Characteristics of heart failure in the elderly — A hospital cohort registry-based study

Abstract 

Heart failure patient in the elderly is a growing population with poor prognosis. However this patient population has not been well studied. The present study is based on a hospital cohort heart failure registry during 2005 at Heart Failure Centre Medicine, Dept. of Medicine, SU/Sahlgrenska Hospital.

In this study 150 patients were enrolled consecutively for analysis. They are aged around 80 years old with high comorbidity. One-year mortality is 30%. Multivariate analyses demonstrated that significant prognostic indicators for mortality are increasing age, New York Heart Association functional class and presence of comorbidities such as chronic obstructive pulmonary disease and renal failure. The use of aldosterone receptor antagonist is also associated with poor prognosis. Prescriptions of ACE inhibitor and beta-blockers are 57.5% and 73% respectively. Added-on therapy with angiotensin receptor 1 antagonist is few. In around 30% of prescriptions of ACE inhibitors daily dose is less than half of target dose. In around 54% of beta-blockers daily dose is less than half of target dose. There are clear potential for improved medications with guideline recommended agents in light of the fact that in these study patients 82% of heart rates is >60 beats/min, 84% of S-creatinine is <150 mmol/l, 17.4% of systolic blood pressure is 140–160 mmHg and 10% is 160–180 mmHg.

Conclusions

This study provides an insight into the characteristics of a very old heart failure group with high comorbidity and mortality in a real situation. In agreement with previous studies, increasing age was associated with reduced likelihood of treatment particularly in ACE inhibitor and angiotensin receptor 1 blocker but this has been improved particularly in beta-blocker. There is a need to further improve education and application of guideline recommended medications for patients with heart failure for their well-being and survival.

Keywords: Heart failure, Elderly, Comorbidity, Prognosis, Medication