Congestive Heart Failure
Chronic heart failure in the very elderly: Clinical status, survival, and prognostic factors in 188 patients more than 70 years old

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Abstract

Background Chronic heart failure (CHF) is a frequent disease with a dismal prognosis, but little is known about survival in the very elderly. There are no data on the prognostic value of cardiopulmonary exercise testing in this population. We aimed to assess exercise capacity, survival, and prognostic parameters in elderly patients with CHF. Methods We evaluated 188 patients with CHF >70 years old (mean 77 ± 4 years, range 70-94 years) seen at our heart failure clinic between March 1992 and June 1998. A cardiopulmonary exercise test was performed in 102 patients (peak VO2 15.3 ± 4.7, VE/VCO2 slope 39.6 ± 15.01). All patients were followed up for at least 12 months. The prognostic end point of the study was all-cause mortality. Results At the end of follow-up (16 ± 10 mo, range 12-41 mo), 67 patients (35.6%) had died (1-year mortality rate 26% [95% confidence interval 20-32]). In univariate analysis New York Heart Association class (NYHA) (relative risk [RR] = 2.56, P <.0001), VE/VCO2 (RR = 1.041, P <.0001), peak VO2 (RR = 0.87, P =.0007), and fractional shortening (RR = 0.95, P <.0001) predicted mortality. Peak VO2 predicted mortality independently of age, NYHA class, and left ventricular ejection fraction. A subgroup of 12 patients with dynamic left ventricular outflow tract obstruction during stress had an excellent outcome, with a 100% survival at the end of follow-up (mean 16 ± 7 mo, range 12-39 mo). Conclusions The prognosis in elderly patients with CHF is poor. Valid exercise testing results can be obtained in more than 50% of elderly patients with CHF. NYHA class and peak VO2 are the strongest prognostic factors in this population. (Am Heart J 2001;142:174-80.)

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

References (33)

  • PA Ades et al.

    Referral patterns and exercise response in the rehabilitation of female coronary patients aged > 62 years

    Am J Cardiol

    (1992)
  • M Metra et al.

    Use of cardiopulmonary exercise testing with haemodynamic monitoring in the prognostic assessment of ambulatory patients with chronic heart failure

    J Am Coll Cardiol

    (1999)
  • WC Brogan et al.

    The natural history of isolated left ventricular diastolic dysfunction

    Am J Med

    (1992)
  • JN Cohn et al.

    A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congestive heart failure

    N Engl J Med

    (1991)
  • SOLVD Investigators

    Effect of enalapril on survival in patients with reduced left ventricular ejection fraction and congestive heart failure

    N Engl J Med

    (1991)
  • WM Smith

    Epidemiology of congestive heart failure

    Am J Cardiol

    (1985)
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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]

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