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Author Spotlight: Unveiling Prognostic Indicators in Heart Failure - The Role of Phase Angle and Bioelectrical Impedance Analysis
Published on: June 30, 2023
Prognostic value of geriatric and cardiac parameters for one-year mortality in older heart failure patients. A
L Kestens1, S Billet1, L Hens2
1Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium.
Insights
Older heart failure patients with lower blood pressure and more severe comorbidities face higher one-year mortality risk. Functional status and geriatric risk profiles did not predict survival in this high-risk group.
Area of Science:
- Geriatric Medicine
- Cardiology
- Internal Medicine
Background:
- Heart failure (HF) is a prevalent condition in the elderly population, often associated with a poor prognosis.
- Identifying older HF patients at high risk for mortality is crucial for effective clinical management and resource allocation.
Purpose of the Study:
- To identify prognostic, geriatric, and cardiac parameters that can predict one-year mortality in older patients hospitalized with heart failure.
- To differentiate between factors influencing survival in elderly individuals with HF.
Main Methods:
- A multicentre, observational cohort study involving 147 heart failure patients aged 75 years and older.
- Patients were recruited from cardiac or geriatric departments of two hospitals.
- One-year survival was the primary outcome measure, analyzed using univariate (Chi-square, T-test) and multivariate (Logistic, Cox regression) methods.
Main Results:
- The one-year mortality rate was 28% (41/147).
- Non-survivors exhibited significantly lower systolic blood pressure at discharge (125.26 mmHg vs. 137.59 mmHg) and more severe comorbidities (age-adjusted Charlson Comorbidity Index: 8.80 vs. 7.40) compared to survivors.
- Decreasing systolic blood pressure and increasing Charlson Comorbidity Index were significant predictors of mortality (Logistic and Cox regression analyses).
Conclusions:
- Lower systolic blood pressure at discharge and a higher comorbidity burden are independently associated with increased one-year mortality in older, hospitalized heart failure patients.
- Patient functionality and the presence of a geriatric risk profile were not significantly related to one-year mortality in this cohort.
Purpose:
Heart failure is prevalent among older people and has a poor prognosis. The aim of this study is to identify potential prognostic, geriatric, and cardiac parameters which could help clinicians identify older heart failure patients at high risk for one-year mortality.
Methods:
The multicentre, observational cohort study which included 147 heart failure patients aged ≥75 years, hospitalized in the cardiac or geriatric department in two hospitals. One-year survival was the outcome measure. For univariate analysis Chi-square test and independent sample T-test were used; for multivariate analysis Logistic regression and Cox regression for time-dependent analysis.
Results:
One-year mortality was 28% (41/147). One-year survivors and non-survivors did not differ in the following characteristics: age, gender, sodium level at hospital discharge, ejection fraction, NYHA Class, basic and instrumental activities of daily living, and the presence of a geriatric risk profile. There was a significant lower systolic blood pressure at discharge in non-survivors compared to one-year-survivors (mean 125.26 mmHg vs. 137.59 mmHg). Non-survivors had more severe underlying comorbidities according to the age adjusted Charlson Comorbidity index (CCI) (mean 8.80 vs. 7.40).Both logistic and Cox regression showed a higher risk and rate of mortality with decreasing systolic blood pressure at discharge (OR 0.963, p=0.001 and HR 0.970, p<0.001) and with increasing CCI (OR 1.344, p=0.002 and HR 1.269, p=0.001); the other variables were not significantly related.
Conclusion:
Lower blood pressure and more severe comorbidities, but not functionality nor the presence of a geriatric risk profile, are related to one-year mortality in older, in-hospital heart failure patients.
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