P3437Chronic kidney disease: role in treatment and prognosis of elderly patients with heart failure and low ejection fraction

Abstract

Introduction: Heart failure with reduced ejection fraction (HFrEF) is relatively common in the elderly population. As well, chronic kidney disease (CKD) affects more frequently patients suffering from heart failure, specially the very old population. The purpose of this work is to assess the role of CKD in the treatment and prognosis of patients with HFrEF aged ≥75 years old. Methods: From January 2008 to July 2014 we have recruited prospectively 802 patients aged >75 years diagnosed with left ventricular EF <35% by transthoracic echocardiography in our laboratory. We obtained and analysed clinical, electrocardiographic and echocardiographic variables and continued follow up prospectively using electronic medical history and telephonic visits. We evaluated the rates of mortality and cardiac events (defined as total mortality or hospitalization for heart failure). Results: 802 patients were included in the final analysis including 66.2% of males. The mean age was 82±4.9 years and the mean ejection fraction was 28±6.5%. Ischemic etiology was found in 51.1% of the cases being the reason for ventricular dysfunction. We identified 390 patients with renal failure at inclusion time. Glomerular filtration rate (GFR) value was found to be between 60 to 45 ml/min/1.73 in 50.3% of patients, between 45 to 30 in 37.4%, and less than 30 in 12.3%. Betablockers were being used in 70.3% of patients with CKD compared with 73% in patients without CKD (p 0.42). The use of ACEIs or ARBs was lower in CKD group, 68.7% compared with 78.8% in non CKD (p 0.001) and this happened equally with mineralocorticoid receptor antagonist (MRA) use, being 41.7% in patients with CKD vs 51.3% in patients without CKD (p 0.008). Finally 6.9% of the patients received a cardiac resynchronization device in the CKD group while this device was implanted in 5.6% of the patients with normal renal function (p 0.53). The mean follow-up was 29.3±22.6 months. During the study period, 381 patients (47.5%) died and 496 patients (61.8%) had a major cardiovascular event (death or hospitalization for heart failure). After a multivariate Cox regression analysis, CKD was independently related with cardiovascular events (death or hospitalization for heart failure) (OR 1.13 [1.02-1.27]), and as well with mortality (OR 1.35 [1.03-1.76]). Lower GFR levels were inversely related with higher mortality rates (see figure). Conclusion: The presence of CKD in elderly patients with HFrEF is associated with increased morbidity and mortality. It is also associated with underuse of evidence-based heart failure therapy, especially MRA and ACEI/ARB. Better adherence to the current guidelines may lead to improved prognosis in this particular population (in abscense of formal contraindication), but more studies are needed to confirm this hypothesis. (Figure Presented).