Skip to main content

Advertisement

SpringerLink
Log in

Differential characteristics of acute heart failure in very elderly patients: the prospective RICA study

  • Original Article
  • Published:
Aging Clinical and Experimental Research Aims and scope Submit manuscript

Abstract

Introduction

Acute heart failure (AHF) is a frequent epidemic in geriatrics. The main aim of this study was to evaluate the clinical and prognostic differences of very elderly patients with AHF compared to the rest, and evaluate the factors associated with 90-day mortality.

Methods

We analyzed 3828 patients hospitalized for AHF with an age of ≥ 70 years. The population was divided into three groups: 70–79, 80–89 and ≥ 90 years old (nonagenarians). The baseline characteristics of patients nonagenarians were compared with the rest. In the group of nonagenarians, their clinical characteristics were analyzed according to the left ventricular ejection fraction (LVEF) and the factors associated with mortality at 90 days of follow-up.

Results

Nonagenarians showed higher comorbidity and cognitive deterioration, worse basal functional status, and preserved LVEF. Alternatively, they presented a lower rate of diabetes mellitus, lower incidence of de novo AHF, and lower prescription of angiotensin-converting-enzyme inhibitors, aldosterone blockers, anticoagulants, and statins at hospital discharge. Of the total, 334 patients (9.3%) had died by 90 days. The 90-day mortality rate was highest in nonagenarians (7.1% vs 9.8% vs 17%; p = 0.001). Multivariate analysis showed that renal failure, New York Heart Association (NYHA) functional classifications of III–IV, and a more advanced functional deterioration at baseline are predictors of mortality within 90 days.

Conclusions

The AHF in patients nonagenarians has a different clinical profile compared to younger patients and a higher mortality. In this subgroup of patients having a worse baseline functional status, higher NYHA classification (III–IV), and renal failure are predictors of 90-day mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Lee JH, Lim NK, Cho MC et al (2016) Epidemiology of heart failure in Korea: present and future. Korean Circ J. 46:658–664

    Article  PubMed  PubMed Central  Google Scholar 

  2. Roger VL, Go AS, Lloyd-Jones DM et al (2012) Heart disease and stroke statistics–2012 update: a report from the American heart association. Circulation 125:e2–e220. https://doi.org/10.1161/CIR.0b013e31823ac046

    Article  PubMed  Google Scholar 

  3. Chivite D, Franco J, Formiga F (2015) Chronic heart failure in the elderly patient. Rev Esp Geriatr Gerontol. 50:237–246

    Article  PubMed  Google Scholar 

  4. Mizuno M, Kajimoto K, Sato N et al (2016) Clinical profile, management, and mortality in very-elderly patients hospitalized with acute decompensated heart failure: an analysis from the ATTEND registry. Eur J Intern Med. 27:80–85

    Article  PubMed  Google Scholar 

  5. Komajda M, Hanon O, Hochadel M et al (2009) Contemporary management of octogenarians hospitalized for heart failure in Europe: Euro Heart Failure Survey II. Eur Heart J 30:478–486

    Article  PubMed  Google Scholar 

  6. Barsheshet A, Shotan A, Cohen E et al (2010) Predictors of long-term (4-year) mortality in elderly and young patients with acute heart failure. Eur J Heart Fail 12:833–840

    Article  PubMed  Google Scholar 

  7. Conde-Martel A, Formiga F, Pérez-Bocanegra C et al (2013) Clinical characteristics and one-year survival in heart failure patients more than 85 years of age compared with younger. Eur J Intern Med. 24:339–345

    Article  PubMed  Google Scholar 

  8. Mogensen UM, Ersbøll M, Andersen M et al (2011) Clinical characteristics and major comorbidities in heart failure patients more than 85 years of age compared with younger age groups. Eur J Heart Fail 13:1216–1223

    Article  PubMed  Google Scholar 

  9. Lazzarini V, Mentz RJ, Fiuzat M et al (2013) Heart failure in elderly patients: distinctive features and unresolved issues. Eur J Heart Fail 15:717–723

    Article  PubMed  PubMed Central  Google Scholar 

  10. Ponikowski P, Voors AA, Anker SD et al (2016) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 37:2129–2200

    Article  Google Scholar 

  11. Cohen-Solal A, McMurray JJV, Swedberg K et al (2008) Benefits and safety of candesartan treatment in heart failure are independent of age: insights from the Candesartan in heart failure—assessment of reduction in mortality and morbidity programme. Eur Heart J 29:3022–3028

    Article  CAS  PubMed  Google Scholar 

  12. Herrero-Puente P, Marino-Genicio R, Martín-Sánchez FJ et al (2014) Characteristics of acute heart failure in very elderly patients—EVE study (EAHFE very elderly). Eur J Intern Med. 25:463–470

