Differential characteristics of acute heart failure in very elderly patients: the prospective RICA study
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ORIGINAL ARTICLE
Differential characteristics of acute heart failure in very elderly patients: the prospective RICA study Jorge Huerta‑Preciado1 · Jonathan Franco1 · Francesc Formiga2 · Pau Llácer Iborra3 · Francisco Epelde4 · Álvaro González Franco5 · Gabriela Ormaechea6 · Luis Manzano7 · José María Cepeda‑Rodrigo8 · Manuel Montero‑Pérez‑Barquero9 · With the Aid of RICA Investigators Group Received: 9 June 2019 / Accepted: 21 September 2019 © Springer Nature Switzerland AG 2019
Abstract 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. Keywords Heart failure · Nonagenarians · Comorbidities · Intermediate ejection fraction · Prognosis
* Jorge Huerta‑Preciado [email protected] 1
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Multidisciplinary Unit on Heart Failure, Hospital de Clínicas Dr. Manuel Quintela, Montevideo, Uruguay
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Department of Internal Medicine, Hospital Universitario Ramón y Cajal, Universidad de Alcalá/IRYCIS, Madrid, Spain
Department of Internal Medicine, Hospital Universitario Quirón Dexeus, Barcelona, Spain
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Department of Internal Medicine, Hospital Universitario Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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Department of Internal Medicine, Hospital de Manises, Manises, Spain
Department of Internal Medicine, Hospital Vega Baja, Orihuela, Spain
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Short‑Stay Unit, Hospital Universitari Parc Taulí, Sabadell
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