TY - JOUR
T1 - Younger- vs Older-Old Patients with Heart Failure with Preserved Ejection Fraction
AU - Matsushita, Kenichi
AU - Harada, Kazumasa
AU - Miyazaki, Tetsuro
AU - Miyamoto, Takamichi
AU - Kohsaka, Shun
AU - Iida, Kiyoshi
AU - Yamamoto, Yoshiya
AU - Nagatomo, Yuji
AU - Yoshino, Hideaki
AU - Yamamoto, Takeshi
AU - Nagao, Ken
AU - Takayama, Morimasa
N1 - Funding Information:
The authors thank Nobuko Yoshida (Tokyo CCU Network office) for help with data collection. Financial Disclosure: The Tokyo CCU Network data registry is supported financially by the Tokyo Metropolitan Government. Kenichi Matsushita was supported by research grants from the Japan Society for the Promotion of Science (KAKENHI 17K09523) and the Vehicle Racing Commemorative Foundation (No. 5991). Conflict of Interest: Morimasa Takayama reports receiving lecture fees from Daiichi Sankyo Pharmaceutical Co. Ltd. outside the submitted work. All other authors declare that they have no conflicts of interest to disclose. Author Contributions: Study concept and design, acquisition of data, analysis and interpretation of data, draft of manuscript, and final approval of version to be published: Matsushita. Acquisition of data, analysis and interpretation of data, revision of manuscript for important intellectual content, and final approval of version to be published: Harada, Miyazaki, Miyamoto, Kohsaka, Iida, Yamamoto Y, Nagatomo, Yoshino, Yamamoto T, Nagao, and Takayama. Sponsor's Role: The founding sponsors had no role in the execution of this study or the interpretation of the results.
Publisher Copyright:
© 2019 The American Geriatrics Society
PY - 2019/10/1
Y1 - 2019/10/1
N2 - OBJECTIVES: Heart failure with preserved ejection fraction (HFpEF) is now recognized as a geriatric syndrome with multifactorial pathophysiology and clinical heterogeneity rather than a solely left ventricular diastolic dysfunction. Because the pathophysiology of HFpEF is suggested to differ by age, this study compared the clinical characteristics and prognostic factors between HFpEF patients aged 65 to 84 years and those aged 85 years or older. DESIGN: Retrospective cohort study. SETTING: The Tokyo CCU Network including 73 hospitals in Tokyo, Japan. PARTICIPANTS: Individuals aged 65 years or older with HFpEF (N = 4305). MEASUREMENTS: Very old patients were defined as those aged 85 years or older. Potential risk factors for in-hospital mortality were selected by univariate analyses, and those with a P value <.10 were used in multivariate Cox regression analysis with forward selection (likelihood ratio) to identify significant factors. RESULTS: Prevalence of hypertension was significantly higher in very old patients, whereas prevalence of coronary artery disease, diabetes mellitus, hyperlipidemia, and smoking was significantly higher in patients aged 65 to 84 years. In very old patients, low systolic blood pressure (hazard ratio [HR] =.988), high serum creatinine level (HR = 1.34), and coexisting chronic obstructive pulmonary disease (COPD; HR = 2.01) were identified as independent risk factors for in-hospital mortality. In contrast, low systolic blood pressure (HR =.987) and low body mass index (HR =.935) were identified as independent risk factors in patients aged 65 to 84 years. CONCLUSION: Significant differences were observed in the clinical characteristics and prognostic factors for in-hospital mortality between HFpEF patients aged 65 to 84 and those 85 years and older. Of note, coexisting COPD was associated with significantly lower survival rate only in patients aged 85 years and older, suggesting the prognostic impact of concomitant pulmonary disease in HFpEF may increase with age. These results have implications for future research and management of older HFpEF patients. J Am Geriatr Soc 00:1–6, 2019. J Am Geriatr Soc 67:2123–2128, 2019.
AB - OBJECTIVES: Heart failure with preserved ejection fraction (HFpEF) is now recognized as a geriatric syndrome with multifactorial pathophysiology and clinical heterogeneity rather than a solely left ventricular diastolic dysfunction. Because the pathophysiology of HFpEF is suggested to differ by age, this study compared the clinical characteristics and prognostic factors between HFpEF patients aged 65 to 84 years and those aged 85 years or older. DESIGN: Retrospective cohort study. SETTING: The Tokyo CCU Network including 73 hospitals in Tokyo, Japan. PARTICIPANTS: Individuals aged 65 years or older with HFpEF (N = 4305). MEASUREMENTS: Very old patients were defined as those aged 85 years or older. Potential risk factors for in-hospital mortality were selected by univariate analyses, and those with a P value <.10 were used in multivariate Cox regression analysis with forward selection (likelihood ratio) to identify significant factors. RESULTS: Prevalence of hypertension was significantly higher in very old patients, whereas prevalence of coronary artery disease, diabetes mellitus, hyperlipidemia, and smoking was significantly higher in patients aged 65 to 84 years. In very old patients, low systolic blood pressure (hazard ratio [HR] =.988), high serum creatinine level (HR = 1.34), and coexisting chronic obstructive pulmonary disease (COPD; HR = 2.01) were identified as independent risk factors for in-hospital mortality. In contrast, low systolic blood pressure (HR =.987) and low body mass index (HR =.935) were identified as independent risk factors in patients aged 65 to 84 years. CONCLUSION: Significant differences were observed in the clinical characteristics and prognostic factors for in-hospital mortality between HFpEF patients aged 65 to 84 and those 85 years and older. Of note, coexisting COPD was associated with significantly lower survival rate only in patients aged 85 years and older, suggesting the prognostic impact of concomitant pulmonary disease in HFpEF may increase with age. These results have implications for future research and management of older HFpEF patients. J Am Geriatr Soc 00:1–6, 2019. J Am Geriatr Soc 67:2123–2128, 2019.
KW - aging
KW - chronic obstructive pulmonary disease
KW - geriatrics
KW - heart failure with preserved ejection fraction
KW - very old
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U2 - 10.1111/jgs.16050
DO - 10.1111/jgs.16050
M3 - Article
C2 - 31260098
AN - SCOPUS:85068477334
SN - 0002-8614
VL - 67
SP - 2123
EP - 2128
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 10
ER -
