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Comparisons of prognostic factors between young and elderly patients with chronic heart failure
Takamasa Sato1, Hiroyuki Yamauchi, Yuki Kanno
1Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan.
Insights
Prognostic factors for chronic heart failure (CHF) events differ between elderly and younger patients. Key predictors in younger individuals include hemoglobin, B-type natriuretic peptide (BNP), and exercise capacity, while elderly patients
Area of Science:
- Cardiology
- Geriatrics
- Internal Medicine
Background:
- Chronic heart failure (CHF) affects diverse age groups, with potential variations in disease progression and risk factors.
- Understanding age-specific prognostic factors is crucial for tailoring treatment strategies in CHF management.
Purpose of the Study:
- To compare prognostic risk factors between elderly (≥75 years) and younger (<75 years) patients diagnosed with chronic heart failure (CHF).
- To identify distinct predictors of adverse outcomes in these two age cohorts.
Main Methods:
- Examined 598 CHF patients undergoing cardiopulmonary exercise testing, echocardiography, and blood analysis.
- Divided patients into elderly (n=123) and younger (n=475) groups for comparative analysis.
- Followed patients for a median of 782 days to record cardiac deaths or rehospitalizations due to heart failure worsening.
Main Results:
- Elderly patients exhibited higher rates of atrial fibrillation, diuretic use, impaired renal function, and lower exercise capacity.
- Key predictors of cardiac events in younger patients were hemoglobin, B-type natriuretic peptide (BNP), and peak VO(2).
- In elderly patients, estimated glomerular filtration rate, atrial fibrillation, and peak VO(2) independently predicted adverse outcomes.
Conclusions:
- Prognostic factors for adverse events in chronic heart failure (CHF) are significantly different between elderly and younger patient populations.
- Age-specific risk stratification is essential for optimizing management and improving outcomes in CHF patients.
Aim:
The purpose in the present study was to compare prognostic risk factors between older and younger chronic heart failure (CHF) patients.
Methods:
We examined 598 consecutive CHF patients (476 men and 122 women, mean age 61.4 ± 14.3 years) who underwent cardiopulmonary exercise testing, echocardiography and blood examination. We divided the 598 patients into two groups: the elderly group (age ≥75 years, n = 123) and the young group (age <75, n = 475). We compared blood testing data, exercise capacity, cardiac function and prognosis between the two groups. Patients were followed up (median 782 days) to register cardiac deaths or rehospitalization as a result of worsening heart failure.
Results:
Patients in the elderly group were associated with higher frequencies of atrial fibrillation and diuretic use than those in the young group. Patients in the elderly group had lower hemoglobin concentration, more impaired renal function, higher plasma B-type natriuretic peptide (BNP) levels, smaller left ventricular volume, longer deceleration time of early mitral wave and lower exercise capacity than those in the young group. There were 199 cardiac events during follow-up periods. As expected, Kaplan-Meier analysis showed that patients in the elderly group had higher cardiac event rates than those in the young group. In the young group, multivariable Cox hazard analysis showed that hemoglobin concentration, log BNP and peak VO(2) were independent predictors related to cardiac events. In contrast, in the elderly group, estimated glomerular filtration rate, atrial fibrillation and peak VO(2) were independent factors to predict adverse clinical outcomes.
Conclusions:
Prognostic factors were different between the elderly and young patients in CHF.
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