Long-term prognosis after acute heart failure: a differential impact of age in different age strata

Increasing age predicts ominous prognosis in heart failure. Age influences the success of therapeutic approaches and interacts with other prognostic predictors. We aimed to study the impact of age in long-term survival in different age strata.

Patients were prospectively included in an acute heart failure registry; those with acute coronary syndromes and those with primary valvular disease were excluded. Outcome studied was all-cause mortality. Follow-up was 5 years. A receiver-operating characteristic curve was used to define the age cut-off for 5-year death prediction. A multivariate Cox regression analysis was used to study mortality predictors. Analysis was stratified according to the 75-year-age cut-off.

We studied 473 patients. Mean age was 75 ± 12 years, 48.4% were men and 68.7% had reduced ejection fraction. Older patients were more often women, with preserved ejection fraction, history of arterial hypertension and atrial fibrillation; they were discharged in higher NYHA classes and with lower haemoglobin. Older patients were less often discharged with evidence-based heart failure therapy. In 5 years, 339 (71.7%) patients died. Patients aged more than 75 years had a multivariate-adjusted hazard ratio of mortality of 1.87 (95% confidence interval 1.46-2.38). In older patients, there was a 5% mortality increase per each 1-year increase in age; 75 years or less, age had no prognostic impact; and P for interaction (age continuous and age dichotomized) was 0.01.

Age is a strong long-term prognostic determinant in acute heart failure. The prognostic impact of age was significantly different between age subgroups: it was an independent predictor of mortality in patients aged more than 75 years and had no impact in those aged 75 years or less.