Yang Mingming, Kondo Toru, Anand Inder S, de Boer Rudolf A, Campbell Ross T, Køber Lars, Lam Carolyn S P, Maggioni Aldo P, Martinez Felipe A, O'Meara Eileen, Packer Milton, Sabatine Marc S, Kerr Saraiva Jose F, Shah Sanjiv J, Zannad Faiez, Zile Michael R, Jhund Pardeep S, Solomon Scott D, McMurray John J V
British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.
Eur J Heart Fail. 2024 Aug 21. doi: 10.1002/ejhf.3417.
Although the prevalence of heart failure (HF) increases markedly with advancing age, surprisingly little is known about HF in the very elderly. The aim of this study was to describe the clinical characteristics and outcomes of octogenarians with HF.
Individual participant meta-analysis of patients with HF and reduced, mildly reduced, and preserved ejection fraction (HFrEF, HFmrEF, and HFpEF, respectively) enrolled in eight large randomized trials. Overall, the proportion of octogenarians was 1518 of 20 168 patients (7.5%) with HFrEF, 610 of 4609 (13.2%) with HFmrEF, and 3130 of 15 354 (20.4%) with HFpEF. Regardless of HF phenotype, octogenarian patients were more often female and had more comorbidities, more symptoms and signs of congestion, and worse health status (but not quality of life), in comparison to patients aged <80 years. The incidence (per 100 person-years) of the composite of cardiovascular death or HF hospitalization was 13.3 (95% confidence interval [CI] 12.7-14.0) in octogenarians versus 9.5 (95% CI 9.3-9.7) in non-octogenarians (adjusted hazard ratio [aHR] 1.40, 95% CI 1.32-1.48). Each component of the composite was more frequent in octogenarians with rates of cardiovascular mortality of 7.0 (95% CI 6.5-7.4) per 100 person-years versus 4.9 (95% CI 4.8-5.1) in non-octogenarians (aHR 1.60, 95% CI 1.48-1.72, p < 0.001). Octogenarians received less evidence-based therapy, especially mineralocorticoid receptor antagonists, than younger patients.
Despite worse health status and higher hospitalization and mortality rates, octogenarians were undertreated compared to younger patients.
尽管心力衰竭（HF）的患病率随年龄增长显著增加，但令人惊讶的是，对于高龄老年人的HF了解甚少。本研究的目的是描述八旬老人HF的临床特征和结局。
对纳入八项大型随机试验的射血分数降低、轻度降低和保留的HF患者（分别为HFrEF、HFmrEF和HFpEF）进行个体参与者荟萃分析。总体而言，在20168例HFrEF患者中，八旬老人占1518例（7.5%）；在4609例HFmrEF患者中，八旬老人占610例（13.2%）；在15354例HFpEF患者中，八旬老人占3130例（20.4%）。与年龄<80岁的患者相比，无论HF表型如何，八旬老人患者女性更多，合并症更多，充血症状和体征更多，健康状况更差（但生活质量不差）。八旬老人心血管死亡或HF住院综合发生率（每100人年）为13.3（95%置信区间[CI]12.7-14.0），而非八旬老人为9.5（95%CI 9.3-9.7）（调整后风险比[aHR]1.40，95%CI 1.32-1.48）。综合指标的每个组成部分在八旬老人中更常见，八旬老人心血管死亡率为每100人年7.0（95%CI 6.5-7.4），而非八旬老人为4.9（95%CI 4.8-5.1）（aHR 1.60，95%CI 1.48-1.72，p<0.001）。与年轻患者相比，八旬老人接受的循证治疗较少，尤其是盐皮质激素受体拮抗剂。
尽管八旬老人健康状况较差，住院率和死亡率较高，但与年轻患者相比，其治疗不足。
