PREVALENCE AND CLINICAL OUTCOME OF MAIN ECHOCARDIOGRAPHIC AND HEMODYNAMIC HEART FAILURE PHENOTYPES IN A POPULATION OF HOSPITALIZED PATIENTS 70 YEARS OLD AND OLDER

BACKGROUND: Heart failure (HF) echocardiographic and hemodynamic categories are poorly characterized in the elderly. We aimed to evaluate the prevalence and clinical outcomes of echocardiographic and hemodynamic HF phenotypes in a consecutive series of hospitalized patients aged ≥70 years.

METHODS: All consecutive patients ≥70 years old discharged from the Internal Medicine Unit of our Hospital with a diagnosis of HF, between January and November 2020, entered this retrospective study. All patients underwent physical examination, complete blood tests, chest-X ray and transthoracic echocardiography. At 1-year follow-up, we evaluated the occurrence of the composite outcome of all‐cause mortality and re-hospitalization.

RESULTS: 261 patients (86.3±6.4 yrs, 60.9% women) were retrospectively analyzed. From the study group, 106 “old” (70-84 yrs) and 155 “oldest-old” (≥85 yrs) patients were separately analyzed. A total of 169 (64.7%) patients reported the composite outcome during follow-up: 41 (15.7%) died and 128 (49.0%) were re-hospitalized. At 1-year follow-up, survival analysis did not show any statistically significant difference between age groups (p = 0.31) and between HF echocardiographic categories (p=0.34), whereas HF patients with “cold-dry” phenotype had significantly poorer survival compared to the other hemodynamic subtypes (p<0.001). Male sex (HR 1.44, 95%CI 1.04-1.98), “cold-dry” phenotype (HR 3.90, 95%CI 1.73-8.77), high sodium level (HR 1.03, 95%CI 1.01-1.04) and low estimated glomerular filtration rate (eGFR) (HR 0.98, 95%CI 0.97-0.99) were independently associated with the outcome occurrence.

CONCLUSIONS: Male sex, “cold-dry” phenotype, high sodium level and low eGFR are the main adverse prognostic indicators over a mid-term follow-up in hospitalized patients aged ≥70 yrs.