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. 2021 Jun 28;18(6):407-415.
doi: 10.11909/j.issn.1671-5411.2021.06.003.

Acute heart failure in the elderly: setting related differences in clinical features and management

Francesco Orso  1 , Alessandra Pratesi  2 , Andrea Herbst  1 , Anna Chiara Baroncini  1 , Francesca Bacci  3 , Gabriele Ciuti  4 , Andrea Berni  5 , Camilla Tozzetti  5 , Carlo Nozzoli  3 , Alberto Moggi Pignone  4 , Loredana Poggesi  5 , Luciano Gabbani  6 , Mauro Di Bari  1   2 , Francesco Fattirolli  2   7 , Massimo Milli  8 , Andrea Ungar  1   2 , Niccolò Marchionni  2   7 , Samuele Baldasseroni  1
Affiliations

Acute heart failure in the elderly: setting related differences in clinical features and management

Francesco Orso et al. J Geriatr Cardiol. .

Abstract

Background: Administrative data show that acute heart failure (HF) patients are older than those enrolled in clinical registries and frequently admitted to non-cardiological settings of care. The purpose of this study was to describe clinical characteristics of old patients hospitalised for acute HF in Cardiology, Internal Medicine or Geriatrics wards.

Methods: Data came from ATHENA (AcuTe Heart failurE in advaNced Age) registry which included elderly patients (≥ 65 years) admitted to the above mentioned settings of care from December 1, 2014 to December 1, 2015.

Results: We enrolled 396 patients, 15.4% assigned to Cardiology, 69.7% to Internal Medicine, and 14.9% to a Geriatrics ward. Mean age was 83.5 ± 7.6 years (51.8% of patients ≥ 85 years) and was higher in patients admitted to Geriatrics (P < 0.001); more than half were females. Medical treatments did not differ significantly among settings of care (in a context of a low prescription rate of renin-angiotensin-aldosterone system inhibitors) whereas significant differences were observed in comorbidity patterns and management guidelines recommendation adherence for decongestion evaluation with comparison of weight and N-terminal pro-B-type natriuretic peptide levels on admission and at discharge (both P = 0.035 and P < 0.001), echocardiographic evaluation ( P < 0.001) and follow-up visits planning ( P < 0.001), all higher in Cardiology. Mean in-hospital length of stay was 9 ± 5.9 days, significantly higher in Geriatrics (13.7 ± 6.5 days) and Cardiology (9.9 ± 6.7 days) compared to Internal Medicine (8 ± 5.2 days), P < 0.001. In-hospital mortality was 9.3%, resulting higher in Geriatrics (18.6%) and Cardiology (16.4%) than Internal Medicine (5.8%), P = 0.001.

Conclusions: In elderly patients hospitalised for acute HF, clinical characteristics and management differ significantly according to the setting of admission.

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Figures

Figure 1
Figure 1
Total in-hospital length of stay (A) and in-hospital mortality (B) in the study population and among the different settings of care.
Figure 2
Figure 2
Follow-up visit planning at discharge in study population and among the different settings of care.
See this image and copyright information in PMC

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