Prevalence and clinical outcome of main echocardiographic and hemodynamic heart failure phenotypes in a population of hospitalized patients 70 years old and older.
Echocardiographic categories
Elderly
Heart failure
Hemodynamic categories
Outcome
Journal
Aging clinical and experimental research
ISSN: 1720-8319
Titre abrégé: Aging Clin Exp Res
Pays: Germany
ID NLM: 101132995
Informations de publication
Date de publication:
May 2022
May 2022
Historique:
received:
12
09
2021
accepted:
07
11
2021
pubmed:
7
1
2022
medline:
31
5
2022
entrez:
6
1
2022
Statut:
ppublish
Résumé
Heart failure (HF) echocardiographic and hemodynamic categories are poorly characterized in the elderly. We aimed to evaluate the prevalence and clinical outcomes of echocardiographic and hemodynamic HF phenotypes in a consecutive series of hospitalized patients aged ≥ 70 years. All consecutive patients ≥ 70 years old discharged from the Internal Medicine Unit of our Hospital with a diagnosis of HF, between January and November 2020, entered this retrospective study. All patients underwent physical examination, complete blood tests, chest X-ray and transthoracic echocardiography. At 1-year follow-up, we evaluated the occurrence of the composite outcome of all-cause mortality and re-hospitalization. Two hundred and sixty-one patients (86.3 ± 6.4 years, 60.9% women) were retrospectively analyzed. From the study group, 106 "old" (70-84 years) and 155 "oldest-old" (≥ 85 years) patients were separately analyzed. A total of 169 (64.7%) patients reported the composite outcome during follow-up: 41 (15.7%) died and 128 (49.0%) were re-hospitalized. At 1-year follow-up, survival analysis did not show any statistically significant difference between age groups (p = 0.31) and between HF echocardiographic categories (p = 0.34), whereas HF patients with "cold-dry" phenotype had significantly poorer survival compared to the other hemodynamic subtypes (p < 0.001). Male sex (HR 1.44, 95% CI 1.04-1.98), "cold-dry" phenotype (HR 3.90, 95% CI 1.73-8.77), high sodium level (HR 1.03, 95% CI 1.01-1.04) and low estimated glomerular filtration rate (eGFR) (HR 0.98, 95% CI 0.97-0.99) were independently associated with the outcome occurrence. Male sex, "cold-dry" phenotype, high sodium level and low eGFR are the main adverse prognostic indicators over a mid-term follow-up in hospitalized patients aged ≥ 70 years.
Sections du résumé
BACKGROUND
BACKGROUND
Heart failure (HF) echocardiographic and hemodynamic categories are poorly characterized in the elderly. We aimed to evaluate the prevalence and clinical outcomes of echocardiographic and hemodynamic HF phenotypes in a consecutive series of hospitalized patients aged ≥ 70 years.
METHODS
METHODS
All consecutive patients ≥ 70 years old discharged from the Internal Medicine Unit of our Hospital with a diagnosis of HF, between January and November 2020, entered this retrospective study. All patients underwent physical examination, complete blood tests, chest X-ray and transthoracic echocardiography. At 1-year follow-up, we evaluated the occurrence of the composite outcome of all-cause mortality and re-hospitalization.
RESULTS
RESULTS
Two hundred and sixty-one patients (86.3 ± 6.4 years, 60.9% women) were retrospectively analyzed. From the study group, 106 "old" (70-84 years) and 155 "oldest-old" (≥ 85 years) patients were separately analyzed. A total of 169 (64.7%) patients reported the composite outcome during follow-up: 41 (15.7%) died and 128 (49.0%) were re-hospitalized. At 1-year follow-up, survival analysis did not show any statistically significant difference between age groups (p = 0.31) and between HF echocardiographic categories (p = 0.34), whereas HF patients with "cold-dry" phenotype had significantly poorer survival compared to the other hemodynamic subtypes (p < 0.001). Male sex (HR 1.44, 95% CI 1.04-1.98), "cold-dry" phenotype (HR 3.90, 95% CI 1.73-8.77), high sodium level (HR 1.03, 95% CI 1.01-1.04) and low estimated glomerular filtration rate (eGFR) (HR 0.98, 95% CI 0.97-0.99) were independently associated with the outcome occurrence.
