title: Clinical profile, management, and mortality in very-elderly patients hospitalized with acute decompensated heart failure: An analysis from the ATTEND registry.
abstract: BACKGROUND
  Acute decompensated heart failure (ADHF) is a leading cause of hospitalization among the elderly. Discussion of optimal management of ADHF in older patients is a growing health care priority. The aim of this study was to examine the clinical profile, management, and mortality in patients admitted with ADHF according to age.
  
  
  METHODS
  We analyzed 4824 patients enrolled in the Acute Decompensated Heart Failure Syndromes registry from April 2007 to December 2011. Patient characteristics, management, and in-hospital outcomes were compared among four age groups (<65, 65-74, 75-84, and ≥85 years).
  
  
  RESULTS
  The mean age of the overall population was 73 years; approximately 20% were aged ≥85 years. Older patients were more likely to be women and have preserved left ventricular ejection fraction (LVEF) and decreased renal function. Intravenous treatments were well administered in both young and elderly patients irrespective of LVEF. Invasive procedures were less frequently performed in the eldest group. The median length of hospital stay was 21 days, and in-hospital cardiac death in the eldest group was four-fold higher than that in the youngest group (2.2% vs. 8.9%, P<0.001).
  
  
  CONCLUSIONS
  Clinical characteristics of ADHF differ considerably with age, and cardiac death increases linearly with age. Despite a higher rate of preserved systolic function in very-elderly individuals aged ≥85 years, in-hospital mortality was higher, suggesting that more suitable treatments for the elderly might be needed.
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan. Electronic address: masa07010@gmail.com.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Mizuno
authors.affiliation: Department of Cardiology, Sekikawa Hospital, Tokyo, Japan.
authors.forename: Katsuya
authors.initials: K
authors.lastname: Kajimoto
authors.affiliation: Department of Cardiology, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Sato
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Dai
authors.initials: D
authors.lastname: Yumino
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Minami
authors.affiliation: Intensive and Cardiac Care Unit, Nippon Medical School, Tokyo, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Murai
authors.affiliation: Intensive and Cardiac Care Unit, Nippon Medical School, Tokyo, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Munakata
authors.affiliation: Division of Cardiology, Hepatology, Geriatrics, and Integrated Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Kuniya
authors.initials: K
authors.lastname: Asai
authors.affiliation: Department of Cardiology, Edogawa Hospital, Tokyo, Japan.
authors.forename: Takehiko
authors.initials: T
authors.lastname: Keida
authors.affiliation: Department of Cardiology, Osaka University, Osaka, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Sakata
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Nobuhisa
authors.initials: N
authors.lastname: Hagiwara
authors.affiliation: Intensive and Cardiac Care Unit, Nippon Medical School, Tokyo, Japan.
authors.forename: Teruo
authors.initials: T
authors.lastname: Takano
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D019468:Disease Management; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D011446:Prospective Studies; D012042:Registries; D013318:Stroke Volume; D013599:Systole; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: Acute heart failure; Elderly; Epidemiology; Outcome