Elderly heart failure with preserved ejection fraction showed different predictors for cardiovascular mortality than their younger counterparts

Abstract

BACKGROUND AND PURPOSE: Heart failure with preserved ejection fraction (HFPEF) has been shown to be more common among the elderly population. Nevertheless, little is known about the clinical characteristics and outcomes specific for this population. METHODS: We retrospectively reviewed 1,940 patients who had their first heart failure admission to our institution between January 2005 and April 2012. Clinical characteristics and outcomes of patients who were ≥70 years of age and had HFPEF, as defined by left ventricular ejection fraction (LVEF) ≥40%, were compared to those who were <70 years of age. Parameters predictive of cardiovascular mortality were studied in a Cox-regression model. RESULTS: Among the 569 patients with HFPEF, 109 (19.2%) were <70 and 460 (80.8%) were ≥70 years old. Compared with those who were <70, patients who were ≥70 were more likely to be female (60.9% vs 46.8%, p=0.009) and have hypertension (75.4% vs 56.9%, p<0.001), but less likely to have diabetes (35.9% vs 49.5%, p=0.01). At a mean follow-up of 35.8±30.2 months, 175 (38.0%) of those who were ≥70 years old and 44 (40.4%) of those who were <70 years old died, of whom 112 (24.3%) and 20 (18.3%) of them died of cardiovascular cause, respectively (log rank test p=0.06). Multivariate model showed that age (HR 1.88 per decade, 95% CI 1.45–2.43, p=0.006), LVEF <50% (HR 2.11, 95% CI 1.24–3.59, p=0.006), systolic blood pressure on admission (HR 0.992, 95% CI 0.986–0.999, p=0.02) and aldosterone antagonist (HR 5.79, 95% CI 2.09–16.03, p=0.001) independently predicted cardiovascular mortality among those who were ≥70 years old, while only smoking history (HR 3.34, 95% CI 1.39–8.03, p=0.007) was found to be predictive of cardiovascular mortality among those who were <70 years old. CONCLUSION: Elderly patients ≥70 years of age who had HFPEF showed similar survival to but different predictors for cardiovascular mortality than their younger counterparts, reflecting potentially different contributing factors to cardiovascular mortality between the two groups of patients. Development of risk model that assesses clinical risk factors and effect of treatment specific for this group of patients can improve their management.