European Heart Journal Advance Access originally published online on December 21, 2006
European Heart Journal 2007 28(11):1310-1318; doi:10.1093/eurheartj/ehl443
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Management of octogenarians hospitalized for heart failure in Euro Heart Failure Survey I
1 Department of Cardiology, Pitie Salpetriere Hospital, University Pierre et Marie Curie, 47/83, boulevard de l'Hôpital, 75013 Paris, France
2 Department of Geriatrics, Broca Hospital, University Paris-Descartes, Paris, France
3 Stiftung Institut für Herzinfarktforschung, Ludwigshafen am Rhein, Germany
4 University Hospital, Zurich, Switzerland
5 Department of Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
6 Department of Cardiology, Institut für Herzinfarktforschung Ludwigshafen, Germany
7 Department of Cardiology, University of Hull, Kingston upon Hull, UK
Received 9 April 2006; revised 13 November 2006; accepted 30 November 2006; online publish-ahead-of-print 21 December 2006.
* Corresponding author. Tel: +33 1 42 16 30 03; fax: +33 1 42 16 30 20. E-mail address: michel.komajda{at}psl.aphp.fr
Aims Here, the aim is to study the management of octogenarians hospitalized for heart failure in Euro Heart Failure Survey I. Heart Failure (HF) is common in older people and associated with poor outcome.
Methods and results We compared clinical characteristics, treatment, and short-term outcomes in 2780 octogenarians (group A, median age 85 years) and in 7912 younger patients (group B, median age 69 years) enrolled in the Euro Heart Failure Survey I.
There were 37% males in group A vs. 59% in group B (P < 0.001). Co-morbidities were more common in group A. Ejection fraction was measured only in 38% in group A vs. 65% in group B (P < 0.001) and when measured was preserved in 50 vs. 40% (P < 0.001). In-hospital and 12 weeks follow-up mortality were, respectively, 13 vs. 5% (P < 0.001) and 12 vs. 6% (P < 0.001) in groups A and B. Acute cardiac conditions and co-morbidity predicted mortality, whereas the use of angiotensin-converting enzyme inhibitor (ACE-I) and beta-blockers was associated with a better outcome. ACE-I and beta-blockers were used in 50 vs. 66% (P < 0.001) and 24 vs. 42% (P < 0.001) in groups A and B, respectively, whereas diuretics, digitalis, and nitrates were more commonly used in octogenarians.
Conclusion Preserved systolic function, multiple co-morbidities, and high mortality are observed in octogenarians with HF. In these patients, cardiac function is assessed in only a minority and treatments known to improve prognosis in younger patients under-utilized. Overall, the management of octogenarians with HF does not follow international guidelines.
Key Words: Heart failure • Very elderly • Treatment • Guidelines • Mortality
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