Department of Geriatry, Hôpitaux Universitaire Saint Louis - Lariboisière, Assistance Publique des Hôpitaux de Paris, Paris, France.
University Paris Diderot, Paris, France.
Eur J Heart Fail. 2015 Nov;17(11):1114-23. doi: 10.1002/ejhf.330. Epub 2015 Sep 30.
To assess, according to age groups, patients' characteristics according to region of origin, the chronic therapeutic management, prognostic utility of clinical variables, and natriuretic peptides.
The GREAT registry consisted of patients identified as presenting with acute heart failure at the emergency department. Four groups of patients were defined according to age: the young patient group (<65 years); 'middle-old' (65-74 years), 'old-old' (75-84 years) and the 'oldest-old' (85-94 years). Follow-up at 1 year was performed via personal contact or national data registries at 1 year. Dataset consisted of 14 758 patients aged up to 95 years, with the 'oldest-old' group being more prevalent in North America and Western Europe. The 30-day mortality rate were, respectively, 8.1%, 8.9%, 10.3%, and 16.3% among the four age groups and 1-year mortality rates were, respectively, 3.1%, 17.1%, 24.7%, and 39.9%. Chronic heart failure treatment was less frequently administered with age (percentage of the 'fully treated' group was 14% in the 'young' compared with 2% in the 'oldest-old' patient group). Reduced left ventricular ejection fraction was present in 70%, 62.3%, 52.5%, and 46.8% among the four age groups, respectively. The prognostic utility of most variables for short- and long-term outcome was attenuated with age, with the exception of natriuretic peptides.
This study found a large heterogeneity in age among geographic regions and that the eldest are less likely to be treated in accordance with recommendations of current heart failure guidelines. Natriuretic peptide concentrations retained prognostic value in patients across age strata.
根据年龄组评估患者的原籍地区分布特征、慢性治疗管理情况、临床变量的预后价值和利钠肽。
GREAT 登记研究纳入了在急诊科就诊的急性心力衰竭患者。根据年龄将患者分为 4 组：年轻患者组（<65 岁）；“中老年人”组（65-74 岁）、“老年人”组（75-84 岁）和“最老老年人”组（85-94 岁）。通过个人联系或国家数据登记处进行为期 1 年的随访。数据集包括年龄最大可达 95 岁的 14758 例患者，其中“最老老年人”组在北美和西欧更为常见。4 个年龄组的 30 天死亡率分别为 8.1%、8.9%、10.3%和 16.3%，1 年死亡率分别为 3.1%、17.1%、24.7%和 39.9%。随着年龄的增长，心力衰竭的慢性治疗频率降低（“完全治疗”组的百分比在年轻患者组为 14%，而在最老老年人组为 2%）。左心室射血分数降低分别见于 70%、62.3%、52.5%和 46.8%的 4 个年龄组。大多数变量对短期和长期预后的预后价值随着年龄的增长而降低，但利钠肽除外。
本研究发现地理区域之间存在很大的年龄异质性，最老老年人不太可能按照当前心力衰竭指南的建议进行治疗。利钠肽浓度在各年龄段患者中仍具有预后价值。
