The Effects Of Aging On Clinical Features And Prognosis Of Patients With Heart Failure

Purpose: Heart failure(HF)is the serious and terminal stage of multiple heart disease and a major public health issues affecting approximately 23 million patients around the world.According to the epidemiology of HF,the prevalence of the disease is increasing owing to the aging population.The prevalence is about 1-2% in adults but more than 10% in people over the age of 70.This chronic,developmental disease remains the leading cause of hospitalization in an older population aged over 65 years and imposed a massive socio-economic burden through the use of a large amount of medical resources.Nowadays,gradual update and fast advancement of medical technology,such as reperfusion,has saved many patients with cardiovascular disease,including acute myocardial infaraction.However,the incidence of elders’ heart failure increased despite their survival.Heart failure is one of the most common causes of death among the elderly.The incidence of the sudden death is five times that of the general population.Heart failure has a high mortality rate and the five-year survival rate is less than 50%.The ESC heart failure guidelines in 2016 has recategorized causes of heart failure according to the LVEF: it adds a HFmrEF based on the HFrEF <40%;LVEF and HFpEF;LVEF ≥50%.Since then,the ACC/ AHA Heart Failure administration guideline in 2017 and the guidelines for the diagnosis and treatment of heart failure in China in 2018 both adopted the same methods of diagnosis,establishing HFmrEF as an independently identified type of heart failure.Since this is a new subtype,the relationship between age and this subtype is barely published and reported in medical journals.Therefore,this article will discuss the relationship among three subtypes of heart failures with the aging population.Heart failure has become one of the severe threats to the elders’ survival.This research aims to observe the effects of aging on clinical features and prognosis of patients with heart failure.It plays an important role in optimizing the living standard of an increasing number of elder patients and providing the best therapeutic strategies.Method: The data comes from a multicenter cohort study(Clinical registration study)of chronic heart failure in the elderly in Tianjin,China.A multicenter retrospective cohort study was adopted in this research to collect data from nine tertiary hospitals in Tianjin from March in 2014 to February in 2016.A total of 1747 patients were followed up for 2-year outcome events with complete data.These patients were mainly caused by heart failure and NYHA cardiac function classification II-IV.These patients are categorized into three groups based on age: 650 cases from non-elderly group(<65 years),718 cases from the general elderly group(aged 65 and 79 years),and 379 cases from the advanced senior group(aged ≥80 years).This research is going to analyze the effects of aging on clinical features and prognosis of heart failure patients.Results:(1)Effect of aging on gender composition of patients with heart failure: after analyzing their age stratification,the male gradually decreases while the female goes up with aging(the ratio of males in non-elderly,elderly and advanced senior group is 74.9%,59.2% and 55.1%,respectively,P < 0.001).(2)Effects of aging on the categorization of heart failure: with aging,the ratio of HFrEF patients gradually declines(the ratio in non-elderly,elderly,and advanced senior group is 49.2%,39.8 % and 34.6%,respectively,P < 0.001)The ratio of HFmrEF patients in non-elderly,elderly,and advanced senior group is 27.5%,27.9 % and 27.7%,respectively.The ratio is not influenced by aging.(P>0.05).(3)After comparing the etiology of heart failure and its complication in different age groups,the etiology and comorbidity were as follows: coronary heart disease(CHD)(79.8%),high blood pressure(60.3%),arrhythmia(50.8%),diabetes(32.0%),pulmonary infection(28.5%),cerebrovascular diseases(24.0%),and renal insufficiency(20.9%).Among all these causes,CHD is the leading cause.With aging,the proportion of CHD,pulmonary,cerebrovascular diseases,and renal insufficiency in all three age groups showed a gradually increasing trend.The ratio of senior aging group developing these diseases is higher than the non-elderly group(P<0.001).With aging,the ratio of senior aging group developing arrhythmia is higher than the non-elderly group,the ratio of general elderly group developing arrhythmia is higher than the senior aging group(P<0.05).With aging,three groups heart failure patients’ comorbidities gradually increase: 3.1±1.4 in non-elderly group,3.6±1.5 in elderly group and 4.0±1.8 in advanced senior group(P<0.001).