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

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.

Retrospective cohort study.

Kyorin University Hospital.

Individuals with acute decompensated HF (N = 335).

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.

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.

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.