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Original article
Available online 4 May 2022
Temporal trends in characteristics, treatment, and outcomes of heart failure in octogenarians over two decades
Tendencias temporales en las características, tratamiento y resultados de la insuficiencia cardiaca en octogenarios durante dos décadas
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Renata De Mariaa,
Corresponding author
enata_de_maria@hotmail.com

Corresponding author: Heart Failure Working Group, ANMCO. Via La Marmora 36, 50121 Florence, Italy.
, Mauro Gorib, Marco Marinic, Lucio Gonzinid, Manuela Benvenutoe, Leonarda Cassanitif, Annamaria Municinòg, Alessandro Navazioh, Enrico Ammiratii, Giuseppe Leonardij, Nicoletta Pagnonik, Laura Montagnal, Mariarosaria Catalanom, Paolo Midin, Agata Marina Florestao, Giovanni Pulignanop, Massimo Iacovielloq, on behalf of the Italian Network on Heart Failure (IN-HF) Investigators
a Heart Failure Working Group, Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO), Florence, Italy
b Cardiology Division, Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
c Department of Cardiovascular Sciences Cardiology, Ospedali Riuniti, Ancona, Italy
d ANMCO Research Center, Heart Care Foundation, Florence, Italy
e Intensive Cardiac Care Unit Cardiology and Hemodynamics, Giuseppe Mazzini Hospital, Teramo, Italy
f Cardiology Division, Hospital of National Importance and High Specialization “Garibaldi”, “Garibaldi-Nesima” Hospital, Catania, Italy
g Department of Cardiology, Andrea Gallino Hospital, Genova, Italy
h Cardiology Division, Arcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale (AUSL) di Reggio Emilia – Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy
i De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy
j Severe Heart Failure Unit, Policlinico Catania, Rodolico Hospital, Catania, Italy
k Cardiology and Cardiac Rehabilitation, Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
l Heart Failure Unit, Cardiology Division, San Luigi Gonzaga University Hospital, Orbassano, Italy
m Cardiology Department with Intensive Cardiac Care Unit and Hemodynamics, Azienda Ospedaliera Cannizzaro, Catania, Italy
n Heart Failure and Cardiomyopathies Department, Cardiology Division, Castelli Hospital, Ariccia, Italy
o Cardiology Division Villa Sofia-Regional reference Center for the Diagnosis and Treatment of Heart Failure, Azienda Ospedaliera Villa Sofia-Cervello, Palermo, Italy
p Heart Failure Unit, Cardiology Department, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
q Cardiology Unit, University Hospital Policlinico Riuniti, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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Table 1. Clinical characteristics, drug and device therapy, and outcomes by phenotype
Table 2. Changes in clinical characteristics over time
Table 3. Changes in drug and device therapy over time
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Abstract
Introduction and objectives

Octogenarians represent the most rapidly expanding population segment in Europe. The prevalence of heart failure (HF) in this group exceeds 10%. We assessed changes in clinical characteristics, therapy, and 1-year outcomes over 2 decades in chronic HF outpatients aged ≥ 80 years enrolled in a nationwide cardiology registry.

Methods

We included 2520 octogenarians with baseline echocardiographic ejection fraction measurements and available 1-year follow-up, who were recruited at 138 HF outpatient clinics (21% of national hospitals with cardiology units), across 3 enrolment periods (1999-2005, 2006-2011, 2012-2018).

Results

At recruitment, over the 3 study periods, there was an increase in age, body mass index, ejection fraction, the prevalence of obesity, diabetes, dyslipidemia, pre-existing hypertension, and atrial fibrillation history. The proportion of patients with preserved ejection fraction rose from 19.4% to 32.7% (P for trend <.0001). Markers of advanced disease became less prevalent. Prescription of beta-blockers and mineralocorticoid receptor antagonists increased over time. During the 1-year follow-up, 308 patients died (12.2%) and 360 (14.3%) were admitted for cardiovascular causes; overall, 591 (23.5%) met the combined primary endpoint of all-cause mortality or cardiovascular hospitalization. On adjusted multivariable analysis, enrolment in 2006 to 2011 (HR, 0.70; 95%CI, 0.55-0.90; P=.004) and 2012 to 2018 (HR, 0.61; 95%CI, 0.47-0.79; P=.0002) carried a lower risk of the primary outcome than recruitment in 1999 to 2005.

Conclusions

Among octogenarians, over 2 decades, risk factor prevalence increased, management strategies improved, and survival remained stable, but the proportion hospitalized for cardiovascular causes declined. Despite increasing clinical complexity, in cardiology settings the burden of hospitalizations in the oldest old with chronic HF is declining.

Keywords:
Octogenarians
Chronic heart failure
Temporal trends
Outcomes
Polypharmacy
Abbreviations:
GDMT
HFmrEF
HFpEF
HFrEF
LVEF
Resumen
Introducción y objetivos

Los octogenarios representan el segmento de población de más rápida expansión en Europa; la prevalencia de la insuficiencia cardiaca (IC) en este grupo supera el 10%. Se evaluaron los cambios en las características clínicas, el tratamiento y los resultados a un año durante dos décadas en pacientes ambulatorios con IC crónica de edad ≥80 años incluidos en un registro nacional de cardiología.

Métodos

Se incluyeron 2520 octogenarios con mediciones de la fracción de eyección ecocardiográfica basal y seguimiento a 1 año disponibles, que fueron reclutados en 138 clínicas ambulatorias de IC (21% de los hospitales nacionales con unidades de cardiología), reclutados a lo largo de tres épocas (1999-2005, 2006-2011, 2012-2018).

Resultados

En el momento del reclutamiento, a lo largo de los tres periodos de estudio, aumentaron la edad, el índice de masa corporal, la fracción de eyección, la prevalencia de obesidad, diabetes, dislipidemia, hipertensión preexistente y la historia de fibrilación auricular. La proporción de pacientes con fracción de eyección preservada aumentó del 19,4% al 32,7% (p de tendencia <0.0001). Los marcadores de enfermedad avanzada se hicieron menos prevalentes. La prescripción de bloqueadores beta y antagonistas de los receptores de mineralocorticoides aumentó con el tiempo. Durante el seguimiento a un año, 308 pacientes fallecieron (12,2%) y 360 (14,3%) fueron ingresados por causas cardiovasculares; en total, 591 (23,5%) cumplieron el objetivo primario combinado de mortalidad por todas las causas u hospitalización cardiovascular. Mediante un análisis multivariable ajustado, el reclutamiento en 2006-2011 (HR=0,70; IC95%, 0,55-0,90; p=0,004) y 2012-2018 (HR=0,61; IC95%, 0,47-0,79; p=0,0002), conllevaron un menor riesgo del resultado primario que el reclutamiento en el periodo 1999-2005.

Conclusiones

Entre los octogenarios, a lo largo de dos décadas, la prevalencia de los factores de riesgo aumentó, las estrategias de manejo mejoraron, la supervivencia se mantuvo estable, pero la proporción de hospitalizados por causas cardiovasculares disminuyó. A pesar de la creciente complejidad clínica, en el ámbito de la cardiología la carga de hospitalizaciones en los ancianos con IC crónica está disminuyendo.

Palabras clave:
Octogenarios
Insuficiencia cardiaca crónica
Tendencias temporales
Resultados
Polifarmacia

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