Kardiologia polska 2016 12 13() doi 10.5603/KP.a2016.0132
In the elderly the most common cause of hospitalization and the leading cause of death is heart failure.
The purpose was to determine prognostic factors in chronic heart failure (CHF) in octogenarians and nonagenarians.
The analysis included 197 consecutive patients older than 80 years old (mean age 83.63±3.01 years; 46.19% of men) hospitalized in 2010-2013 in the Department of Cardiology due to CHF. Sixty two parameters were investigated such as: age, gender, NYHA functional class, body mass index, blood pressure, other comorbidities, the parameters of the 12-lead resting ECG and the echocardiography, the results of basic laboratory tests and selected biomarkers, including N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitive troponin T (hs-TnT), high-sensitive C-reactive protein (hs-CRP). Participants remained in a prospective follow-up for 12 months. We defined the primary endpoint – death due to cardiovascular causes and the composite endpoint, which consisted of: death due to cardiovascular causes and/or hospitalization for exacerbation of CHF. Follow-up concerning the deaths was performed in 189 patients, composite endpoint in 168 and hospitalization in 166. The uni- and multivariate logistic regression stepwise analysis was performed for entire population, according to left ventricular ejection fraction (LVEF<45% and ≥45%) and in group with glomerular filtration rate (GFR)<60 ml/min. RESULTS
Patients who died constituted 11,1% of the study population (21/189). In multivariate analysis four variables were independently associated with the primary endpoint: GFR (OR=0.92), hypertension (OR=0.19), lung diseases (OR=9.36) and vascular diseases (OR=6.07). In turn, in group of patients who reached the composite endpoint (55/168; 32.7%), the only statistically significant independent variable was anemia (OR=4.71). In the subpopulation of patients with LVEF<45% prognostic for each endpoint were vascular diseases and lung diseases and they increased the risk from 10 to 24-fold. In the subgroup of patients with LVEF≥45% the independent variable associated with the composite endpoint was hemoglobin (Hb) (OR=0.61), in turn for death prognostic were: white blood cell count (WBC), hs-TnT and vascular diseases (respectively OR=1.30; OR=1.04; OR=3.96). In the population with GFR<60 ml/min variables with prognostic importance for the composite endpoint were red blood cell parameters: Red Blood Cell Distribution Width (RDW) (OR=1.42) and anemia (OR=3.79), while for occurrence of death were the same as for the entire population - vascular (OR=5.16) and lung diseases (OR=4.72). CONCLUSIONS
In patients over 80 years old with CHF, comorbidities have important prognostic value for annual prognosis. The most aggravating factor in studied subgroups were lung diseases.