In-hospital mortality predictors of heart failure patients 80 years and older: An observational retrospective single-center experience

Mortality and hospitalization rates of heart failure (HF) increase with advancing age. However, the elderly are underrepresented in clinical trials; therefore, data on in-hospital outcomes and influencing factors of patients with HF in advanced age groups are limited. We aimed to investigate in-hospital outcomes and related factors in patients aged ≥80 years with decompensated HF. Records of patients hospitalized in the coronary care unit of a tertiary hospital between January 1, 2015, and December 31, 2020, were retrospectively reviewed. Eligible patients were ≥80 years of age and were followed for exacerbation of chronic HF. The primary outcome was in-hospital mortality rate. Patients were enrolled into 2 groups according to their survival status during index admission. The relationship between clinical, laboratory, and imaging features and in-hospital mortality rates was investigated. This study included 250 patients. The mean age of the subjects was 84.7 ± 4.8 years, and 57.6% of the population were women. The in-hospital mortality rate was 20.1%. The median length of hospitalization was 9 (4-12) days for non-survivors and 4 (3-6) days for survivors (P < .001). The median hospitalization count was 0 (0-1) for survivors and 1 (0-2) for non-survivors (P = .002). Systolic HF was more prevalent in non-survivors (73.8% vs 61.1%, P = .038), and ischemic HF was also more prevalent in deceased patients than in survivors (61.9% vs 45.2%, P = .048). Receiver operating characteristic analysis showed that risk factors increasing in-hospital mortality were white blood cell count ≥ 9.75 × 109/L, serum creatinine ≥ 1.75 mg/dL, serum sodium ≤ 137.5 mmol/L, serum potassium ≥ 4.65 mmol/L, C-reactive protein ≥ 28.45 mg/L, and serum albumin ≤ 33.5 g/L. This study provides preliminary data on the characteristics of older patients with HF who are at a higher risk of in-hospital mortality. Large prospective trials should be conducted to describe the causative relationship between these predictive factors and in-hospital outcomes in elderly HF patients.