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IM was used sparingly in our ADHF cohort, and was independently associated with increased in-hospital death in multivariable analysis, but not in propensity score analysis. Thus, IM may be used in ADHF, but with caution. Further randomized trials are warranted.

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AimsThe present study was designed to identify and compare predictors of short-and long-term mortality in elderly and young patients hospitalized with acute heart failure (HF). Methods and resultsThe risk of in-hospital, 1-and 4-year mortality was assessed among 2336 acute HF patients in a prospective national survey. Interaction-term analysis was utilized to identify and compare independent risk factors between elderly (.75 years [n ¼ 1182]) and younger (≤75 years [n ¼ 1154]) study patients. Elderly patients exhibited a 1.8-fold (P ¼ 0.004), 1.4-fold (P , 0.001), and 1.7-fold (P , 0.001) increase in the adjusted risk of in-hospital, 1-year, and 4-year mortality, respectively, as compared with younger patients. Independent risk factors for 4-year mortality among elderly patients included NYHA functional Class III -IV before admission (HR ¼ 1.46, P , 0.001), systolic blood pressure ,115 mmHg (HR ¼ 1.45, P ¼ 0.002), renal dysfunction ([eGFR , 60 mL/min/1.73 m 2 ] HR ¼ 1.35, P ¼ 0.002), diabetes mellitus (HR ¼ 1.28, P ¼ 0.006), and anaemia (HR ¼ 1.25, P ¼ 0.012). In the young group, but not in the elderly group, left ventricle ejection fraction (LVEF) ,50% and hyponatraemia (sodium ,136 mmol/L) were significant predictors of 4-year mortality. (LVEF ,50%, HR ¼ 1.47 for the young and 1.04 for the elderly, P for interaction ¼ 0.025; hyponatraemia HR ¼ 1.59 for the young and 1.17 for the elderly, P for interaction ¼ 0.035). ConclusionElderly patients exhibit different risk factors for long-term mortality as compared with young patients with acute HF. In contrast to younger patients, mortality risk in the older population is not decreased among those with preserved LVEF.--