Characteristics of acute heart failure in very elderly patients - EVE study (EAHFE very elderly).
OBJECTIVE
To determine the characteristics and prognostic factors of early death in the very elderly with acute heart failure (AHF).


METHODS
We performed a prospective, observational study of AHF patients attended in Emergency Departments (ED), analyzing 45 variables collected in ED and studying troponin, natriuretic peptides and echocardiographies, not always available in the ED. The patients were divided into 2 groups: nonagenarian (age ≥ 90 years) and controls (age < 90 years). The study variables were mortality and death or reconsultation to the ED for AHF within 30 days after inclusion.


RESULTS
We included 4700 patients (nonagenarians: 520, 11.1%). The 30-day mortality was 21.5% and 8.7% (p<0.01), respectively with a combined event of 33.3% and 26.7% (p=0.001). Age ≥ 90 years was maintained in all the models associated with death (OR: 1.94, CI 95%: 1.40-2.70). In nonagenarians, chronic kidney insufficiency (OR: 2.07, CI95%: 1.16-3.69), severe functional dependence (OR: 2.18, CI95%; 1.30-3.64) and basal oxygen saturation <90% (OR: 1.97, CI95%: 1.17-3.32) and hyponatremia <135 mEq/L (OR: 1.89, CI95%: 1.05-3.42) were predictive variables of mortality. We observed an association between elevated troponin levels and natriuretic peptide values > 5,180 pg/mL and mortality (OR: 4.26, CI95%: 1.83-9.89; and OR: 3.51, CI95%: 1.45-8.48; respectively).


CONCLUSIONS
The profile of nonagenarians with AHF differs from that of younger patients. Although very advanced age is an independent prognostic factor of mortality, these patients have fewer predictive factors of mortality, being only functional deterioration, basal kidney disease, hyponatremia and respiratory insufficiency on arrival at the ED and probably troponin values and elevated natriuretic peptides.
Department of Clinical Management of the Emergency Medicine Department, Hospital Universitario Central of Asturias, Group of Investigation in Emergency Medicine-HUCA, Oviedo, Spain. Electronic address: pabloherrero71@hotmail.com.
Pablo
P
Herrero-Puente
Department of Clinical Management of the Emergency Medicine Department, Hospital Universitario Central of Asturias, Group of Investigation in Emergency Medicine-HUCA, Oviedo, Spain.
Rocio
R
Marino-Genicio
Department of Emergency Medicine and Short-Stay Unit, Hospital Clínico San Carlos, Madrid, Spain.
Francisco Javier
FJ
Martín-Sánchez
Department of Clinical Management of the Emergency Medicine Department, Hospital Universitario Central of Asturias, Group of Investigation in Emergency Medicine-HUCA, Oviedo, Spain.
Joaquín
J
Vázquez-Alvarez
Department of Emergency Medicine, Hospital Universitaride Bellvitge, Barcelona, Spain.
Javier
J
Jacob
Department of Management of Geriatric Care, Hospital Monte Naranco, Oviedo, Spain.
Manuel
M
Bermudez
Department of Emergency Medicine-Short-Stay Unit and Home Hospitalization, Hospital Universitario General de Alicante, Alicante, Spain.
Pere
P
Llorens
Department of Emergency Medicine, Hospital Clinic, IDIBAPS, Barcelona, Spain.
Oscar
O
Miró
Department of Emergency Medicine, Hospital La Fe, Valencia, Spain.
María José
MJ
Pérez-Durá
Department of Emergency Medicine, Hospital Clinic, IDIBAPS, Barcelona, Spain.
Victor
V
Gil
Department of Clinical Management of the Emergency Medicine Department, Hospital Universitario Central of Asturias, Group of Investigation in Emergency Medicine-HUCA, Oviedo, Spain.
Ana
A
Alonso-Morilla
D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D016015:Logistic Models; D008297:Male; D045265:Natriuretic Peptides / Q000097:blood; D011379:Prognosis; D011446:Prospective Studies; D014336:Troponin / Q000097:blood
D045265:Natriuretic Peptides; D014336:Troponin
Acute heart failure; Hospital emergency departments; Mortality; Very elderly