Prognostic Factors in Stage D Heart Failure in the Very Elderly
2009; Karger Publishers; Volume: 55; Issue: 6 Linguagem: Inglês
10.1159/000237872
ISSN1423-0003
AutoresIsabelle Martin-Pfitzenmeyer, S. Gauthier, Michèle Bailly, Nathalie Loi, Laura Popitéan, Philippe d’Athis, Anne‐Marie Bouvier, Pierre Pfitzenmeyer,
Tópico(s)Dialysis and Renal Disease Management
Resumo<i>Background:</i> The clinical characteristics of frail older patients with advanced heart failure have scarcely been studied. <i>Objective:</i> To describe this population and to identify some prognostic factors of mortality. <i>Methods:</i> 104 patients aged 75 years and older hospitalized with refractory heart failure were enrolled in a prospective multicentric study. <i>Results:</i> Mean age was 87.2 ± 5.3 years. Dyspnea (79.8%), crepitant rales (76.9%) and peripheral edema (73.1%) were particularly frequent. Signs of low cardiac output such as renal insufficiency (46.9%), cutaneous low flow (40.4%), and systolic hypotension (≤100 mm Hg) (24.3%) were observed less often. Signs of cognitive impairment including anxiety (55.4%), sleep disorders (43.7%) and delirium (35.5%) were frequent. Asthenia and chronic pain were noted in 92.3 and 37.5% of cases, respectively. Mortality rates were 32.7, 59.6 and 71.2% during hospitalization, at 6 months and at 12 months, respectively. According to the multivariate Cox model, six significant factors suggesting a poor prognosis were observed: chronic renal insufficiency, past neuropsychological pathology, long-term treatment with nitrates, presence of edema, low cutaneous flow, and pain. The ability to sit on a chair was the only significant factor associated with a good prognosis. <i>Conclusion:</i> Our study identified some clinical and prognostic factors which had been observed in very old patients with refractory heart failure. Pain management has to be a priority in these patients in order to improve their quality of life.
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