old) and the presence of multiple comorbidities (HF alone is a rarity indeed). The use of echocardiography and the pharmacological therapy with ACE-I, ARB, b-blocker and anti-aldosterone agents is wider than previous surveys, but some diagnostic, therapeutic and prognostic aspects are not similar to that recommended by the most recent HF guidelines. This survey underscores again some differences between HF trials world and HF real world, where the management is probably also driven by a clinical holistic approach. Correspondence: Valerio Verdiani, via Faccioli 15, 50145 Firenze, Italy. Tel.: +39.366.6581380 -Fax: +39.0564.48533. E-mail: verdiani@fastwebnet This work is licensed under a Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0).

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“…These studies raised the hypothesis that low serum sodium may be a marker of neurohormonal activation, reflecting the severity of the disease. Indeed, the degree of neurohormonal activation [23][24][25] and the prevalence of low serum sodium (21% versus 7%) 1,26 are markedly higher in hospitalized patients with worsening heart failure than in outpatients with stable disease.…”

Section: Discussionmentioning

confidence: 99%

Lower Serum Sodium Is Associated With Increased Short-Term Mortality in Hospitalized Patients With Worsening Heart Failure

et al. 2005

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MD; for the OPTIME-CHF InvestigatorsBackground-The prognostic value of serum sodium in patients hospitalized for worsening heart failure has not been well defined. Methods and Results-The Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic HeartFailure (OPTIME-CHF) study randomized 949 patients with systolic dysfunction hospitalized for worsening heart failure to receive 48 to 72 hours of intravenous milrinone or placebo in addition to standard therapy. In a retrospective analysis, we investigated the relationship between admission serum sodium and the primary end point of days hospitalized for cardiovascular causes within 60 days of randomization, as well as the secondary end points of in-hospital mortality, 60-day mortality, and 60-day mortality/rehospitalization. The number of days hospitalized for cardiovascular causes was higher in the lowest sodium quartile: 8.0 (4.5, 18.5) versus 6 (4, 13) versus 6 (4, 11.5) versus 6 (4, 12) days (PϽ0.015 for comparison with the lowest quartile). Lower serum sodium was associated with higher in-hospital and 60-day mortality: 5.9% versus 1% versus 2.3% versus 2.3% (PϽ0.015) and 15.9% versus 6.4% versus 7.8% versus 7% (Pϭ0.002), respectively. There was a trend toward higher mortality/rehospitalization for patients who were in the lowest sodium quartile. Multivariable-adjusted Cox proportional hazards analysis showed that serum sodium on admission, when modeled linearly, predicted increased 60-day mortality: sodium (per 3-mEq/L decrease) had a hazard ratio of 1.18 with a 95% CI of 1.03 to 1.36 (Pϭ0.018). Conclusions-In patients hospitalized for worsening heart failure, admission serum sodium is an independent predictor of increased number of days hospitalized for cardiovascular causes and increased mortality within 60 days of discharge.

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Clinical features and outcomes of elderly outpatients with heart failure followed up in hospital cardiology units: Data from a large nationwide cardiology database (IN-CHF Registry)

Cited by 161 publications

References 62 publications

Long‐term survival in patients older than 80 years hospitalised for heart failure. A 5‐year prospective study

Long‐term survival in patients older than 80 years hospitalised for heart failure. A 5‐year prospective study

The heart failure in Internal Medicine in Tuscany: the SMIT Study

Lower Serum Sodium Is Associated With Increased Short-Term Mortality in Hospitalized Patients With Worsening Heart Failure

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