Characteristics and Outcomes of Super-Elderly Patients (Aged ≥90 Years) Hospitalized for Heart Failure　― Analysis of a Nationwide Inpatient Database ―

Abstract

Background: Although the aged population is increasing in developed countries, clinical evidence on super-elderly heart failure (HF) patients is scarce. This study determined the characteristics and outcomes of Japanese hospitalized super-elderly HF patients (aged ≥90 years) using a nationwide inpatient database. Methods and Results: A comprehensive analysis was performed of 447,818 HF patients in the Diagnosis Procedure Combination database who were hospitalized and discharged between January 2010 and March 2018. Among the study population, 243,028 patients (54.3%) were aged ≥80 years and 64,628 patients (14.4%) were aged ≥90 years. The percentage of elderly patients increased over time. Elderly patients were more likely to be female and had a higher New York Heart Association functional class at admission. Invasive and advanced procedures were rarely performed, whereas infectious complications were more common in patients with older age. Length of hospital stay and in-hospital mortality increased with age. Multivariable logistic regression analysis fitted with a generalized estimating equation showed higher in-hospital mortality in patients aged ≥80 and ≥90 years (odds ratios 1.99 and 3.23, respectively) compared with those aged <80 years. Conclusions: The number of hospitalized super-elderly HF patients has increased, and these patients are associated with worse clinical outcomes. The results of this study may be useful in establishing an optimal management strategy for super-elderly HF patients in the era of HF pandemic.

Promoting analysis of real-world data: Prospects for preventive cardiology in Japan

“…Because aging is the greatest risk factor for heart failure, the number of patients with heart failure in Japan will inevitably increase in the future. In our study, more than 50% of heart failure patients were aged 80 years or older, and the number of very old people aged 90 years or older was close to 20% of heart failure patients (11). As an advanced aging society, Japan's efforts to address the heart failure pandemic at the national level are getting attention from countries around the world.…”

Impact of hospital volume on clinical outcomes of hospitalized heart failure patients: analysis of a nationwide database including 447,818 patients with heart failure

“…Academic hospitals are obliged to participate in this database. The participation in this database of community hospitals is voluntary [17][18][19][20]. The database collates main diagnoses, comorbidities present at admission, and complications during hospitalization using the International Classification of Disease and Related Health Problems 10th Revision (ICD-10) codes.…”

Serial Changes in Clinical Presentations and Outcomes of 5,740 Patients Requiring Repeated Hospital Admissions (Four or More Times) due to Worsened Heart Failure

“…We performed a retrospective cohort study using the Diagnosis Procedure Combination database, a nationwide inpatient database in Japan. [11][12][13] The database includes ad-ITOH, ET AL (3)]. We conducted this study in accordance with the Declaration of Helsinki.…”