Risk factors for poor prognosis in elderly patients with chronic heart failure

Introduction. Chronic heart failure (CHF) is an important problem in cardiology, as it often becomes the final stage of cardiovascular diseases. Elderly people make up a significant proportion of patients with CHF. To optimize treatment, it is important to understand the factors affecting the prognosis, as this will help to more accurately assess the risks and develop individual treatment strategies.
Aim. To identify prognostic factors for adverse outcome in elderly patients with CHF with preserved ejection fraction.
Materials and methods. The study included 95 elderly patients with CHF with preserved ejection fraction. The study was a register, prospective, observational, single-center study. To analyze survival time, Kaplan-Meier curves were constructed, with an assessment of the long rank test. Cox proportional hazards models were used to assess the effect of each factor on the time to an unfavorable outcome.
Results. The average age of patients was 81.3 ± 4.2 years, of which 76.8% were women and 23.2% were men. Age is a statistically significant (p = 0.019) factor for unfavorable outcome, with an increase in age by 1 year, the chances of a fatal outcome increase by 16.8%. Patients with functional class (FC) 3 and 4 have a statistically significantly higher risk of death (p = 0.040), 4.5 times higher than the risk in patients with FC 1 and 2. High functional status scores of patients according to the Barthel index and Instrumental Activities of Daily Living scale did not show an association with a reduced risk of adverse outcome in patients with preserved ejection fraction. The use of beta-blockers is associated with a significant (p = 0.02) reduction in the risk of death by 91.1%. Taking RAAS inhibitors is associated with a statistically significant (p = 0.049) 80.0% reduction in the risk of death.
Conclusion. A comprehensive assessment of factors affecting the prognosis in individuals with CHF in old age can contribute to improving the effectiveness of treatment and improving the prognosis.

1. Reznik EV, Ushakova NA, Ershov NS, Krupnova ES, Platonova EN, Gavrilova OV, Golukhov GN. Gender- and age-specific characteristics of patients with chronic heart failure in real clinical practice. RMJ. Medical Review. 2023;7(1):13–21. (In Russ.) https://doi.org/10.32364/2587-6821-2023-7-1-13-21.

2. Krivoshapova KE, Wegner EA, Barbarash OL. Frailty syndrome as an independent predictor of adverse prognosis in patients with chronic heart failure. Kardiologiya. 2022;62(3):89–96. (In Russ.) https://doi.org/10.18087/cardio.2022.3.n1206.

3. Wang MC, Li TC, Li CI, Liu CS, Lin CH, Lin WY et al. Cognitive function and its transitions in predicting all-cause mortality among urban communitydwelling older adults. BMC Psychiatry. 2020;20(1):203. https://doi.org/10.1186/s12888-020-02618-9.

4. Taras ES, Atakanova AN, Erlich AD, Kislyak OA. Reviews heart failure with preserved ejection fraction in elderly and senile patients. Lichebnoe Delo. 2020;(1):75–81. (In Russ.) https://doi.org/10.24411/2071-5315-2020-12196.

5. Meshcherina NS, Khardikova EM, Gorshunova NK, Abrosimova NV, Leontieva TS. The role of compliance in the treatment of chronic heart failure and the ways to improve it. Humans and their Health. 2021;24(3):4–13. (In Russ.) https://doi.org/10.21626/vestnik/2021-3/01.

6. Grachev DS, Petrov VS. Parameters of daily monitoring of arterial pressure in patients of senile age with chronic heart failure depending on vascular stiffness. Science of the Young (Eruditio Juvenium). 2023;(4):483–492. (In Russ.) https://doi.org/10.23888/HMJ2023114483-492.

7. Grachev DS, Petrov VS, Namazova KI, Maksyakova TA, Tokareva VI. Vascular Stiffness in Senile Patients with Chronic Heart Failure. I.P. Pavlov Russian Medical Biological Herald. 2024;(1):65–72. (In Russ.) https://doi.org/10.17816/PAVLOVJ375266.

8. Saito H, Yamashita M, Endo Y, Mizukami A, Yoshioka K, Hashimoto T et al. Cognitive impairment measured by Mini-Cog provides additive prognostic information in elderly patients with heart failure. J Cardiol. 2020;76(4):350–356. https://doi.org/10.1016/j.jjcc.2020.06.016.

9. Andrews AM, Russell CL, Cheng AL. Medication Adherence Interventions for Older Adults With Heart Failure: A Systematic Review. J Gerontol Nurs. 2017;43(10):37–45. https://doi.org/10.3928/00989134-20170523-01.

10. Orlova YA, Tkacheva ON, Arutyunov GP, Kotovskaya YuV, , Lopatin YuM, Mareev VYu et al. Features of diagnostics and treatment of chronic heart failure in elderly and senile patients. Expert opinion of the Society of Experts in Heart Failure, Russian Association of Gerontologists, and Euroasian Association of Therapists. Kardiologiya. 2018;58(12S):42–72. (In Russ.) https://doi.org/10.18087/cardio.2560.

