Predictors of long-term (4-year) mortality in elderly and young patients with acute heart failure.
OBJECTIVE
The present study was designed to identify and compare predictors of short- and long-term mortality in elderly and young patients hospitalized with acute heart failure (HF).


RESULTS
The risk of in-hospital, 1- and 4-year mortality was assessed among 2336 acute HF patients in a prospective national survey. Interaction-term analysis was utilized to identify and compare independent risk factors between elderly (>75 years [n = 1182]) and younger (< or =75 years [n = 1154]) study patients. Elderly patients exhibited a 1.8-fold (P = 0.004), 1.4-fold (P < 0.001), and 1.7-fold (P < 0.001) increase in the adjusted risk of in-hospital, 1-year, and 4-year mortality, respectively, as compared with younger patients. Independent risk factors for 4-year mortality among elderly patients included NYHA functional Class III-IV before admission (HR = 1.46, P < 0.001), systolic blood pressure <115 mmHg (HR = 1.45, P = 0.002), renal dysfunction ([eGFR < 60 mL/min/1.73 m(2)] HR = 1.35, P = 0.002), diabetes mellitus (HR = 1.28, P = 0.006), and anaemia (HR = 1.25, P = 0.012). In the young group, but not in the elderly group, left ventricle ejection fraction (LVEF) <50% and hyponatraemia (sodium <136 mmol/L) were significant predictors of 4-year mortality. (LVEF <50%, HR = 1.47 for the young and 1.04 for the elderly, P for interaction = 0.025; hyponatraemia HR = 1.59 for the young and 1.17 for the elderly, P for interaction = 0.035).


CONCLUSIONS
Elderly patients exhibit different risk factors for long-term mortality as compared with young patients with acute HF. In contrast to younger patients, mortality risk in the older population is not decreased among those with preserved LVEF.
Barsheshet
Alon
A
Heart Institute, Sheba Medical Center, Tel Hashomer and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel. alon.barsheshet@heart.rochester.edu
Shotan
Avraham
A
Cohen
Eytan
E
Garty
Moshe
M
Goldenberg
Ilan
I
Sandach
Amir
A
Behar
Solomon
S
Zimlichman
Eyal
E
Lewis
Basil S
BS
Gottlieb
Shmuel
S
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D005260:Female; D005919:Glomerular Filtration Rate; D006306:Health Surveys; D006333:Heart Failure / Q000453:epidemiology / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D007557:Israel / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D013318:Stroke Volume; D013997:Time Factors; D016277:Ventricular Function, Left