Chronic heart failure in elderly people: clinical course and prognosis depending on the functional state of left ventricle
Larina V. N., Bart B. Ya., Dergunova E. N., Alieva Z. I.
Keywords: age, left ventricle, prognosis, CHF
Relevance. Chronic HF still has a high prevalence rate and poor clinical outcome, particularly in older age groups. Objective. Study of CHF course, quality of life and prognosis in patients at the age of 60 years and older who have been followed up in outpatient clinics for a long period of time. Materials and methods. Depending on LVEF level, 248 patients with CHF II–IV FC (NYHA) were divided into 2 groups: the 1st group included 119 patients with LVEF≤45 %, the 2nd one included 129 patients with LVEF >45 %. Results. CHF patients with preserved LVEF were older than patients with reduced LVEF (р=0.014). In II FC 59.7 % patients with preserved LVEF and 12.6 % with reduced LVEF corresponded (р<0.001). 34.5 % patients with reduced LVEF and only 2.9 % – with preserved LVEF had IV FC (p<0.001). Hypothyroidism (р=0.005), obesity (р<0.001), lipid disorders (р=0.005) and LV hypertrophy (р<0.001) occurred more often in CHF patients with preserved LVEF, than in patients with reduced LVEF. Quality of life in both groups is comparable (р=0.084). Patients with reduced LVEF walked shorter distance in 6 minutes, than patients with preserved LVEF [260 (200–380) m and 325 (250–390) m, relatively, р=0.003]. Restrictive and possibly pseudonormal types of disorders were registered more often in patients with LVEF≤45 % in comparison with patients with LVEF>45 %, in whom poorer LV compliance prevailed. Lethal risk in elderly CHF patients with reduced LVEF was 5 time higher than risk of death of preserved LVEF patients (OR 5.35). Predictors of lethal outcome in elderly CHF patients were CHF FC (OR 1.45), LVEF (OR –0.54) and hyperuricemy (OR 2.93). Conclusion. Elderly CHF patients with preserved LVEF have more легкое течение заболевания, they have more often an extracardiac accompanying pathology and better survival rate, that that of patients with reduced LVEF. Predictors of lethal outcome in elderly patients with CHF were FC, LVEF and hyperuricemy.
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Larina V. N., Bart B. Ya., Dergunova E. N., Alieva Z. I. Chronic heart failure in elderly people: clinical course and prognosis depending on the functional state of left ventricle. Russian Heart Failure Journal. 2012;13(2):67-72