Impact of selenium deficiency on clinical outcomes in elderly patients with acute heart failure: a prospective observational study
S Watanabe, J Onuma, R Ishida, R Masuda, M UsuiAbstract
Background
The "Heart Failure Pandemic" in the rapidly aging global population has emerged as a critical socio-economic challenge. While recent European data suggest an association between low serum selenium levels and poor prognosis in heart failure (HF), the prevalence and clinical significance of selenium deficiency specifically in the very elderly (≥75 years) remain inadequately characterized. Given selenium’s vital role in antioxidant defense and myocardial function, identifying it as a modifiable prognostic factor is of paramount importance.
Methods
We prospectively analyzed 367 consecutive patients aged 75 years or older hospitalized for acute HF between 2020 and 2024. Patients were stratified into two groups based on admission serum selenium levels: the Selenium Deficiency (SD) group (<10.0 μg/dL, n=171) and the Normoselenemia (NS) group (≥10.0 μg/dL, n=196), using the established clinical reference threshold. The primary endpoints were one-year all-cause mortality and heart failure-related readmission.
Results
The prevalence of selenium deficiency was remarkably high, affecting 46.6% of the entire cohort.Baseline Characteristics: Compared to the NS group, the SD group exhibited significantly lower Body Mass Index (20.9 ±2.9 vs. 22.0±3.8 kg/m², P=0.02) and serum albumin levels (3.2 ±0.5 vs. 3.5±0.5 g/dL, P<0.001). Furthermore, the SD group demonstrated lower Left Ventricular Ejection Fraction (LVEF: 49.4 ±16.4% vs. 54.3±15.5%, P=0.003) and higher serum creatinine levels (1.5 ± 0.9 vs. 1.3 ± 0.7 mg/dL, P=0.02).Clinical Outcomes: The SD group suffered significantly worse clinical outcomes at one year:All-cause mortality: 28.7% (SD) vs. 16.8% (NS), P=0.006HF readmission rate: 45.8% (SD) vs. 25.6% (NS), P<0.001Multivariate Analysis: After adjusting for confounding factors, selenium deficiency remained a robust independent predictor of HF readmission (Odds Ratio: 0.77; 95% CI: 0.67–0.88, P<0.001).
Conclusion
Selenium deficiency is strikingly prevalent—affecting nearly one in two elderly HF patients—and serves as a potent independent predictor of poor clinical prognosis. These findings suggest that serum selenium is not merely a marker of malnutrition but a crucial factor in HF pathophysiology. Routine screening and potential therapeutic supplementation in this vulnerable population warrant urgent investigation to mitigate the burden of the HF pandemic.