11. Larina VN, Bart BY, Karpenko DG, Starostin IV, Larin VG, Kulbachinskaya OM. Polymorbidity and its association with the unfavorable course of chronic heart failure in outpatients aged 60 years and older. Kardiologiya. 2019;59(12S):25–36. (In Russ.) https://doi.org/10.18087/cardio.n431.

12. Vinogradova NG, Polyakov DS, Fomin IV. Analysis of mortality in patients with heart failure after decompensation during long-term follow-up in specialized medical care and in real clinical practice. Kardiologiya. 2020;60(4):91–100. (In Russ.) https://doi.org/10.18087/cardio.2020.4.n1014.

13. Plaksina KG, Tatarintseva YuV, Khachaturov AN. Features of chronic heart failure in elderly and senile patients (literature review). Current Problems of Health Care and Medical Statistics. 2022;(5):323–336. (In Russ.) https://doi.org/10.24412/2312-2935-2022-5-323-336.

14. Solovieva AE, Medvedev AE, Lubkovskiy AV, Shmakov AI, Solovev AE, Endubaeva GV et al. Total, ageand sex-specific mortality after discharge of patients with heart failure: the first large-scale cohort real-world study on Russian population. Russian Journal of Cardiology. 2024;29(6):105–115. (In Russ.) https://doi.org/10.15829/1560-4071-2024-5940.

15. Tsao CW, Lyass A, Enserro D, Larson MG, Ho JE, Kizer JR et al. Temporal Trends in the Incidence of and Mortality Associated With Heart Failure With Preserved and Reduced Ejection Fraction. JACC Heart Fail. 2018;6(8):678–685. https://doi.org/10.1016/j.jchf.2018.03.006.

16. Shchendrygina AA, Zhbanov KA, Privalova EV, Yusupova AO, Danilogorskaya YuA, Salakheeva EYu. Heart Failure with Perserved Ejection Fraction Current Diagnostic and Therapeutic Approaches. Rational Pharmacotherapy in Cardiology. 2021;17(3):476–483. (In Russ.) https://doi.org/10.20996/1819-6446-2021-05-01.

17. Shevcova VI, Pashkova AA, Kolpacheva MG, Salamatova VN. Palliative care for chronic heart failure: non-pharmacological methods of relieving the main symptoms. Meditsinskiy Sovet. 2024;(6):250–259. (In Russ.) https://doi.org/10.21518/ms2024-019.

18. Stefil M, Manzano L, Montero-PéRez-Barquero M, Coats AJS, Flather M. New horizons in management of heart failure in older patients. Age and Ageing. 2020;49(1):16–19. https://doi.org/10.1093/ageing/afz122.

19. Shikh EV, Shindryaeva NN, Rebrova EV, Lapidus NI, Zhukova OV, Stuk IV, Koroleva IG. A personalised approach to the choice of oral anticoagulants in elderly and senile patients with atrial fibrillation. Meditsinskiy Sovet. 2022;16(14):228–234. (In Russ.) https://doi.org/10.21518/2079-701X-2022-16-14-228-234.

20. Molina S, Martinez-Urrea A, Malik K, Libori G, Monzon H, Martı´nez-Camblor P, Almagro P. Medium and long-term prognosis in hospitalised older adults with multimorbidity. A prospective cohort study. PLoS ONE. 2023;6:e0285923. https://doi.org/10.1371/journal.pone.0285923.

21. Woodford HJ, McKenzie D, Pollock LM. Appropriate management of heart failure in older people with frailty. BMJ. 2024;387:e078188. https://doi.org/10.1136/bmj-2023-078188.

22. Shishkova VN, Shishkov VA, Ustarbekova DB. Marker associations of chronic heart failure severity and cognitive dysfunction in elderly patients. Meditsinskiy Sovet. 2023;(23):60–66. (In Russ.) https://doi.org/10.21518/ms2023-331.

23. Simenyura SS, Sizova ZM. The role of non-drug methods of increasing adherence to the treatment of patients with arterial hypertension in a polyclinic. Meditsinskiy Sovet. 2021;(21–2):16–25. (In Russ.) https://doi.org/10.21518/2079-701X-2021-21-2-16-25.

24. Warner V, Nguyen D, Bayles T, Hopper I. Management of heart failure in older people. J Pharm Pract Res. 2022;52:72–79. https://doi.org/10.1002/jppr.1796.

25. Liu E, Lampert BC. Heart Failure in Older Adults: Medical Management and Advanced Therapies. Geriatrics. 2022;7(2):36. https://doi.org/10.3390/geriatrics7020036.

26. Chulkov VS, Gasanov MZ, Azovtseva OV, Minina EE, Chulkov VS. The role of beta blockers in the treatment of cardiovascular diseases. Meditsinskiy Sovet. 2024;18(16):28–36. (In Russ.) https://doi.org/10.21518/ms2024-467.

27. Milinkovic I, Polovina M, Coats AJS, Rosano G, Seferovic PM. Medical Treatment of Heart Failure with Reduced Ejection Fraction in the Elderly. Card Fail Rev. 2022;8:e17. https://doi.org/10.15420/cfr.2021.14.