FACTORS EFFECTING THE DECOMPENSATION OF CHRONIC HEART FAILURE IN THE ELDERLY

Abstract

Aim. To identify risk factors of decompensation of chronic heart failure (CHF) and related hospitalization in elderly outpatients. Material and methods. The total of 248 patients aged 60-85 years with CHF NYHA class II-IV were enrolled into the study. The first group consisted of 87 (35.1%) patients who required hospitalization due to CHF decompensation during the follow-up, the second group - of 161 patients without need for hospital admission. All the patients had undergone clinical and laboratory examination, estimation of CHF severity by the Scale of clinical state, assessment of quality of life and 6-minute walk test (6MWT), echocardiography. Results. Patients were matched for age, gender, disability occurrence, education level, body mass index, quality of life, hemodynamic parameters, incidence rates of anemia, diabetes mellitus and atrial fibrillation. CHF was more severe in patients who had required hospitalization (p<0.001), they were more often diagnosed with left ventricular aneurysm (p=0.001), chronic kidney disease (p=0.001), left ventricular ejection fraction (LVEF)<35% (p<0.001), history of stroke (p<0.001), III-IV degree mitral regurgitation (p=0.007), hyperuricemia (p<0.001), lower exercise tolerance (p=0.007) compared with patients without hospitalization. Higher functional class of CHF (OR=0.29; 95% CI 0.13-0.69; p=0.003), LVEF<35% (OR 0.37; 95% CI 0.18-0.76; p=0.007), chronic kidney disease (OR=0.29; 95% CI 0.13-0.68; p=0.004) and hyperuricemia (OR=0.23; 95%CI 0.10-0.50; p<0.001) were shown to be independent risk factors of CHF decompensation that required hospital admission in elderly patients. Conclusuion. High FC of CHF, low LVEF, hyperuricemia and renal dysfunction play a key role in CHF decompensation and related hospitalization in elderly patients.