Clinical profile, management, and mortality in very-elderly patients hospitalized with acute decompensated heart failure: An analysis from the ATTEND registry

•Frequency of preserved left ventricular function increased with advancing age.•Coronary risk factors excluding hypertension were lowest in very-elderly patients.•Diuretics and vasodilators were administered well in older patients.•However, very-elderly patients had worst cardiac mortality.•Further, very-elderly patients were at high risk for cardiac death even though it was their first episode.

BackgroundAcute decompensated heart failure (ADHF) is a leading cause of hospitalization among the elderly. Discussion of optimal management of ADHF in older patients is a growing health care priority. The aim of this study was to examine the clinical profile, management, and mortality in patients admitted with ADHF according to age.MethodsWe analyzed 4824 patients enrolled in the Acute Decompensated Heart Failure Syndromes registry from April 2007 to December 2011. Patient characteristics, management, and in-hospital outcomes were compared among four age groups (< 65, 65–74, 75–84, and ≥ 85 years).ResultsThe mean age of the overall population was 73 years; approximately 20% were aged ≥ 85 years. Older patients were more likely to be women and have preserved left ventricular ejection fraction (LVEF) and decreased renal function. Intravenous treatments were well administered in both young and elderly patients irrespective of LVEF. Invasive procedures were less frequently performed in the eldest group. The median length of hospital stay was 21 days, and in-hospital cardiac death in the eldest group was four-fold higher than that in the youngest group (2.2% vs. 8.9%, P < 0.001).ConclusionsClinical characteristics of ADHF differ considerably with age, and cardiac death increases linearly with age. Despite a higher rate of preserved systolic function in very-elderly individuals aged ≥ 85 years, in-hospital mortality was higher, suggesting that more suitable treatments for the elderly might be needed.