1. Prognosis of elderly patients in a heart failure management program depending on their left ventricular ejection fraction
H. Magro Garcia, J A. Satue, JC. Belinchon Paraiso, J. Marrero Frances, A. Perez Martin, S. Gonzalo Pascua, P. Talavera Calle*, A. San Martin Prado
Internal Medicine and *Cardiology, University Hospital of Fuenlabrada, Fuenlabrada, Madrid, Spain.
Purpose: to compare the clinical profile and prognosis of patients included in the Congestive Heart Failure Management Program (UMIPIC) from the University Hospital of Fuenlabrada depending on their Left Ventricular Ejection Fraction (LVEF).
Preserved EF
Patients and methods: patients were included in the UMIPIC from June 2011 until July Epidemiological, clinical, analytical, functional and echocardiographical data at inclusion were recorded in an electronical formulary. Tracking of these patients was made through consult visits and phone interviews until January 2014, inclusive.
Reduced EF
Figure 1: Survival rates / days of follow up
Results: 74 patients were included in the Congestive Heart Failure Program during the referred period. Their mean age was years (SD= 7,812). 80% were women. Echocardiography was performed by a Cardiologist  in 81% of these patients. Left ventricular ejection fraction  was higher than 45%  in  80% of the patients tested. In 20% patients with LEVF<45%, 50% were males, with a mean age of years; 16.7% were in atrial fibrillation (AF) and there was left ventricle hypertrophy (LVH) in 16.7%. On the other hand, patients with LEVF>45% were women in 87.5% of the cases, 60% were in AF and 52.1% had echocardiographical criteria for LVH. Amongst cuantitative parameters,  there were statistically significant differences between groups at albuminaemia, sideraemia and serum transferrin (lower mean levels in the LVEF<45%), and also higher mean levels of NT-proBNP in the LVEF<45% group. There were not significant differences in age, heart rate, body mass index, functional capacity (measured with the Barthel test), comorbidity (measured with the Charlson test) and cognitive impairment (measured with Pfeiffer test). Neither in haemoglobin mean levels,  red blood cell width, pulmonary hipertension, nor in number of patients with chronic respiratory insufficiency. Survival, defined as number of tracking days, was significantly lower in the group LVEF<45%  (p=0,001),  with a mean of 313,75 days (CI95% 175,24 – 472,21). However, patients with a LEVF>45% had a mean follow up  of  607,48 days, (CI95% 529,46 – 685,50) (Figure 1). Patients with LEVF<45% had a Relative Risk of dying of 6,784, compared with patients with LEVF>45%.
Conclussions: mortality was significantly higher amongst elderly patients with LVEF<45%, usually males, in sinus rhythm, without left ventricle hypertrophy. This high risk group of patients also has lower sideraemia, transferrin saturation and albuminaemia, and higher mean levels of NT-proBNP,  but there were no significant differences in age, BMI, functional capacity, comorbidity or cognitive impairment with patients with LVEF>45%.