Younger- vs Older-Old Patients with Heart Failure with Preserved Ejection Fraction

Kenichi Matsushita, Kazumasa Harada, Tetsuro Miyazaki, Takamichi Miyamoto, Shun Kosaka, Kiyoshi Iida, Yoshiya Yamamoto, Yuji Nagatomo, Hideaki Yoshino, Takeshi Yamamoto, Ken Nagao, Morimasa Takayama

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

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.

Original languageEnglish
JournalJournal of the American Geriatrics Society
DOIs
Publication statusPublished - 2019 Jan 1
Externally publishedYes

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Heart Failure
Hospital Mortality
Chronic Obstructive Pulmonary Disease
Tokyo
Hypotension
Blood Pressure
Left Ventricular Dysfunction
Hyperlipidemias
Geriatrics
Lung Diseases
Coronary Artery Disease
Creatinine
Diabetes Mellitus
Japan
Body Mass Index
Cohort Studies
Survival Rate
Retrospective Studies
Smoking
Regression Analysis

Keywords

  • aging
  • chronic obstructive pulmonary disease
  • geriatrics
  • heart failure with preserved ejection fraction
  • very old

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Younger- vs Older-Old Patients with Heart Failure with Preserved Ejection Fraction. / Matsushita, Kenichi; Harada, Kazumasa; Miyazaki, Tetsuro; Miyamoto, Takamichi; Kosaka, Shun; Iida, Kiyoshi; Yamamoto, Yoshiya; Nagatomo, Yuji; Yoshino, Hideaki; Yamamoto, Takeshi; Nagao, Ken; Takayama, Morimasa.

In: Journal of the American Geriatrics Society, 01.01.2019.

Research output: Contribution to journalArticle

Matsushita, K, Harada, K, Miyazaki, T, Miyamoto, T, Kosaka, S, Iida, K, Yamamoto, Y, Nagatomo, Y, Yoshino, H, Yamamoto, T, Nagao, K & Takayama, M 2019, 'Younger- vs Older-Old Patients with Heart Failure with Preserved Ejection Fraction', Journal of the American Geriatrics Society. https://doi.org/10.1111/jgs.16050
Matsushita, Kenichi ; Harada, Kazumasa ; Miyazaki, Tetsuro ; Miyamoto, Takamichi ; Kosaka, Shun ; Iida, Kiyoshi ; Yamamoto, Yoshiya ; Nagatomo, Yuji ; Yoshino, Hideaki ; Yamamoto, Takeshi ; Nagao, Ken ; Takayama, Morimasa. / Younger- vs Older-Old Patients with Heart Failure with Preserved Ejection Fraction. In: Journal of the American Geriatrics Society. 2019.
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AU - Matsushita, Kenichi

AU - Harada, Kazumasa

AU - Miyazaki, Tetsuro

AU - Miyamoto, Takamichi

AU - Kosaka, Shun

AU - Iida, Kiyoshi

AU - Yamamoto, Yoshiya

AU - Nagatomo, Yuji

AU - Yoshino, Hideaki

AU - Yamamoto, Takeshi

AU - Nagao, Ken

AU - Takayama, Morimasa

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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.

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.

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KW - heart failure with preserved ejection fraction

KW - very old

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