Impact on mortality of systolic and/or diastolic heart failure in the elderly—10 years of follow-up

There is a lack of long-term follow-up studies for elderly patients with heart failure (HF) in primary health care. There is conflicting information on prognostic differences between systolic or diastolic HF in elderly patients. Our aims were, first, to study the association between overall HF or types of HF and all-cause and cardiovascular mortality, and second, to explore the impact of N-terminal prohormone of brain natriuretic peptide (NTproBNP) and comorbidities. A longitudinal, prognostic, observational primary health care study with 10 years of follow-up comparing an elderly patient population with HF (systolic and/or diastolic HF) to patients without HF was conducted. HF was diagnosed with echocardiography according to the European Society of Cardiology guidelines. Seventy-seven of 144 patients (102 women and 42 men; mean age, 77 years) had systolic and/or diastolic HF and were compared with 67 patients without HF (Reference group). During the 10-year follow-up, 71 (49%) patients died (women, 68%; men, 32%). In univariate Cox regression analysis, significant associations were found for overall HF [hazard ratio (HR), 1.86; 95% confidence interval (CI), 1.15–3.01], isolated systolic HF (HR, 1.95; 95% CI, 1.06–3.61), and combined (systolic and diastolic) HF (HR, 3.28; 95% CI, 1.74–6.14) with all-cause mortality, but not for isolated diastolic HF. Similar results were found for cardiovascular mortality. In multivariate analysis, age (HR, 1.11; 95% CI, 1.06–1.17), kidney dysfunction (HR, 1.91; 95% CI, 1.11–3.29), smoking (HR, 3.70; 95% CI, 2.02–6.77), and NTproBNP (HR, 1.01; 95% CI, 1.00–1.02) significantly predicted all-cause mortality, but not any type of HF. Patients diagnosed with systolic HF had a worse prognosis for mortality compared to the reference group, but in patients with diastolic HF the prognosis for mortality was similar with that in the reference group. NTproBNP was a valuable prognostic factor in elderly patients. Emphasis should be placed on kidney dysfunction and smoking/having smoked.