Neurohormonal Activation in Very Elderly Patients Over 80years Old with Acute Decompensated Heart Failure

Backgrounds: In heart failure, the adverse effects of neurohormonal activation are known and the suppression of renin aldosterone system is effective to improve the prognosis in clinical trial. However population for these trials is under 80 years old. This purpose is to assess whether neurohormonal factors are activated irrespective of age in patients with acute decompensated heart failure (ADHF). Methods: A total of 360 patients with ADHF were admitted in ICU (77 ± 12 years, male 197) for four years. The number of patients over and under 80 years old were 184 (O group), 176 (U group). Hemodynamics, blood chemistry, neurohormonal factors on admission and pre-hospital medication were studied retrospectively. