Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima City, Fukushima, Japan.
Geriatr Gerontol Int. 2017 Nov;17(11):2194-2199. doi: 10.1111/ggi.13060. Epub 2017 May 21.
To investigate the clinical features of heart failure in extremely elderly patients.
We analyzed 1163 consecutive hospitalized heart failure patients. The patients were divided into an extremely elderly group (≥85 years-of-age, n = 88) and a non-extremely elderly group (<85 years-of-age, n = 1075).
The extremely elderly group had higher rates of hypertension, chronic kidney disease, anemia, higher systolic blood pressure and lower body mass index, and lower use of β-blockers and anticoagulants compared with the non-extremely elderly group. During the mean follow-up period of 1038 days, the extremely elderly group had higher mortality compared with the non-extremely elderly group (P < 0.001). In multivariate analysis, in the non-extremely elderly group, age (HR 1.027, P < 0.001), body mass index (HR 0.919, P < 0.001), New York Heart Association III or IV (HR 3.626, P < 0.001), preserved ejection fraction (HR 0.553, P < 0.001), anemia (HR 1.941, P < 0.001), β-blockers (HR 0.695, P = 0.028) and renin-angiotensin system inhibitors (HR 0.603, P = 0.001) were independent predictors for all-cause death. In contrast, atrial fibrillation (HR 2.042, P = 0.015) and renin-angiotensin system inhibitors (HR 0.470, P = 0.014) were independent predictors for all-cause death in the extremely elderly group, suggesting that the prognostic factors were different between the two groups.
We should be careful of atrial fibrillation and renin-angiotensin system inhibitors in managing extremely elderly patients with heart failure. Geriatr Gerontol Int 2017; 17: 2194-2199.
探讨高龄老年心力衰竭患者的临床特征。
分析了 1163 例连续住院心力衰竭患者。患者分为高龄组（≥85 岁，n=88）和非高龄组（<85 岁，n=1075）。
高龄组高血压、慢性肾脏病、贫血发生率较高，收缩压较高，体质指数较低，β受体阻滞剂和抗凝剂使用率较低。在平均 1038 天的随访期间，高龄组死亡率高于非高龄组（P<0.001）。多因素分析显示，在非高龄组中，年龄（HR 1.027，P<0.001）、体质指数（HR 0.919，P<0.001）、纽约心脏协会（NYHA）心功能分级 III 或 IV 级（HR 3.626，P<0.001）、射血分数保留（HR 0.553，P<0.001）、贫血（HR 1.941，P<0.001）、β受体阻滞剂（HR 0.695，P=0.028）和肾素-血管紧张素系统抑制剂（HR 0.603，P=0.001）是全因死亡的独立预测因素。相反，高龄组心房颤动（HR 2.042，P=0.015）和肾素-血管紧张素系统抑制剂（HR 0.470，P=0.014）是全因死亡的独立预测因素，提示两组患者的预后因素不同。
管理高龄老年心力衰竭患者时，应注意心房颤动和肾素-血管紧张素系统抑制剂的使用。