CONCLUSIONS
CONCLUSIONS
Male sex, "cold-dry" phenotype, high sodium level and low eGFR are the main adverse prognostic indicators over a mid-term follow-up in hospitalized patients aged ≥ 70 years.
Identifiants
pubmed: 34988931
doi: 10.1007/s40520-021-02025-4
pii: 10.1007/s40520-021-02025-4
doi:
Substances chimiques
Sodium
9NEZ333N27
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1081-1094Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.
Références
Cleland JGF, van Veldhuisen DJ, Ponikowski P (2019) The year in cardiology 2018: heart failure. Eur Heart J 40:651–661
pubmed: 30778534
doi: 10.1093/eurheartj/ehz010
Groenewegen A, Rutten FH, Mosterd A et al (2020) Epidemiology of heart failure. Eur J Heart Fail 22:1342–1356
pubmed: 32483830
doi: 10.1002/ejhf.1858
Redfield MM, Jacobsen SJ, Burnett JC et al (2003) Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA 289:194–202
pubmed: 12517230
doi: 10.1001/jama.289.2.194
Bleumink GS, Knetsch AM, Sturkenboom MCJM et al (2004) Quantifying the heart failure epidemic: prevalence, incidence rate, lifetime risk and prognosis of heart failure. The Rotterdam study. Eur Heart J 25:1614–1619
pubmed: 15351160
doi: 10.1016/j.ehj.2004.06.038
Mosterd A, Hoes AW (2007) Clinical epidemiology of heart failure. Heart 93:1137–1146
pubmed: 17699180
pmcid: 1955040
doi: 10.1136/hrt.2003.025270
McMurray JJ, Adamopoulos S, Anker SD et al (2012) ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 14:803–869
pubmed: 22828712
doi: 10.1093/eurjhf/hfs033
van Riet EE, Hoes AW, Wagenaar KP et al (2016) Epidemiology of heart failure: the prevalence of heart failure and ventricular dysfunction in older adults over time. A systematic review. Eur J Heart Fail 18:242–252
pubmed: 26727047
doi: 10.1002/ejhf.483
Benjamin EJ, Virani SS, Callaway CW et al (2018) Heart disease and stroke statistics—2018 update: a report from the American Heart Association. Circulation 137:e67–e492
pubmed: 29386200
doi: 10.1161/CIR.0000000000000558
Braunstein JB, Anderson GF, Gerstenblith G et al (2003) Noncardiac comorbidity increases preventable hospitalizations and mortality among medicare beneficiaries with chronic heart failure. J Am Coll Cardiol 42:1226–1233
pubmed: 14522486
doi: 10.1016/S0735-1097(03)00947-1
Ather S, Chan W, Bozkurt B et al (2012) Impact of noncardiac comorbidities on morbidity and mortality in a predominantly male population with heart failure and preserved versus reduced ejection fraction. J Am Coll Cardiol 59:998–1005
pubmed: 22402071
pmcid: 4687406
doi: 10.1016/j.jacc.2011.11.040
Allen LA, Fonarow GC, Liang L et al (2015) Medication initiation burden required to comply with heart failure guideline recommendations and hospital quality measures. Circulation 132:1347–1353
pubmed: 26316616
pmcid: 4941099
doi: 10.1161/CIRCULATIONAHA.115.014281
Manemann SM, Chamberlain AM, Boyd CM et al (2016) Multimorbidity in heart failure: effect on outcomes. J Am Geriatr Soc 64:1469–1514
pubmed: 27348135
pmcid: 4943753
doi: 10.1111/jgs.14206
Cannon JA, Moffitt P, Perez-Moreno AC et al (2017) Cognitive impairment and heart failure: systematic review and meta-analysis. J Card Fail 23:464–475
pubmed: 28433667
doi: 10.1016/j.cardfail.2017.04.007
Gorodeski EZ, Goyal P, Hummel SL et al (2018) Domain management approach to heart failure in the geriatric patient: present and future. J Am Coll Cardiol 71:1921–1936
