PURPOSE: To assess the prevalence, patient characteristics, repeated hospitalization and prognosis in elderly patients with diastolic heart failure(DHF)in comparison to systolic heart failure (SHF).
METHODS: A clinical analysis of 519 patients above the age 65 years admitted with congestive heart failure (CHF) and was followed up for 5 years (mean 3.4±2 years). We assessed ejection fraction (EF), the prevalence of hypertension, hypertrophy, diabetes mellitus (DM), atrial fibrillation, pulmonary hypertension, and coronary artery disease (CAD). Follow-up included management and correlation with repeated hospitalization, length of hospital stay (LOS), morbidity, and 5 years survival.
RESULTS: Patients were divided into two groups: 321 (61.8%) Patients with preserved left ventricular (LV) systolic function with EF ≥50% (P) and 198 patients with reduced LV function with EF < 50% (R). The prevalence of hypertension (81%) was the strongest predictor of CHF in elderly population, followed by DM (46%), and CAD (33%). Compared to SHF, DHF was more predominant in; elderly female (38 vs. 26%, P = 0.007), hypertensive (86 vs.72%, P = 0.0001), and LV hypertrophy (67 vs. 45 %, P = 0.001). Pulmonary systolic pressures, left atrial size, E/A ratio were lower in DHF as well as treatment with B-blockers, diuretics, ACEI, and digoxin. Readmission rate and LOS were not statistically different in both groups, but repeated readmission was significantly higher in patients with reduced LV function [15.3% in group P and 36.2% in group R (P = 0.0001)]. The predictor for cardiovascular readmission was low EF. All cause morbidity was similar with 71.4 % in-group P and 70.4% in R group. The total mortality was 6.74%, not statistically significant between both groups (5.3% in group P and 9 % in group R) with a trend towards higher mortality in patients with reduced LV function (P= 0.09).
CONCLUSION: Diastolic cardiac failure is more prevalent in elderly female hypertensive patients, has less rate of repeat hospitalization, and long-term prognosis is not better compared to SHF.
CLINICAL IMPLICATIONS: More effective management strategies are still needed.
DISCLOSURE: Walid Hassan, No Financial Disclosure Information; No Product/Research Disclosure Information