    Article  PubMed  Google Scholar 

  13. Formiga F, Chivite D, Conde A et al (2014) Basal functional status predicts three-month mortality after a heart failure hospitalization in elderly patients—the prospective RICA study. Int J Cardiol 172:127–131

    Article  PubMed  Google Scholar 

  14. Kannel WB, Belanger AJ (1991) Epidemiology of heart failure. Am Heart J 121:951–957

    Article  CAS  PubMed  Google Scholar 

  15. Franco J, Formiga F, Chivite D et al (2015) New onset heart failure–Clinical characteristics and short-term mortality. A RICA (Spanish registry of acute heart failure) study. Eur J Intern Med. 26:357–362

    Article  PubMed  Google Scholar 

  16. Yokokawa T, Yoshihisa A, Kanno Y et al (2017) Clinical features of extremely elderly patients with heart failure. Geriatr Gerontol Int. 17:2194–2199

    Article  PubMed  Google Scholar 

  17. Holmström A, Sigurjonsdottir R, Edner M et al (2013) Increased comorbidities in heart failure patients ≥ 85 years but declined from > 90 years: data from the Swedish Heart Failure Registry. Int J Cardiol 167:2747–2752

    Article  PubMed  Google Scholar 

  18. Testa G, Della-Morte D, Cacciatore F et al (2013) Precipitating factors in younger and older adults with decompensated chronic heart failure: are they different? J Am Geriartr Soc 61:1827–1828

    Article  Google Scholar 

  19. Kotecha D, Piccini JP (2015) Atrial fibrillation in heart failure: what should we do? Vol. 36, European Heart Journal. Oxford University Press, Oxford, pp 3250–3257

    Google Scholar 

  20. Franco J, Formiga F, Cepeda J et al (2018) Influence of atrial fibrillation on the mortality of patients with heart failure with preserved ejection fraction. Med Clin (Barc). 150:376–382

    Article  PubMed  Google Scholar 

  21. Leon MB (2012) Transcatheter aortic valve replacement: a breakthrough medical therapy! The 20-year odyssey, and now, a 10-year anniversary. Arch Cardiovasc Dis 105:129–131

    Article  PubMed  Google Scholar 

  22. Saczynski JS, Darling CE, Spencer FA et al (2009) Clinical features, treatment practices, and hospital and long-term outcomes of older patients hospitalized with decompensated heart failure: the Worcester heart failure study. J Am Geriatr Soc 57:1587–1594

    Article  PubMed  PubMed Central  Google Scholar 

  23. Franco J, Formiga F, Trullas JC et al (2017) Impact of prealbumin on mortality and hospital readmission in patients with acute heart failure. Eur J Intern Med. 43:36–41

    Article  CAS  PubMed  Google Scholar 

  24. Miani D, Fresco C, Lucci D et al (2009) Clinical characteristics, management, and prognosis of octogenarians with acute heart failure admitted to cardiology wards: results from the Italian Survey on Acute Heart Failure. Am Heart J 158:126–132

    Article  PubMed  Google Scholar 

  25. Harjola VP, Follath F, Nieminen MS et al (2010) Characteristics, outcomes, and predictors of mortality at 3 months and 1 year in patients hospitalized for acute heart failure. Eur J Heart Fail 12:239–248

    Article  PubMed  Google Scholar 

  26. Chivite D, Formiga F, Corbella X et al (2018) Basal functional status predicts one-year mortality after a heart failure hospitalization in elderly patients—the RICA prospective study. Int J Cardiol 254:182–188

    Article  PubMed  Google Scholar 

  27. Testa G, Liguori I, Curcio F et al (2019) Multidimensional frailty evaluation in elderly outpatients with chronic heart failure: a prospective study. Eur J Prev Cardiol 26:1115–1117

    Article  PubMed  Google Scholar 

  28. Cacciatore F, Abete P, Mazzella F et al (2012) Six-minute walking test but not ejection fraction predicts mortality in elderly patients undergoing cardiac rehabilitation following coronary artery bypass grafting. Eur J Prev Cardiol 19:1401–1409

    Article  PubMed  Google Scholar 

  29. Uchmanowicz I, Kuśnierz M, Wleklik M et al (2018) Frailty syndrome and rehospitalizations in elderly heart failure patients. Aging Clin Exp Res 30:617–623

    Article  PubMed  Google Scholar 

  30. Senni M, Gavazzi A, Oliva F et al (2014) In hospital and 1 year outcomes of acute heart failure pacients according to presentation (de novo vs. Worsening) and ejection fraction. Results from IN-HF outcome registry. Int J Cardiol 173:163–169

    Article  PubMed  Google Scholar 

  31. Shah RU, Tsai V, Klein L et al (2011) Characteristics and outcomes of very elderly patients after first hospitalization for heart failure. Circ Heart Fail. 4:301–307

