Estimated Pulmonary Artery Systolic Pressure and Mortality in Older‐Elderly Heart Failure Patients

Abstract

OBJECTIVES To evaluate the association between high estimated pulmonary artery systolic pressure (ePASP) obtained by echocardiography and 1‐year mortality in patients with acute heart failure (HF), comparing findings in individuals aged 80 and older with those of individuals younger than 80. DESIGN Retrospective cohort study. SETTING Kyorin University Hospital. PARTICIPANTS Individuals with acute decompensated HF (N = 335). MEASUREMENTS High ePASP was defined as a tricuspid regurgitation pressure gradient greater than 47 mmHg (ePASP >50 mmHg). Potential risk factors for 1‐year mortality were selected using univariate analysis followed by multivariate Cox regression analysis with backward stepwise selection of variables with P < .10 on univariate analysis to identify significant factors. RESULTS In individuals aged 80 and older, high ePASP (hazard ratio (HR)=3.07; 95% confidence interval (CI)=1.21–7.80), discharge medications without diuretics (HR=4.18, 95% CI=1.66–10.54), and discharge medications without renin–angiotensin–aldosterone system inhibitors (HR=3.38, 95% CI=1.29–8.81) were independent risk factors for 1‐year mortality. In contrast, low systolic blood pressure at admission was the sole independent risk factor for 1‐year mortality (HR=0.94, 95% CI=0.89–0.99) in those younger than 80. CONCLUSION High ePASP is a significant predictor of 1‐year mortality in individuals aged 80 and older with acute HF but not in those younger than 80. Elucidation of the pathophysiological mechanisms behind these findings should facilitate the development of more effective individualized therapies for older adults with acute HF. J Am Geriatr Soc 67:323–328, 2019.

CAUSES, mortality rates and risk factors of death in community-dwelling Europeans aged 50 years and over: Results from the Survey of Health, Ageing and Retirement in Europe 2013–2015

“…Increased comorbidity has been identified as a general risk factor for mortality (Nunes et al, 2016) and specifically in cancer (Ferrat et al, 2015), dementia (Zekry et al, 2011;Todd, Barr, Roberts, & Passmore, 2013) or some fractures (Chang et al, 2018). In the same line, pulmonary diseases were seen to present a higher risk in patients with heart failure (Matsushita, Sakata, Satoh, & Yoshino, 2019), and heart disease had an increased risk with cholesterol (Liao, Zeng, Zhao, Guo, & Zhang, 2017). Moreover, diabetes was associated with higher mortality in patients with stroke, cholesterol (Araki et al, 2012), and pulmonary diseases (Ho et al, 2017).…”