Management and 1 year outcome of oldest-old hospitalized heart failure patients: a subacute geriatric hospital survey.

Background: Guidelines are frequently under-implement in older patients with heart failure. Octogenerians are often excluded from clinical trials.

Objectives: To characterize the clinical profile of the oldest-old (age > or =80 years) heart failure patients hospitalized in a subacute geriatric hospital and to evaluate their management and 1 year outcome.

Methods: Patient characteristics and in-hospital course were retrospectively collected. Diagnosis of heart failure was based mainly on clinical evaluation in addition to chest x-ray results and echocardiographic findings when available.

Results: The study population comprised 96 consecutive unselected heart failure patients hospitalized from January to June 2003. The patients were predominantly women (67%), aged 85 +/- 5 years, fully dependent or frail with a high rate of comorbidities. Adherence to guidelines and useof recommended heart failure medications were poor. Their 1 year mortality was 57%. According to logistic regression analysis the predictor of lower 1 year mortality was higher body mass index (odds ratio 0.86, 95% confidence interval 0.78-0.96), and the predictor of higher 1 year mortality was high urea levels (OR 1.04, 95% CI 1.02-1.06).

Conclusions: Our study confirms that the managementof oldest-old heart failure patients hospitalized in a subactute geriatric hospital was suboptimal and their mortality was exceptionally high.