Clinical features of heart failure with mid‐range and preserved ejection fraction in octogenarians: Results of a multicentre, observational study

Özlek, Bülent; Özlek, Eda; Tekinalp, Mehmet; Kahraman, Serkan; Ağuş, Hicaz Zencirkıran; Çeli̇k, Oğuzhan; Çil, Cem; Kaya, Bedri Caner; Rencüzoğulları, İbrahim; Mert, Kadir Uğur; Çakır, Mustafa; Ösken, Altuğ; Bekar, Lütfü; Çelik, Yunus; Başaran, Özcan; Doğan, Volkan; Mert, Gurbet Özge; Sancar, Kadriye Memiç; Sevinç, Samet; Biteker, Murat

doi:10.1111/ijcp.13341

Cited by 5 publications

(5 citation statements)

References 29 publications

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“…In a study analyzing long-term mortality after coronary artery bypass grafting, octogenarians showed a mortality rate of 23% 5 years post-surgery [18], and a 5 year mortality rate of 44% has been reported in octogenarians undergoing surgical aortic valve replacement [19], which is lower than the mortality seen in our cohort of HF patients. A sex difference in prognosis was also observed in octogenarian HF patients, similar to that which has also been observed in European patients [20]. Sarcopenia, which is closely related with frailty, was found to be more prevalent in the elderly, and was an independent predictor of mortality.…”

Section: Distinctions Of Octogenarian Hf Patientssupporting

confidence: 81%

Management and Prognosis of Heart Failure in Octogenarians: Final Report from the KorAHF Registry

Cho

Lee

et al. 2020

JCM

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Treatment of heart failure (HF) in the elderly face many difficulties due to lack of robust evidence. We analyzed the outcome of HF in octogenarians using a nationwide HF registry. Among 5625 patients from the Korean Acute Heart Failure (KorAHF) registry, prognosis of octogenarian HF and the association of guideline-directed medical therapy (GDMT) with mortality and readmissions were analyzed. Octogenarian patients (1185, 22.4%) showed a higher mortality, and males were especially at increased risk (HR (hazard ratio) 1.19, 95% CI 1.01–1.40). A J-curve association between blood pressure (BP) and mortality was observed regardless of age, but the nadir value was lower in octogenarians (123.8 vs. 127.9 mmHg for systolic blood pressure (SBP); 67.1 vs. 73.9 mmHg for diastolic blood pressure (DBP), p < 0.001). Use of GDMT in octogenarian patients with HF and reduced ejection fraction (EF) were inadequate (74.3%, 47.1%, and 46.1% in octogenarians vs. 78.4%, 59.8%, and 55.2% in non-elderly for renin-angiotensin system inhibitors, beta-blockers, and aldosterone antagonists, respectively; all p < 0.05). However, those on medications had a significant reduction in 6 month mortality. For octogenarians with HF and preserved EF, angiotensin receptor blocker use reduced hospitalizations for HF in men (HR 0.19, 95% CI 0.04–0.87), but not in women (p-interaction = 0.037). HF in octogenarians were found to have different characteristics compared with the non-elderly. However, adequate use of GDMT was still associated with improved survival, and more attention should be given to prescribing medications with clinical benefits.

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Section: Distinctions Of Octogenarian Hf Patientssupporting

confidence: 81%

Management and Prognosis of Heart Failure in Octogenarians: Final Report from the KorAHF Registry

Cho

Lee

et al. 2020

JCM

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“…Considering that the majority of our patients are in NYHA Class II, it can be asserted that they follow an adequate treatment regimen as established in the current clinical practice guidelines [ 36 ]. The degree of dyspnea, when considering gender, showed that women with HF are more limited in this regard, presenting a higher percentage of individuals in NYHA classes III and IV, as current the literature has shown [ 32 , 37 , 38 ]. This could explain why women participating in this study present worse results in the Barthel index.…”

Section: Discussionmentioning

confidence: 90%

“…Hormonal, pathophysiological, and structural factors have been postulated as explanations for these gender differences, but much remains to be investigated [ 30 , 31 ]. We also know that HFpEF is higher in older age groups [ 32 , 33 ], which justifies the lower number of people with HFrEF among the studied population. Research is nowadays scarce, mainly due to the smaller number of women and older people included in clinical trials [ 34 , 35 ].…”