    Article  PubMed  Google Scholar 

  32. Boully C, Vidal J-S, Guibert E et al (2019) National survey on the management of heart failure in individuals over 80 years of age in French geriatric care units. BMC Geriatrics 19:204. https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-019-1215-y

  33. Gómez-Otero I, Ferrero-Gregori A, Varela Román A et al (2017) Mid-range ejection fraction does not permit risk stratification among patients hospitalized for heart failure. Rev Esp Cardiol 70:338–346

    Article  PubMed  Google Scholar 

  34. Manzano L, Babalis D, Roughton M et al (2011) Predictors of clinical outcomes in elderly patients with heart failure. Eur J Heart Fail. 13:528–536

    Article  PubMed  Google Scholar 

  35. Formiga F, Moreno-Gonzalez R, Chivite D et al (2018) High comorbidity, measured by the Charlson comorbidity index, associates with higher 1-year mortality risks in elderly patients experiencing a first acute heart failure hospitalization. Aging Clin Exp Res 30:927–933. https://doi.org/10.1007/s40520-017-0853-1

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We gratefully acknowledge all investigators who form part of the RICA Registry. We would like to thank RICA’s Registry Coordinating Center “S&H Medical Science Service” for their quality control data, logistic support, and administrative work and Prof. Salvador Ortiz, Universidad Autónoma de Madrid and Statistical Advisor S&H Medical Science Service, for the statistical analysis of the data presented in this paper.

RICA Registry members: Álvarez Rocha P, Anarte L, Arévalo-Lorido JC, Cabanes Y, Carrascosa S, Carrera Izquierdo M, Cepeda JM, Cerqueiro JM, Conde Martel A, Epelde F, Formiga F, Franco Vanegas J, García Escrivá D, González Franco A, León A, Llàcer P, López-Castellanos G, Lorente Furió O, Manzano L, Montero-Pérez-Barquero M, Ormaechea G, Pérez-Silvestre J, Ruiz Ortega R, Suárez-Pedreira I.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Hospital Universitario Quirón Dexeus, Barcelona, Spain

    Jorge Huerta-Preciado & Jonathan Franco

  2. Department of Internal Medicine, Hospital Universitario Bellvitge, Hospitalet de Llobregat, Barcelona, Spain

    Francesc Formiga

  3. Department of Internal Medicine, Hospital de Manises, Manises, Spain

    Pau Llácer Iborra

  4. Short-Stay Unit, Hospital Universitari Parc Taulí, Sabadell, Spain

    Francisco Epelde

  5. Department of Internal Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain

    Álvaro González Franco

  6. Multidisciplinary Unit on Heart Failure, Hospital de Clínicas Dr. Manuel Quintela, Montevideo, Uruguay

    Gabriela Ormaechea

  7. Department of Internal Medicine, Hospital Universitario Ramón y Cajal, Universidad de Alcalá/IRYCIS, Madrid, Spain

    Luis Manzano

  8. Department of Internal Medicine, Hospital Vega Baja, Orihuela, Spain

    José María Cepeda-Rodrigo

  9. Department of Internal Medicine, IMIBIC/Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain

    Manuel Montero-Pérez-Barquero

Authors
  1. Jorge Huerta-Preciado
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jonathan Franco
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Francesc Formiga
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pau Llácer Iborra
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Francisco Epelde
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Álvaro González Franco
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Gabriela Ormaechea
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Luis Manzano
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. José María Cepeda-Rodrigo
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Manuel Montero-Pérez-Barquero
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

With the Aid of RICA Investigators Group

  • P. Álvarez Rocha
  • , L. Anarte
  • , j. C. Arévalo-Lorido
  • , Y. Cabanes
  • , S. Carrascosa
  • , M. Carrera Izquierdo
  • , J. M. Cepeda
  • , J. M. Cerqueiro
  • , A. Conde Martel
  • , F. Epelde
  • , F. Formiga
  • , J. Franco Vanegas
  • , D. García Escrivá
  • , A. González Franco
  • , A. León
  • , P. Llàcer
  • , G. López-Castellanos
  • , O. Lorente Furió
  • , L. Manzano
  • , M. Montero-Pérez-Barquero
  • , G. Ormaechea
  • , J. Pérez-Silvestre
  • , R. Ruiz Ortega
  •  & I. Suárez-Pedreira

Corresponding author

Correspondence to Jorge Huerta-Preciado.

Ethics declarations

Conflict of interest

The authors declare that there are no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (El Comité de Ética de Investigación Clínica from Reina Sofía University Hospital in Córdoba, Spain) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Huerta-Preciado, J., Franco, J., Formiga, F. et al. Differential characteristics of acute heart failure in very elderly patients: the prospective RICA study. Aging Clin Exp Res 32, 1789–1799 (2020). https://doi.org/10.1007/s40520-019-01363-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40520-019-01363-8

Keywords

Search

Navigation