Original ArticleClinical profile, management, and mortality in very-elderly patients hospitalized with acute decompensated heart failure: An analysis from the ATTEND registry
Introduction
Improvement in the treatment of cardiovascular diseases, including revascularization therapy for myocardial infarction and strict control of hypertension, has resulted in both reduced in-hospital mortality and length of hospital stay in the aging the population [1], [2]. However, better treatment and salvage of patients with these diseases have resulted in a steady increase in the prevalence of chronic heart failure in the elderly; heart failure (HF) is the leading cause of hospitalization in seniors [3], [4], [5], [6], [7], [8]. Cumulative morbidity, mortality, and associated costs will undoubtedly escalate as the elderly population increases; thus, optimal management of HF in older adults is a growing health care priority.
It is well known that evidence-based guidelines have the potential to improve health care. However, patients enrolled in most randomized clinical trials are relatively young males; thus, a clinical gap may exist between clinical trials and the real-world population [8], [9]. In fact, previous studies have suggested that elderly patients with HF differ from younger patients with HF in terms of several biologic characteristics; older patients are more often women and are more likely to present with preserved left ventricular (LV) systolic function [10], [11], [12], [13], [14], [15]. Furthermore, some studies have reported that evidence-based therapies are less frequently used, and underdosage of recommended medications is constantly observed in the elderly [16], [17]. Therefore, information from adequate population-based studies is required to elucidate real-world data.
Many studies have addressed the issue of chronic HF management, and a limited number of acute HF studies have dedicated data specifically to age. Because patient characteristics and clinical signs in elderly patients with acute HF may differ from those of younger populations, it might be inappropriate to contextualize data derived from younger patients with acute HF to older patients with acute HF. In addition, few studies have demonstrated age differences in intravenous treatment, in-hospital management, and in-hospital cardiac mortality.
Thus, the purpose of this study was to examine the clinical profile, management, and outcome, especially pertaining to cardiac death, in patients admitted with acute decompensated HF according to age.
Section snippets
Study population
The study population consisted of patients enrolled in the Acute Decompensated Heart Failure Syndromes (ATTEND) registry. A detailed description of the study design has been described elsewhere [18] and will be briefly summarized here. The ATTEND registry is a prospective observational multicenter cohort study of patients hospitalized for acute decompensated HF in Japan. The present data were collected for patients admitted to 53 district hospitals from April 2007 to December 2011. Eligible
Patient characteristics
A total of 4824 patients were enrolled in the ATTEND registry, and data from these patients were analyzed among four age groups. The mean age of the total population was 72.9 ± 13.8 years, the age distribution was 24% < 65 years, 22% 65 to 74 years, 33% 75 to 84 years, and 20% ≥ 85 years. Table 1 demonstrates baseline and clinical characteristics according to age. Older patients were more likely to be women and have a lower body mass index and a higher proportion of preserved LVEF. In terms of
Discussion
The main findings of the present investigation of ADHF can be summarized as follows. First, more than half of patients hospitalized with ADHF were > 75 years of age, and approximately 20% of the patients were in the very-elderly age group (≥ 85 years). Second, body mass index and renal function decreased and frequency of anemia increased proportionately according to age, but coronary risk factors did not increase linearly with age. Third, intravenous treatments that are recommended in the
Conclusions
Among patients hospitalized with acute decompensated HF, significant differences in clinical characteristics and management exist between younger and older patients. Moreover, in-hospital cardiac mortality increased with advancing age, especially in the very-elderly population segment aged ≥ 85 years, despite a high proportion of preserved LVEF. Because current guidelines have developed from studies in which very-elderly patients were excluded, our real-world data may have implications for
Source of funding
Based on a statement issued by the International Committee of Medical Journal Editors (ICMJE) in September 2004, this study was funded by the Japan Heart Foundation. The funding body had no role in the design or conduct of the study; in the collection, analysis, or interpretation of the data; nor in the preparation, review, or approval of the manuscript.
Conflict of interest
The authors state that they have no conflicts of interest.
Acknowledgments
We express our appreciation to Katsunori Shimada, PhD (STATZ Institute, Inc., Tokyo, Japan) for expert statistical assistance. We also thank all study investigators for their contributions to the study and the Japan Heart Foundation for funding this study.
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