pubmed: 29699619
pmcid: 7304050
doi: 10.1016/j.jacc.2018.02.059
Ponikowski P, Voors AA, Anker SD et al (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 37:2129–2200
pubmed: 27206819
doi: 10.1093/eurheartj/ehw128
Butrous H, Hummel SL (2016) Heart failure in older adults. Can J Cardiol 32:1140–1147
pubmed: 27476982
doi: 10.1016/j.cjca.2016.05.005
Jensen J, Hedin L, Widell C et al (2008) Characteristics of heart failure in the elderly—a hospital cohort registry-based study. Int J Cardiol 125:191–196
pubmed: 18029036
doi: 10.1016/j.ijcard.2007.10.003
Vorilhon C, Chenaf C, Mulliez A et al (2015) Heart failure prognosis and management in over-80-year-old patients: data from a French national observational retrospective cohort. Eur J Clin Pharmacol 71:251–260
pubmed: 25537794
doi: 10.1007/s00228-014-1794-7
Mueller C, McDonald K, de Boer RA et al (2019) Heart Failure Association of the European Society of Cardiology practical guidance on the use of natriuretic peptide concentrations. Eur J Heart Fail 21:715–731
pubmed: 31222929
doi: 10.1002/ejhf.1494
Paulus WJ, Tschope C, Sanderson JE et al (2007) How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J 28:2539–2550
pubmed: 17428822
doi: 10.1093/eurheartj/ehm037
Dokainish H, Nguyen JS, Bobek J et al (2011) Assessment of the American Society of Echocardiography-European Association of Echocardiography guidelines for diastolic function in patients with depressed ejection fraction: an echocardiographic and invasive haemodynamic study. Eur J Echocardiogr 12:857–864
pubmed: 21890470
doi: 10.1093/ejechocard/jer157
Lang RM, Badano LP, Mor-Avi V et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an up-date from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 16:233–270
pubmed: 25712077
doi: 10.1093/ehjci/jev014
Nagueh SF, Smiseth OA, Appleton CP et al (2016) Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 29:277–314
pubmed: 27037982
doi: 10.1016/j.echo.2016.01.011
Savarese G, Lund LH (2017) Global public health burden of heart failure. Card Fail Rev 3:7–11
pubmed: 28785469
pmcid: 5494150
doi: 10.15420/cfr.2016:25:2
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group (2013) KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 3:1–150
doi: 10.1038/kisup.2012.73
Verbalis JG, Goldsmith SR, Greenberg A et al (2013) Diagnosis, evaluation and treatment of hyponatremia: expert panel recommendations. Am J Med 126:S1-42
pubmed: 24074529
doi: 10.1016/j.amjmed.2013.07.006
Muhsin SA, Mount DB (2016) Diagnosis and treatment of hypernatremia. Best Pract Res Clin Endocrinol Metab 30:189–203
pubmed: 27156758
doi: 10.1016/j.beem.2016.02.014
Rudski LG, Lai WW, Afilalo J et al (2010) Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 23:685–713
pubmed: 20620859
doi: 10.1016/j.echo.2010.05.010
Nishimura RA, Otto CM, Bonow RO et al (2017) 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation 135:e1159–e1195
pubmed: 28298458
doi: 10.1161/CIR.0000000000000503
Lee DS, Gona P, Vasan RS et al (2009) Relation of disease etiology and risk factors to heart failure with preserved or reduced ejection fraction: insights from the national heart, lung, and blood institute’s Framingham heart study. Circulation 119:3070–3077
pubmed: 19506115
pmcid: 2775498
