Document Detail


Chronic heart failure in the very elderly: clinical status, survival, and prognostic factors in 188 patients more than 70 years old.
MedLine Citation:
PMID:  11431675     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
M Cicoira; C H Davos; V Florea; W Shamim; W Doehner; A J Coats; S D Anker
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American heart journal     Volume:  142     ISSN:  0002-8703     ISO Abbreviation:  Am. Heart J.     Publication Date:  2001 Jul 
Date Detail:
Created Date:  2001-06-29     Completed Date:  2001-08-09     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  174-80     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiac Medicine, National Heart and Lung Institute, London, United Kingdom. arossi@cardiovr.univr.it
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Chronic Disease
Echocardiography
Exercise Test*
Female
Follow-Up Studies
Heart Failure / mortality*,  physiopathology*
Hemodynamics
Humans
Male
Prognosis
Proportional Hazards Models
Pulmonary Gas Exchange
Regression Analysis
Survival Analysis

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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