title: Clinical presentation and outcome by age categories in acute heart failure: results from an international observational cohort.
abstract: OBJECTIVE
  To assess, according to age groups, patients' characteristics according to region of origin, the chronic therapeutic management, prognostic utility of clinical variables, and natriuretic peptides.
  
  
  RESULTS
  The GREAT registry consisted of patients identified as presenting with acute heart failure at the emergency department. Four groups of patients were defined according to age: the young patient group (<65 years); 'middle-old' (65-74 years), 'old-old' (75-84 years) and the 'oldest-old' (85-94 years). Follow-up at 1 year was performed via personal contact or national data registries at 1 year. Dataset consisted of 14 758 patients aged up to 95 years, with the 'oldest-old' group being more prevalent in North America and Western Europe. The 30-day mortality rate were, respectively, 8.1%, 8.9%, 10.3%, and 16.3% among the four age groups and 1-year mortality rates were, respectively, 3.1%, 17.1%, 24.7%, and 39.9%. Chronic heart failure treatment was less frequently administered with age (percentage of the 'fully treated' group was 14% in the 'young' compared with 2% in the 'oldest-old' patient group). Reduced left ventricular ejection fraction was present in 70%, 62.3%, 52.5%, and 46.8% among the four age groups, respectively. The prognostic utility of most variables for short- and long-term outcome was attenuated with age, with the exception of natriuretic peptides.
  
  
  CONCLUSIONS
  This study found a large heterogeneity in age among geographic regions and that the eldest are less likely to be treated in accordance with recommendations of current heart failure guidelines. Natriuretic peptide concentrations retained prognostic value in patients across age strata.
authors.affiliation: Department of Geriatry, Hôpitaux Universitaire Saint Louis - Lariboisière, Assistance Publique des Hôpitaux de Paris, Paris, France.|University Paris Diderot, Paris, France.|UMR-S 942, INSERM, Paris, France.
authors.forename: Antonio
authors.initials: A
authors.lastname: Teixeira
authors.affiliation: Department of Internal Medicine and Cardiology, University Hospital Brno, and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors.forename: Jiri
authors.initials: J
authors.lastname: Parenica
authors.affiliation: Cardiovascular Center, Division of Cardiology/Department of Internal Medicine, Seoul National University Bundang Hospital, South Korea.
authors.forename: Jin Joo
authors.initials: JJ
authors.lastname: Park
authors.affiliation: Nippon Medical School Musashi-Kosugi Hospital, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Ishihara
authors.affiliation: King Fahad Cardiac Center, Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Khalid F
authors.initials: KF
authors.lastname: AlHabib
authors.affiliation: University Paris Diderot, Paris, France.|UMR-S 942, INSERM, Paris, France.|Emergency Department, Hôpitaux Universitaire Saint Louis - Lariboisière, Assistance Publique des Hôpitaux de Paris, Paris, France.
authors.forename: Said
authors.initials: S
authors.lastname: Laribi
authors.affiliation: ANMCO Research Centre, Firenze, Italy.
authors.forename: Aldo
authors.initials: A
authors.lastname: Maggioni
authors.affiliation: Emergency Department, Hospital Clinic, Barcelona, Emergency Medicine Investigation Group 'Emergency care: processes and diseases', IDIBAPS, Barcelona, Spain.
authors.forename: Òscar
authors.initials: Ò
authors.lastname: Miró
authors.affiliation: Nippon Medical School Musashi-Kosugi Hospital, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Sato
authors.affiliation: Division of Cardiology, Towa Hospital, Tokyo, Japan.
authors.forename: Katsuya
authors.initials: K
authors.lastname: Kajimoto
authors.affiliation: University Paris Diderot, Paris, France.|UMR-S 942, INSERM, Paris, France.|Department of Cardiology, Hôpitaux Universitaire Saint Louis - Lariboisière, Assistance Publique des Hôpitaux de Paris, Paris, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Cohen-Solal
authors.affiliation: Sociedad Argentina de Cardiologia, Area de Investigacion SAC Azcuenaga, Buenos Aires, Argentina.
authors.forename: Enrique
authors.initials: E
authors.lastname: Fairman
authors.affiliation: Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Johan
authors.initials: J
authors.lastname: Lassus
authors.affiliation: Department of Internal Medicine, University Hospital, Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
authors.affiliation: Emergency Medicine Institute, The Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: William F
authors.initials: WF
authors.lastname: Peacock
authors.affiliation: Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
authors.affiliation: Cardiovascular Center, Division of Cardiology/Department of Internal Medicine, Seoul National University Bundang Hospital, South Korea.
authors.forename: Dong-Ju
authors.initials: DJ
authors.lastname: Choi
authors.affiliation: University Paris Diderot, Paris, France.|Emergency Department, Hôpitaux Universitaire Saint Louis - Lariboisière, Assistance Publique des Hôpitaux de Paris, Paris, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Plaisance
authors.affiliation: Department of Internal Medicine and Cardiology, University Hospital Brno, and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors.forename: Jindrich
authors.initials: J
authors.lastname: Spinar
authors.affiliation: Department of Geriatry, Hôpitaux Universitaire Saint Louis - Lariboisière, Assistance Publique des Hôpitaux de Paris, Paris, France.|University Paris Diderot, Paris, France.|UMR-S 942, INSERM, Paris, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mebazaa
authors.affiliation: University Paris Diderot, Paris, France.|UMR-S 942, INSERM, Paris, France.|Department of Anesthesiology and Critical Care Medicine, Hôpitaux Universitaire Saint Louis - Lariboisière, Assistance Publique des Hôpitaux de Paris, Paris, France.
authors.forename: Etienne
authors.initials: E
authors.lastname: Gayat
mesh_terms: D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D014943:Global Health / Q000706:statistics & numerical data; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D045265:Natriuretic Peptides / Q000032:analysis*; D011379:Prognosis; D012042:Registries; D013318:Stroke Volume; D000067251:Symptom Flare Up; D013997:Time Factors
chemical_list: D045265:Natriuretic Peptides
keywords: Cardiac risk factors and prevention; Diabetes; Elderly; Heart failure; Heart failure with preserved ejection fraction; Heart failure with reduced ejection fraction