Acute Heart Failure in the Elderly: Differences in Clinical Characteristics, Outcomes, and Prognostic Factors in the VERITAS Study

• Interaction between age and prognostic variables in acute heart failure (VERITAS trial)
• Older patients had more comorbidities, hypertension, and atrial fibrillation
• Older patients had increased mortality and rehospitalizations
• Value of some prognostic variables differed according to age
• BUN and hemoglobin more important in younger, albumin more in older patients

BackgroundAcute heart failure (HF) is common in the elderly, but the association of age with clinical outcomes and prognostic factors has not been examined thoroughly.Methods and ResultsWe analyzed the clinical and laboratory characteristics and the outcomes of 1,347 patients with acute HF enrolled in the VERITAS trial. Subjects were subdivided based on their median age of 72 years. Older patients had a higher prevalence of comorbidities and a higher prevalence of hypertension and atrial fibrillation. During a mean follow-up of 149 ± 61 days, 432 patients (32.1%) reached the composite end point of death, in-hospital worsening HF, or HF rehospitalization by 30 days, and 135 patients (10.4%) died by 90 days, with a worse outcome in elderly patients in both cases. At multivariable analysis, different variables were related with each of these outcomes in elderly compared with younger patients. Regarding deaths at 90 days, plasma urea nitrogen and hemoglobin levels were predictive only in the younger patients, whereas respiratory rate and albumin levels were associated with mortality only in the older patients.ConclusionsElderly patients with acute HF have different clinical characteristics and poorer outcomes. Prognostic variables differ in elderly compared with younger patients.