Department of Cardiology, Medipol Üniversity Faculty of Medicine, İstanbul.
Department of Cardiology, University of Health Sciences, Adana Training and Research Hospital, Adana, Turkey.
Heart Lung. 2020 Sep-Oct;49(5):495-500. doi: 10.1016/j.hrtlng.2020.03.023. Epub 2020 May 18.
Elderly patients hospitalized with heart failure (HF) have high mortality rates and requires specific evidence based theraphy, however there are few studies which have focused on patients older than 80 years hospitalized with HF. The aim of the present study is to evaluate the overall clinical characteristics, management, and in-hospital outcomes of elderly patients hospitalized with HF.
Journey-HF study was conducted in 37 different centers in Turkey and recruited 1606 patients who were hospitalized with HF between September 2015 and September 2016. In this study, clinical profile of patients ≥ 80 years old and 65-79 years old hospitalized with HF were described and compared based on EF-related classification: HFrEF (HF with reduced ejection fraction), HFmrEF (HF with mid-range ejection fraction) and HFpEF (HF with preserved ejection fraction).
A total of 1034 elder patients (71.6% 65-79 years old and 28.4% ≥80 years old) were recruited. Of the 65-79 years old patients 67.4% had HFrEF, 16.2% had HFmrEF and 16.3% had HFpEF. Among patients ≥80 years old 61.6% had HFrEF, 15.6% had HmrEF and 22.8% had HFpEF. When compared with patients with HFrEF and HFmrEF, patients ≥80 years old with HFpEF were more likely to be older, have atrial fibrilation (AF), and less likely to have diabetes mellitus (DM), coronary artery disease (CAD) or to be recieving an angiotensin-converting enzyme inhibitor (ACEi) or beta blocker theraphy. When compared to patients 65-79 years old with HFpEF, patients ≥80 years with HFpEF had a higher rate of AF and less likely DM. Acute coronary syndrome was the most common precipitant factor for hospitalization in both age groups with HFrEF group. Arrhythmia was a major precipitant factor for hospitalization of patients ≥80 years old with HFpEF. Non-compliance with theraphy was a major problem of patients ≥80 years old with HFrEF.
Elderly patients with HFrEF, HFmrEF and HFpEF each had characterized unique patient profiles and the guideline recommended medications were less likely to be used in these patient populations. In hospital mortality rate is worrisome and reflects a need for more specific tretment strategy.
患有心力衰竭（HF）的老年住院患者死亡率较高，需要特定的循证治疗，但很少有研究关注年龄在 80 岁以上的 HF 住院患者。本研究旨在评估住院 HF 老年患者的总体临床特征、治疗和住院结局。
旅程-HF 研究在土耳其的 37 个不同中心进行，招募了 2015 年 9 月至 2016 年 9 月期间因 HF 住院的 1606 名患者。在这项研究中，根据 EF 相关分类描述并比较了≥80 岁和 65-79 岁因 HF 住院患者的临床特征：射血分数降低性心力衰竭（HFrEF）、射血分数中间值心力衰竭（HFmrEF）和射血分数保留性心力衰竭（HFpEF）。
共纳入 1034 名老年患者（65-79 岁 71.6%，≥80 岁 28.4%）。65-79 岁患者中，67.4%为 HFrEF，16.2%为 HFmrEF，16.3%为 HFpEF。≥80 岁患者中，61.6%为 HFrEF，15.6%为 HmrEF，22.8%为 HFpEF。与 HFrEF 和 HFmrEF 患者相比，≥80 岁的 HFpEF 患者年龄更大，更有可能患有心房颤动（AF），且更不可能患有糖尿病（DM）、冠心病（CAD）或接受血管紧张素转换酶抑制剂（ACEi）或β受体阻滞剂治疗。与 65-79 岁的 HFpEF 患者相比，≥80 岁的 HFpEF 患者的 AF 发生率更高，DM 发生率更低。急性冠状动脉综合征是 HFrEF 两组住院的最常见诱发因素。心律失常是≥80 岁 HFpEF 患者住院的主要诱发因素。不遵医嘱是≥80 岁 HFrEF 患者的主要问题。
HFrEF、HFmrEF 和 HFpEF 老年患者各有其独特的患者特征，指南推荐的药物在这些患者人群中使用的可能性较小。住院死亡率令人担忧，反映出需要更具体的治疗策略。
