LONG-TERM PROGNOSIS AND MODES OF DEATH IN HEART FAILURE PATIENTS WITH REDUCED VERSUS PRESERVED LEFT VENTRICULAR SYSTOLIC FUNCTION

Background: There are conflicting reports regarding the prognosis of heart failure patients with preserved (HFPSF) comparative to reduced systolic left ventricular function (HFRSF). We evaluated the clinical characteristics, mortality rates and modes of death in 309 consecutive symptomatic heart failure patients. In 133(56%) patients LVEF was <50% (HFRSF), and in 133 (44%), LVEF was ≥50% (HFPSF). Methods: Three hundred nine consecutive patients hospitalized between January 1, 2009 and January 1, 2010 (176 men and 133 women, mean age 64.3 years) were followed up for a mean period of 23±14 months. The severity of symptoms at admission was assessed by NYHA classification. 196 patients were in NYHA class I-II, and 113 in III–IV. All patients underwent chest X-ray, echocardiogram, and a 6-minute walking test. We compared the clinical profiles, mortality rates and modes of death. Results: More than a third (44%) of the patients had preserved systolic LVEF based on echocardiography. Compared to the HFPSF group, HFRSF patients were predominantly younger males with ischemic aetiology and less cardiovascular comorbidities such as obesity, hypertension, diabetes mellitus and atrial fibrillation. During a mean follow-up period of 1.9 years, 22 (7.1%) patients died: 14 of cardiac causes and 8 of non-cardiac causes (4 of respiratory causes, 2 of stroke, 1 of major bleeding and 1 of cancer). Overall mortality was similar between the two groups: 8 (6%) in HFPSF patients and 14 (7.9%) in HFRSF patients (p=0.67). HFRSF patients had higher death rates due to pump failure compared to the HFPSF group [ 5/14(36%) vs. 1/8(12%) patients, p=0.5]. Non-cardiac deaths were more frequent in HFPSF group [4/8 (50%) patients vs. 4/14(28%) patients, respectively, p=0.5]. The prevalence of arrhythmic death was similar in the two groups [5/14(36%) vs.3/8(37%) patients, p=0.6]. With Cox stepwise regression analysis for survival, the independent predictors for mortality were age, gender, ischemic etiology of heart failure and renal impairment. Conclusions: Although the characteristics of HFPSF and SHF patients are different, the mortality rates were similar in our study. The mode of death was different among the two groups of patients, as pump failure death rate was higher in patients with LVEF <50%, while non-cardiac death was higher in heart failure patients with preserved systolic function. The differences were not statistically significant. A high NYHA class at admission, age over 65, male gender and renal impairment were related to a worse prognosis

Heart failure as a predictor of functional dependence in hospitalized elderly

AbstractOBJECTIVEIdentify whether Heart Failure (HF) is a predictor of functional dependence for Basic Activities of Daily Living (BADL) in hospitalized elderly.METHODSWe investigated medical records and assessed dependence to BADL (by the Katz Index) of 100 elderly admitted to a geriatric ward of a university hospital. In order to verify if HF is a predictor of functional dependence, linear regression analyzes were performed.RESULTSThe prevalence of HF was 21%; 95% of them were dependent for BADLs. Bathing was the most committed ADL. HF is a predictor of dependence in hospitalized elderlies, increasing the chance of functional decline by 5 times (95% CI, 0.94-94.48), the chance of functional deterioration by 3.5 times (95% CI, 1.28-11.66; p <0.02) and reducing 0.79 points in the Katz Index score (p <0.05).CONCLUSIONHF is a dependency predictor of ADL in hospitalized elderly, who tend to be more dependent, especially for bathing

Factors associated with prolonged hospitalization, readmission, and death in elderly heart failure patients in western Romania

Istvan Gyalai-Korpos,1,2 Oana Ancusa,1,2 Tiberiu Dragomir,1,2 Mirela Cleopatra Tomescu,1,2 Iosif Marincu1,3 1University of Medicine and Pharmacy, 2Cardiology Department, City Hospital, 3Department of Epidemiology and Infectious Diseases, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania Purpose: The purpose of this prospective study was to identify factors associated with prolonged hospitalization, readmission, and death in elderly patients presenting heart failure with reduced ejection fraction.Patients and methods: All consecutive patients aged &ge;65 years discharged with a diagnosis of acute new-onset heart failure and a left ventricular ejection fraction (LVEF) &le;45% were included and followed up for 1 year. The variables associated with outcomes were analyzed in univariate and multivariate logistic regression. For the independent predictors identified by multivariate analysis, receiver operating characteristic (ROC) analysis was performed.Results: A total of 71 patients were included in the study. The patient mean age was 72.5 years, 50% were female, and the mean LVEF was 31.25%&plusmn;5.76%. In all, 34 (48%) patients experienced prolonged hospitalization, and this was independently associated with patients who were living in a rural area (P=0.005), those with a New York Heart Association functional class of 4 (P&lt;0.001), the presence of comorbidities (P=0.023), chronic obstructive pulmonary disease (COPD) infectious exacerbation (P&lt;0.001), and chronic kidney disease (P=0.025). In the multivariate analysis, only COPD infectious exacerbation was independently associated with prolonged hospitalization (P=0.003). A total 19 patients (27%) experienced readmissions during the 1-year follow up, of which 12 (17%) had cardiovascular causes and seven (10%) had noncardiovascular causes. The following independent variables associated with rehospitalizations were outlined in the univariate analysis: infections (P&lt;0.020); COPD infectious exacerbation (P=0.015); one or more comorbidity (P&lt;0.0001); and prolonged baseline hospitalization (P&lt;0.0001). During the multivariate analysis, it was found that the independent predictors of readmissions were the presence of comorbidities (P&lt;0.001) and prolonged baseline hospitalization (P&lt;0.01). The 1-year mortality rate was 9.8%, with no significant difference between cardiovascular (5.6%) and noncardiovascular (4.2%) deaths. The only independent predictive variable for mortality was a New York Heart Association NYHA functional class 4 at baseline hospitalization (P=0.001).Conclusion: Elderly patients are at high risk for prolonged hospitalization, readmission, and death following a first hospitalization for heart failure with reduced ejection fraction. The most powerful predictors for outcomes are the severity of heart failure, the presence of comorbidities, and prolonged hospitalization at baseline. Keywords: reduced ejection fraction, outcome predictors, comorbidities, acute new onset heart failure, left ventricular ejection fractio