Section: Discussionmentioning

confidence: 97%

Palliative Care Needs and Clinical Features Related to Short-Term Mortality in Patients Enrolled in a Heart Failure Unit

et al. 2022

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(1) Background: Heart failure (HF) is a chronic and complex pathology requiring continuous patient management due to clinical instability, associated comorbidity, and extensive pharmacological treatment. Its unpredictable course makes the advanced stages challenging to recognize and raises the need for palliative care. This study aims to identify palliative care needs in HF patients and describe clinical features related to short-term mortality. (2) Methods: A descriptive, observational, cross-sectional, and retrospective study was carried out in an HF unit of a Spanish tertiary hospital. Patients’ socio-demographic and clinical data were collected from clinical records, and different instruments were used to establish mortality risks and patients’ needs for palliative care. Subsequently, univariate and bivariate descriptive analyses were performed. A binary logistic regression model helped to determine variables that could influence mortality 12 months after admission to the Unit. (3) Results: The studied population, sixty-five percent women, had an average age of 83.27 years. Among other clinical characteristics predominated preserved ejection fraction (pEF) and dyspnea NYHA (New York Heart Association) class II. The most prevalent comorbidities were hypertension and coronary heart disease. Forty-nine percent had a low–intermediate mortality risk in the following year, according to the PROFUND index. The NECPAL CCOMS-ICO© instrument identified subjects who meet the criteria for palliative care. This predictive model identified NECPAL CCOMS-ICO© results, using beta-blockers (BB) or AIIRA (Angiotensin II receptor antagonists) and low glomerular filtration rate (GFR) as explanatory variables of patients’ mortality in the following year. (4) Conclusions: The analysis of the characteristics of the population with HF allows us to identify patients in need of palliative care. The NECPAL CCOMS-ICO© instrument and the PROFUND have helped identify the characteristics of people with HF who would benefit from palliative management.

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“…These results reveal the need of adding the assessment of SAR in routine echocardiographic evaluation of HF patients. The HFPEF is currently the most common form of HF, mainly because of the accelerated aging and high prevalence of comorbidities [14]. Identifying high and low-risk ambulatory patients with HFpEF can improve care by preventing delays in appropriate treatment for high-risk patients.…”

Section: Discussionmentioning

confidence: 99%

Systolic aortic regurgitation predicts all-cause mortality and hospitalization in outpatients with heart failure and preserved ejection fraction

Bolat¹

2020

North Clin Istanbul

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Cite this article as: Bolat I, Biteker M. Systolic aortic regurgitation predicts all-cause mortality and hospitalization in outpatients with heart failure and preserved ejection fraction. North Clin Istanb ABSTRACT OBJECTIVE: Systolic aortic regurgitation (SAR) is considered to be a specific sign of heart failure (HF). However, the prevalence and importance of SAR in patients with HF and preserved ejection fraction (HFpEF) is unknown. Therefore, we sought to examine the prevalence of SAR in HFpEF outpatients, and its association with all-cause mortality and/or cardiovascular hospitalizations during 1-year follow-up. METHODS:We enrolled 301 consecutive outpatients with HFpEF (mean age of 67.3±9.6 years, 53.5% women) and prospectively followed up for 1 year. Demographic, clinical, echocardiographic, and laboratory data were obtained at study entry. The composite endpoint of the study was all-cause mortality or HF-related hospitalizations at one year. RESULTS: SAR was noted in 30 (9.9%) of the patients, and 38 patients (12.6%) reached the primary endpoint. The primary composite endpoint at 1 year was greater for patients with SAR (26.3%) compared to those without SAR (7.6%, p<0.001). After adjusting for important covariates, SAR remained independently associated with primary outcome (OR 2.315; 95% CI 1.188-5.477; p=0.008). CONCLUSION:This is the first study to demonstrate that the presence of SAR is associated with adverse events in HFpEF patients.

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Clinical features of heart failure with mid‐range and preserved ejection fraction in octogenarians: Results of a multicentre, observational study

Cited by 5 publications

References 29 publications

Management and Prognosis of Heart Failure in Octogenarians: Final Report from the KorAHF Registry

Management and Prognosis of Heart Failure in Octogenarians: Final Report from the KorAHF Registry

Palliative Care Needs and Clinical Features Related to Short-Term Mortality in Patients Enrolled in a Heart Failure Unit

Systolic aortic regurgitation predicts all-cause mortality and hospitalization in outpatients with heart failure and preserved ejection fraction

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