Congestive Heart FailureChronic heart failure in the very elderly: Clinical status, survival, and prognostic factors in 188 patients more than 70 years old☆
Section snippets
Methods
We evaluated 188 consecutive patients with CHF who were >70 years old seen at the Heart Failure Clinic of the Royal Brompton Hospital between March 1992 and June 1998 (134 men, 54 women, mean age ± SD 76.7 ± 4.5 years). In this time period a total of 580 patients was seen in our clinic (ie, the elderly representing 32% of our CHF population). The diagnosis of heart failure was based on a history of dyspnea and symptomatic exercise intolerance with signs of pulmonary congestion or peripheral
Results
The clinical characteristics of the study population are summarized in Table I. Twenty-three (12%) patients had CHF of New York Heart Association (NYHA) functional class I, 81 (43%) class II, 62 (33%) class III, and 22 (12%) class IV. A total of 85% were taking an ACE inhibitor, 72% a diuretic, and only 15% a β-blocker. The etiology of CHF was ischemic heart disease in 123 patients (66%), idiopathic dilated cardiomyopathy in 27 (14%), valvular heart disease in 13 (7%), restrictive in 10 (5%),
Discussion
In the current study we describe survival in 188 patients with CHF >70 years old and the feasibility of exercise testing and the impact of its results on prognosis assessment in this population. Overall prognosis in this patient group was poor, with a mortality rate of 26% at 12 months. Cardiopulmonary exercise testing was performed in >50% of patients, and peak VO2 was the strongest predictor of impaired survival in the study population.
Although the prevalence of CHF in the very elderly is
Conclusions
This study shows that prognosis in very elderly patients with CHF is poor, and the strongest prognostic factors are NYHA class and peak VO2. Hemodynamic parameters such as LVEF play an important role; in fact, patients with impaired systolic function are at higher risk of death than are patients with preserved systolic function. We identified a small subgroup of patients with dynamic left ventricular outflow obstruction with a particularly favorable outcome. We would like to underline the
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Reprint requests: Mariantonietta Cicoira, MD, Divisione di Cardiologia, Universitá degli Studi di Verona, Ospedale Civile Maggiore, P.le Stefani, 1, 37126 Verona, Italy. E-mail: [email protected]