doi: 10.1161/CIRCULATIONAHA.108.815944
Magana-Serrano JA, Almahmeed W, Gomez E et al (2011) Prevalence of heart failure with preserved ejection fraction in Latin American, Middle Eastern, and North African Regions in the I PREFER study (identification of patients with heart failure and PREserved Systolic Function: an epidemiological regional study). Am J Cardiol 108:1289–1296
pubmed: 22000627
doi: 10.1016/j.amjcard.2011.06.044
Ho JE, Gona P, Pencina MJ et al (2012) Discriminating clinical features of heart failure with preserved vs. reduced ejection fraction in the community. Eur Heart J 33:1734–1741
pubmed: 22507977
pmcid: 3530391
doi: 10.1093/eurheartj/ehs070
Kaneko H, Suzuki S, Yajima J et al (2013) Clinical characteristics and long-term clinical outcomes of Japanese heart failure patients with preserved versus reduced left ventricular ejection fraction: a prospective cohort of Shinken Database 2004–2011. J Cardiol 62:102–109
pubmed: 23731923
doi: 10.1016/j.jjcc.2013.03.013
Martinez-Brana L, Mateo-Mosquera L, Bermudez-Ramos M et al (2015) Clinical characteristics and prognosis of heart failure in elderly patients. Rev Port Cardiol 34:457–463
pubmed: 26162285
doi: 10.1016/j.repc.2015.02.002
Roger VL, Weston SA, Redfield MM et al (2004) Trends in heart failure incidence and survival in a community-based population. JAMA 292:344–350
pubmed: 15265849
doi: 10.1001/jama.292.3.344
Owan TE, Hodge DO, Herges RM et al (2006) Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med 355:251–259
pubmed: 16855265
doi: 10.1056/NEJMoa052256
Upadhya B, Kitzman DW (2020) Heart failure with preserved ejection fraction: New approaches to diagnosis and management. Clin Cardiol 43:145–155
pubmed: 31880340
doi: 10.1002/clc.23321
Toso A, Castelvecchio S, Menicanti L et al (2020) Prognostic value of natriuretic peptides and restrictive filling pattern before surgical ventricular restoration. J Thorac Cardiovasc Surg S0022–5223:32827
Paulus WJ, Tschöpe C (2013) A novel paradigm for heart failure with preserved ejection fraction: comorbidities drive myocardial dysfuntion and remodeling through coronary microvascular inflammation. J Am Coll Cardiol 62:263–271
pubmed: 23684677
doi: 10.1016/j.jacc.2013.02.092
Martín-Sánchez FJ, Carbajosa V, Llorens P et al (2014) Prolonged hospitalization in patients admitted for acute heart failure in the short stay unit (EPICA-UCE study): study of associated factors. Med Clin (Barc) 143:245–251
doi: 10.1016/j.medcli.2013.06.028
Miró Ò, Carbajosa V, Peacock WF et al (2017) The effect of a short-stay unit on hospital admission and length of stay in acute heart failure: REDUCE-AHF study. Eur J Intern Med 40:30–36
pubmed: 28126381
doi: 10.1016/j.ejim.2017.01.015
Martín-Sánchez FJ, Rodríguez-Adrada E, Vidán MT et al (2018) Impact of geriatric assessment variables on 30-day mortality among older patients with acute heart failure. Emergencias 30:149–155
pubmed: 29687668
Ojeda S, Anguita M, Munoz JF et al (2003) Clinical characteristics and medium-term prognosis of patients with heart failure and preserved systolic function. Do they differ in systolic dysfunction? Rev Esp Cardiol 56:1050–1056
pubmed: 14622535
doi: 10.1016/S0300-8932(03)77014-6