(4)Comparing different HF age groups’ drug use demonstrates that with aging,the proportion of using diuretics and nitrates among the three age groups gradually increases(P<0.05);the proportion of using ACEIs,β-blockers,digitalis,and anticoagulants among the three age groups gradually decreases(P<0.05).However,there is no obvious change in the proportion of using ARBs,MRAs and CCBs among the three groups with the aging(P>0.05).The ratio of Energy metabolism drugs in non-elderly,elderly,and advanced senior group is 47.6%,37.2 % and 41.4%,respectively(P < 0.001),Among them non-elderly’s use is higher than the elderly(P<0.001).The ratio of using antiplatelet in non-elderly,elderly,and advanced senior group is 74.5%,79.5% and 72.8% respectively(P<0.05).Among them the elderly’s use is higher than non-elderly(P<0.001),and the senior group’s use is lower than non-elderly(P < 0.001).(5)Comparing the relationship between aging and the severity of heart failure and comparative indicators include NYHA and days of hospitalization.With aging,the proportion of NYHA II HF patients among the three groups gradually decreases(26.8%,16.7%,and 9.2% respectively,P<0.001),while the NYHA IV HF patients gradually increases(19.5%,27.7%,and 53.3% respectively,P<0.001).The proportion of NYHA III HF patients among the three groups is 46.9%、53.1%,and 37.2%(P<0.001).The rate of NYHA III in patients with heart failure in the elderly group was higher than that in non-elderly and advanced senior group,the rate of NYHA III in patients with heart failure in the non-elderly group was higher than that in advanced senior group(both P<0.001).The hospitalization days among non-elderly,elderly and the senior group are 10.38±15.5 days,11.69±20.2 days,and 14.65±24.8 days respectively(P<0.05).Among them the senior group’s hospitalization days are obviously longer than non-elderly’s(P<0.001).(6)The impact of aging on prognosis the follow-up of all picked heart failure patients for 2-year outcome events.Clinical endpoints include all-cause mortality,heart failure readmission,and the composite end point(i.e.all-cause mortality + heart failure readmission).all-cause mortality rate,heart failure readmission rate and the occurrence rate of composite endpoint among non-elderly,elderly,and senior group gradually increases with aging(All-cause mortality rate is 19.1%,32.6%,and 44.1% respectively.Heart failure readmission rate is 20.5%,27.7%,and 33.5% respectively.The occurrence rate of composite end point is 32.8%,47.1%,and 63.1% respectively.P<0.001).With aging,the risks of heart failure patients have noticeably increased in all-cause mortality,heart failure readmission,and the composite end point.In contrast with the non-elderly group,the proportion of elde rly and senior group’s HR of all-cause mortality is 1.81(95% CI 1.45-2.25)and 1.67(95% CI 1.49-1.88);the HR of heart failure readmission is 1.41(95% CI 1.13-1.75),1.34(95% CI 1.18-1.51);the HR of end point is 1.54(95% CI 1.30-1.83)and 1.53(95% CI 1.39-1.68).Conclusions: Aging has noticeable impacts on the clinical characteristics and the prognosis of heart failure patients.(1)Aging has noticeable difference on gender composition of patients with heart failure: after analyzing their age stratification,the male gradually decreases while the female goes up with aging.(2)Aging impacts the percentage of different categories of heart failure: with aging,the ratio of HFrEF patients gradually declines.The ratio of HFpEF patients gradually increases,while the ratio in HFmrEF is not influenced by aging.(P>0.05).(3)The etiology of heart failure and comorbidity tend to increase with aging: the incidence of coronary heart disease(CHD),pulmonary infection,cerebrovascular diseases and renal insufficiency has gradually increased and comorbidity has increased too.Among all these causes,CHD is the most common cause.(4)Different HF age groups have different reaction to drug use : with aging,the proportion of using diuretics and nitrates gradually increases;the proportion of using ACEIs,β-blockers,digitalis and anticoagulants gradually decreases.However,there is no change in the proportion of using ARBs,MRAs and CCBs among all age groups.(5)HF patients suffer from more severe condition and worse prognosis with aging: with aging,those heart failure patients have weaker cardiac function,longer hospitalization,high incidence of occurrence in two years of all-cause mortality rate,heart failure readmission rate and composite endpoints.