title: Heart failure prognosis and management in over-80-year-old patients: data from a French national observational retrospective cohort.
abstract: OBJECTIVE
  The aim of the study was to assess the impact of clinical characteristics and management on the mid- to long-term follow-up prognosis of unselected over-80-year-old patients hospitalized for a first heart failure (HF) episode in a real-life setting. Despite the increasing proportion of HF patients over 80 years of age, the latter remain a poorly studied population.
  
  
  METHODS
  Analysis was based on the EGB ("Echantillon Généraliste des Bénéficiaires") database. A cohort comprising 1825 adult patients with a first admission for HF between 2009 and 2011 was created and followed until June 2013 for survival analysis.
  
  
  RESULTS
  Over-80-year-old patients represented 53 % of this cohort, with a median follow-up of 18.6 (3.3-29.5) months. Only 5 % of patients over 80 years received an optimal treatment at discharge [combination of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB), beta-blockers (BB), and mineralocorticoid receptor antagonists (MRA)]. During the follow-up period, only BB prescription levels (p = 0.02) increased. In over-80-year-olds, in-hospital mortality was 12 % (range, 10-14) and survival was 62.8 % (59.6-65.7) and 48.7 % (45.4-51.9) at 12 and 24 months, respectively. On multivariate analysis, dyslipidemia [0.74 (0.58-0.94), p = 0.02], vitamin K antagonists [0.55 (0.44-0.69), p < 0.001], ACEi/ARB + BB + MRA [0.56 (0.32-0.96), p = 0.04], and ACEi/ARB + BB [0.57 (0.45-0.72), p < 0.001] were associated with improved survival, conversely to cardiogenic shock [3.37 (1.90-5.98), p < 0.001], denutrition [1.61 (1.24-2.09), p < 0.001], and age over 90 [1.35 (1.09-1.67), p = 0.01].
  
  
  CONCLUSIONS
  These real-life HF data provide insight into prognostic factors and demonstrate that over-80-year-old HF patients displaying several comorbidities are poorly managed, despite the confirmed clinical benefit of HF drugs.
authors.affiliation: Cardiology Department, CHU Clermont-Ferrand, 63003, Clermont-Ferrand, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Vorilhon
authors.forename: Chouki
authors.initials: C
authors.lastname: Chenaf
authors.forename: Aurélien
authors.initials: A
authors.lastname: Mulliez
authors.forename: Bruno
authors.initials: B
authors.lastname: Pereira
authors.forename: Guillaume
authors.initials: G
authors.lastname: Clerfond
authors.forename: Nicolas
authors.initials: N
authors.lastname: Authier
authors.forename: Frédéric
authors.initials: F
authors.lastname: Jean
authors.forename: Pascal
authors.initials: P
authors.lastname: Motreff
authors.forename: Bernard
authors.initials: B
authors.lastname: Citron
authors.forename: Alain
authors.initials: A
authors.lastname: Eschalier
authors.forename: Jean-R
authors.initials: JR
authors.lastname: Lusson
authors.forename: Romain
authors.initials: R
authors.lastname: Eschalier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D005602:France / Q000453:epidemiology; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult