Clinical characteristics and in-hospital outcomes in octogenarians compared with younger patients with heart failure
A Preveden, M Belopavlovic, M Rodic, N Stipic, A Milovancev, S Cemerlic Maksimovic, T Popov, R Stefanetti, A Fuller, S Charman, N Okwose, Dj Jakovljevic, L VelickiAbstract
Background
Heart failure (HF) in older adults is characterized by distinct clinical presentation and outcomes. Octogenarians and older patients constitute a growing subgroup, yet data comparing their clinical profile with younger HF patients remain limited.
Purpose
The aim of this study was to compare clinical characteristics and in-hospital mortality between octogenarians and younger patients hospitalized for HF.
Methods
This cross-sectional study analyzed 2,227 consecutive patients hospitalized for HF. Patients were divided into two groups according to age: <80 years and ≥80 years. Clinical characteristics, laboratory parameters, echocardiographic findings, and in-hospital mortality were compared between the groups.
Results
Octogenarians accounted for 488 patients (21.9%) of the cohort. Compared with younger patients, octogenarians had a higher proportion of females (47.9% vs. 31.1%, p<0.001). They more frequently presented with advanced NYHA functional class (NYHA IV: 69.9% vs. 60.9%, p<0.001) and dyspnea (58.6% vs. 50.6%, p=0.002), but less often had fatigue and peripheral edema. Octogenarians had higher prevalence of hypertension and atrial fibrillation, but lower prevalence of diabetes. They had higher levels of inflammatory and renal biomarkers, including CRP, urea, creatinine, troponin and NT-proBNP (all p<0.001), and lower hemoglobin levels (p<0.001). Echocardiography revealed smaller left ventricular dimensions and volumes, higher left ventricular ejection fraction and lower tricuspid annular plane systolic excursion in octogenarians (all p<0.001). Octogenarians more frequently had HFpEF (33.4% vs. 20.8%, p<0.001). In-hospital mortality was higher in octogenarians (30.9% vs. 22.0%, p<0.001).
Conclusion
Octogenarians exhibit a distinct HF phenotype with worse outcomes and specific clinical and echocardiographic characteristics, supporting the need for age-adjusted management strategies.Distribution of HF types across age groups