Prognosis in the hospitalized very elderly: the PROTEGER study

Background: It was reported that many recognized cardiovascular risk factors were no longer valid in the very elderly and, sometimes, even act in the opposite direction. It remains unclear which cardiovascular risk factors are still vital for death prediction in the oldest-old population.

Methods: We assessed cardiac abnormalities and dysfunction by ultrasonography and electrocardiography, blood pressure and arterial stiffness by BP monitor and tonometry, and biochemical parameters by routine laboratory assay, and investigated their associations with all-cause mortality in 331 hospitalized elderly patients (mean age ± standard deviation: 87 ± 7 years). After a mean follow-up of 378 days, 110 deaths occurred.

Results: As compared with survivals, patients with all-cause mortality had significantly lower left ventricular ejection fraction (LVEF) (57.5 ± 13.8% vs 62.4 ± 11.2%, P = 0.002), low-density lipoprotein (LDL) (3.13 ± 0.98 vs 3.56 ± 0.98 mmol/L, P<0.001) and high-density lipoprotein (HDL) cholesterol (1.06 ± 0.30 vs 1.14 ± 0.32 mmol/L, P = 0.04), albumin (33.1 ± 5.4 vs 35.1 ± 4.5 g, P = 0.002), and creatinine clearance rate (Ccr) (42.4 ± 19.4 vs 55.8 ± 28.2 mL/min, P<0.001), and higher incidence of atrial fibrillation (26.4% vs 12.7%, P = 0.002). In multivariate Cox regression model, LVEF, atrial fibrillation, LDL cholesterol, albumin and Ccr were significant and independent death predictors with hazard ratios of 0.82 (0.70, 0.97), 1.74 (1.11, 2.74), 0.70 (0.57, 0.87), 0.66 (0.54, 0.82) and 0.57 (0.44, 0.75), respectively.

Conclusions: In the last stage of lifespan, cardiac systolic dysfunction and atrial fibrillation, as well as malnutrition and renal insufficiency, are crucial risk factors, which should be fully considered in the risk assessment strategy of the hospitalized elderly with cardiovascular diseases.