Acute heart failure in the elderly: setting related differences in clinical features and management

BACKGROUND Administrative data show that acute heart failure (HF) patients are older than those enrolled in clinical registries and frequently admitted to non-cardiological settings of care. The purpose of this study was to describe clinical characteristics of old patients hospitalised for acute HF in Cardiology, Internal Medicine or Geriatrics wards. METHODS Data came from ATHENA (AcuTe Heart failurE in advaNced Age) registry which included elderly patients (= 65 years) admitted to the above mentioned settings of care from December 1, 2014 to December 1, 2015. RESULTS We enrolled 396 patients, 15.4% assigned to Cardiology, 69.7% to Internal Medicine, and 14.9% to a Geriatrics ward. Mean age was 83.5 +/- 7.6 years (51.8% of patients = 85 years) and was higher in patients admitted to Geriatrics ( P < 0.001); more than half were females. Medical treatments did not differ significantly among settings of care (in a context of a low prescription rate of renin-angiotensin-aldosterone system inhibitors) whereas significant differences were observed in comorbidity patterns and management guidelines recommendation adherence for decongestion evaluation with comparison of weight and N-terminal pro-B-type natriuretic peptide levels on admission and at discharge (both P = 0.035 and P < 0.001), echocardiographic evaluation ( P < 0.001) and follow-up visits planning ( P < 0.001), all higher in Cardiology. Mean in-hospital length of stay was 9 +/- 5.9 days, significantly higher in Geriatrics (13.7 +/- 6.5 days) and Cardiology (9.9 +/- 6.7 days) compared to Internal Medicine (8 +/- 5.2 days), P < 0.001. In-hospital mortality was 9.3%, resulting higher in Geriatrics (18.6%) and Cardiology (16.4%) than Internal Medicine (5.8%), P = 0.001. CONCLUSIONS In elderly patients hospitalised for acute HF, clinical characteristics and management differ significantly according to the setting of admission.