Macin SM, Perna ER, Cimbaro Canella JP et al (2004) Differences in clinical profile and outcome in patients with decompensated heart failure and systolic dysfunction or preserved systolic function. Rev Esp Cardiol 57:45–52
pubmed: 14746717
doi: 10.1016/S0300-8932(04)77060-8
Robert ND (2012) The survival of patients with heart failure with preserved or reduced left ventricular ejection fraction: an individual patient data meta-analysis. Eur Heart J 33:1750–1757
doi: 10.1093/eurheartj/ehr254
Mori Y, Nishikawa Y, Kobayashi F et al (2013) Clinical status and outcome of Japanese heart failure patients with reduced or preserved ejection fraction treated with carvedilol. Int Heart J 54:15–22
pubmed: 23428919
doi: 10.1536/ihj.54.15
Yusuf S, Pfeffer MA, Swedberg K et al (2003) Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial. Lancet (London, England) 362:777–781
doi: 10.1016/S0140-6736(03)14285-7
Massie BM, Carson PE, McMurray JJ et al (2008) Irbesartan in patients with heart failure and preserved ejection fraction. N Engl J Med 359:2456–2467
pubmed: 19001508
doi: 10.1056/NEJMoa0805450
Nohria A, Tsang AW, Fang JC et al (2003) Clinical assessment identifies hemodynamic profiles that predict outcomes in patients admitted with heart failure. J Am Coll Cardiol 41:1797–1804
pubmed: 12767667
doi: 10.1016/S0735-1097(03)00309-7
Gheorghiade M, Abraham WT, Albert NM et al (2007) Relationship between admission serum sodium concentration and clinical outcomes in patients hospitalized for heart failure: an analysis from the OPTIMIZE-HF registry. Eur Heart J 28:980–988
pubmed: 17309900
doi: 10.1093/eurheartj/ehl542
Abraham WT, Adams KF, Fonarow GC et al (2005) In-hospital mortality in patients with acute decompensated heart failure requiring intravenous vasoactive medications: an analysis from the Acute Decompensated Heart Failure National Registry (ADHERE). J Am Coll Cardiol 46:57–64
pubmed: 15992636
doi: 10.1016/j.jacc.2005.03.051
Yancy CW, Jessup M, Bozkurt B et al (2013) 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines. J Am Coll Cardiol 62:e147-239
pubmed: 23747642
doi: 10.1016/j.jacc.2013.05.019
Mele D, Pestelli G, Dini FL et al (2020) Novel echocardiographic approach to hemodynamic phenotypes predicts outcome of patients hospitalized with heart failure. Circ Cardiovasc Imaging 13:e009939
pubmed: 32312116
doi: 10.1161/CIRCIMAGING.119.009939
Chioncel O, Mebazaa A, Harjola VP et al (2017) Clinical phenotypes and outcome of patients hospitalized for acute heart failure: the ESC Heart Failure Long-Term Registry. Eur J Heart Fail 19:1242–1254
pubmed: 28463462
doi: 10.1002/ejhf.890
Crespo-Leiro MG, Metra M, Lund LH et al (2018) Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 20:1505–1535
pubmed: 29806100
doi: 10.1002/ejhf.1236
Shah BM, Hajjar ER (2012) Polipharmacy, adverse drug reactions, and geriatric syndromes. Clin Geriatr Med 28:173–186
pubmed: 22500537
doi: 10.1016/j.cger.2012.01.002
Nayor M, Short MI, Rasheed H et al (2020) Aptamer-based proteomic platform identifies novel protein predictors of incident heart failure and echocardiographic traits. Circ Heart Fail 13:e000065
doi: 10.1161/HHF.0000000000000065
Riolet C, Menet A, Verdun S et al (2021) Clinical and prognostic implications of phenomapping in patients with heart failure receiving cardiac resynchronization therapy. Arch Cardiovasc Dis 114:197–210
pubmed: 33431324
doi: 10.1016/j.acvd.2020.07.004