Cardiology Department, Hospital Clínico Universitario. Universitat de Valencia. INCLIVA. Valencia-Spain.
Cardiology Department, Hospital Clínico Universitario. Universitat de Valencia. INCLIVA. Valencia-Spain; CIBER Cardiovascular.
Eur J Intern Med. 2020 Nov;81:78-82. doi: 10.1016/j.ejim.2020.05.017. Epub 2020 Jun 15.
INTRODUCTION: There is scarce information about the clinical profile and prognosis of acute heart failure (AHF) at the extreme ranges of age. We aimed to evaluate the 1-year death (all-cause mortality and HF-death) and HF-rehospitalizations of patients ≥85 years admitted for AHF. METHODS: We prospectively evaluated a cohort of 3054 patients admitted with AHF from 2007 to 2018 in a third-level center. Age was categorized per 10-year categories (<65 years; 65-74 years, 75-84 years, and ≥85 years). The risk of mortality and HF-rehospitalizations across age categories was evaluated with Cox regression analysis and Cox regression adapted for competing events as appropriate. RESULTS: The mean age was 73.6 ± 11.2 years, 48.9% were female, and 52.8% had preserved left ventricular ejection fraction (HFpEF). A total of 414 (13.6%) patients were ≥85 years. Among this group of age, female sex and HFpEF phenotype were more frequent. At 1-year follow-up 667 all-cause deaths (22,1%), 311 HF-deaths (10.1%) and 693 HF-hospitalizations (22,7%) were recorded. After multivariable adjustment, and compared to patients <65 years, a stepwise increased risk of all-cause mortality and HF-death was found for each decade increase in age, especially for patients ≥85 years (HR=3.47; 95% CI: 2.49 - 4.84, p<0.001, HR=3.31; 95% CI: 1.95 - 5.63; p<0.001, respectively). This subgroup of patients also showed an increased risk of HF-rehospitalization (HR=1.58; 95% CI: 1.16 - 2.16, p=0.004). CONCLUSIONS: Super elderly patients admitted with AHF showed a dramatically increased risk of 1-year death. This subset of patients also shown an increased risk of 1-year HF-readmission.
介绍:关于年龄处于极值的急性心力衰竭(AHF)患者的临床特征和预后的信息十分匮乏。我们旨在评估因 AHF 入院且年龄≥85 岁的患者在 1 年内的死亡(全因死亡率和 HF 死亡率)和 HF 再入院情况。
方法:我们前瞻性评估了 2007 年至 2018 年期间在一家三级中心因 AHF 入院的 3054 例患者。年龄按每 10 岁分类(<65 岁;65-74 岁,75-84 岁,≥85 岁)。使用 Cox 回归分析和适当的 Cox 回归分析来评估跨年龄组的死亡率和 HF 再入院风险。
结果:平均年龄为 73.6±11.2 岁,48.9%为女性,52.8%左心室射血分数保留(HFpEF)。共有 414 名(13.6%)患者年龄≥85 岁。在这一年龄组中,女性和 HFpEF 表型更为常见。在 1 年的随访中,记录到 667 例全因死亡(22.1%),311 例 HF 死亡(10.1%)和 693 例 HF 入院(22.7%)。在多变量调整后,与<65 岁的患者相比,年龄每增加 10 岁,全因死亡率和 HF 死亡率的风险逐渐增加,尤其是年龄≥85 岁的患者(HR=3.47;95%CI:2.49-4.84,p<0.001,HR=3.31;95%CI:1.95-5.63;p<0.001)。这一年龄组的患者也显示出 HF 再入院的风险增加(HR=1.58;95%CI:1.16-2.16,p=0.004)。
结论:因 AHF 入院的超高龄患者在 1 年内死亡的风险显著增加。该亚组患者在 1 年内 HF 再入院的风险也增加。
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