title: 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).
abstract: BACKGROUND
  Congestive heart failure (HF) represents a major public health problem with an age-related increasing prevalence. Despite the high mortality and morbidity in elderly patients with HF, limited clinical and prognostic data are available for development of appropriate prevention and treatment strategies.
  
  
  METHODS
  A cohort of 3327 outpatients consecutively enrolled in the Registry of Italian Network on Congestive Heart Failure by 133 cardiology centers was studied. Univariate and multivariate analyses were performed to compare patients <70 and > or =70 years old and to evaluate associations between clinical variables and the 1-year mortality rate and hospitalizations.
  
  
  RESULTS
  With respect to the 2294 patients <70 years old, the 1033 (31%) elderly patients were significantly more likely to be female, to be in New York Heart Association (NYHA) class III-IV, and to have preserved left ventricular systolic function (ejection fraction >40%), an ischemic/valvular etiology, and atrial fibrillation/flutter. Elderly patients received angiotensin-converting enzyme inhibitors, beta-blockers, and anticoagulants less frequently than younger patients did. The 1-year mortality rate was significantly higher in patients > or =70 years old (22% vs 13.7%, P <.001). Age was an independent predictor of 1-year mortality, increasing 2.8% by each year of age. Independent predictors of 1-year mortality in elderly patients were (1) > or =1 hospital admission in the previous year (relative risk [RR] 2.09, 95% CI 1.51-2.87), (2) systolic blood pressure (RR 0.98, 95% CI 0.97-0.99), (3) NYHA class III-IV (RR 1.57, 95% CI 1.20-2.07), and (4) age (RR 1.028, 95% CI 1.001-1.056).
  
  
  CONCLUSIONS
  Our study confirms that elderly patients (1) are seen in a more advanced stage of HF, (2) are less likely to receive evidence-based treatments, (3) show more frequently preserved systolic function, and (4) have a worse prognosis. Consequently, there is a need to develop more effective and targeted management strategies for this escalating health problem.
authors.affiliation: Department of Cardiology, S. Camillo Hospital, Institute of Care and Research, Rome, Italy. gipulig@tin.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pulignano
authors.forename: Donatella
authors.initials: D
authors.lastname: Del Sindaco
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
authors.forename: Donata
authors.initials: D
authors.lastname: Lucci
authors.forename: Marco
authors.initials: M
authors.lastname: Gorini
authors.forename: Francesco
authors.initials: F
authors.lastname: Leggio
authors.forename: Maurizio
authors.initials: M
authors.lastname: Porcu
authors.forename: Marino
authors.initials: M
authors.lastname: Scherillo
authors.forename: Cristina
authors.initials: C
authors.lastname: Opasich
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Lenarda
authors.forename: Michele
authors.initials: M
authors.lastname: Senni
authors.forename: Aldo Pietro
authors.initials: AP
authors.lastname: Maggioni
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002648:Child; D003327:Coronary Disease / Q000150:complications; D016208:Databases, Factual; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D006801:Humans; D006973:Hypertension / Q000150:complications; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016896:Treatment Outcome