Aims: Heart failure (HF) is increasingly prevalent among the growing number of elderly people, but not well studied. We sought to evaluate disease pattern and importance of prognostic factors among very elderly patients with HF.
Methods and results: Among 8507 patients screened for entry into two studies on HF, we analysed the clinical characteristics, major comorbidities and prognostic factors in 825 patients older than 85 years (very elderly) compared with younger age groups. Adjusted hazard ratios [HR (95% confidence intervals)] of long-term mortality were calculated using Cox models. The very elderly were more often female (60 vs. 26%) and had a higher prevalence of preserved ejection fraction (53 vs. 36%) compared with patients younger than 65 years (P< 0.001). The prevalence of cardiovascular comorbidities increased with advancing age only until the seventh decade and then declined, resulting in the lowest prevalence of diabetes (12 vs. 16%, P< 0.001), hypertension (20 vs. 26%, P< 0.001), ischaemic heart disease (42 vs. 53%, P< 0.001), and peripheral artery disease (4 vs. 6%, P= 0.017) among the very elderly compared with patients aged <85 years. Non-cardiovascular comorbidities generally increased linearly with age. Long-term mortality was associated with atrial fibrillation [HR = 1.30 (1.06-1.60), P= 0.013] with greater prognostic importance in the very elderly, while ejection fraction, diabetes [HR = 1.31 (1.01-1.61), P= 0.04], and renal insufficiency [HR = 1.36 (1.13-0.63), P< 0.0001] had less prognostic importance than in younger patients (P for interactions <0.003).
Conclusion: The prevalence of cardiovascular comorbidities is lower in very elderly HF patients and has different prognostic importance.