Acute heart failure in elderly patients: worse outcomes and differential utility of standard prognostic variables. Insights from the PROTECT trial

Abstract

Aims Previous heart failure (HF) trials suggested that age influences patient characteristics and outcome; however, under‐representation of elderly patients has limited characterization of this cohort. Whether standard prognostic variables have differential utility in various age groups is unclear. Methods and results The PROTECT trial investigated 2033 patients (median age 72 years) with acute HF randomized to rolofylline or placebo. Patients were divided into five groups based on the quintiles of age: ≤59, 60–68, 69–74, 75–79, and ≥80 years. Baseline characteristics, medications, and outcomes (30‐day death or cardiovascular/renal hospitalization, and death at 30 and 180 days) were explored. The prognostic utility of baseline characteristics for outcomes was investigated in the different groups and in those aged <80 years vs. ≥80 years. With increasing age, patients were more likely to be women with hypertension, AF, and higher EF. Increased age was associated with increased risk of 30‐ and 180‐day outcomes, which persisted after multivariable adjustment (hazard ratio for 180‐day death = 1.17; 95% confidence interval 1.11–1.24 for each 5‐year increase). The prognostic utility of baseline characteristics such as previous HF hospitalization and serum sodium, systolic blood pressure, and NYHA class was attenuated in the elderly for the endpoint of 180‐day mortality. An increase in albumin was associated with a greater reduction in risk in patients aged ≥80 years vs. <80 years. Conclusions In a large trial of acute HF, there were differences in baseline characteristics and outcomes amongst patients of different ages. Standard prognostic variables exhibit different utility in elderly patients.

Heart failure in elderly patients: differences in clinical characteristics and predictors of 1-year outcome in the Polish ESC-HF Long-Term Registry

“…In the study group, 266 patients were aged less than 65 years (34.8%), and 499 patients-65 criteria, the diagnosis of HF in the elderly may be difficult because of its unusual clinical manifestation and other comorbid conditions. 1,7 There is an ongoing discussion on optimal management of HF in older patients; however, there are no specific guidelines for HF treatment specific to seniors, recommended by the European Society of Cardiology (ESC). 2 Patients enrolled in randomized clinical trials are often young with a reduced left ventricular ejection fraction (LVEF) and do not represent the real-life population.…”

Acute heart failure in the young: Clinical characteristics and biomarker profiles

“…He found that with increasing age, patients more often exhibited characteristics such as female sex, hypertension, atrial fibrillation, and higher left ventricular ejection fraction. This was paralleled by independent increased risk of adverse 30-and 180-day outcomes [4].…”

“…Although several other studies explored the clinical features of acute heart failure and their relationship with patient age, these studies primarily focused on the characteristics of elderly patients, rarely included patients younger than 50 years of age and are limited to only few standard blood biomarkers [4,7,14]. Importantly, Metra et al previously analyzed the influence of age on patient characteristics and outcome.…”

“…Data on HF in patients aged less than 50 years are limited [1,3,4]. Three studies reported on the characteristics and clinical outcome of younger patients with chronic HF, which indicate a distinct phenotype, typically comprising non-ischemic etiology, more severe left ventricular dysfunction and less concomitant comorbidities compared to older patients [5][6][7][8][9][10].…”

“…Most studies in AHF focus on the elderly [3,4]. However, the specific characteristics and the clinical outcome of young patients who are hospitalized for acute HF (AHF) are currently not well described.…”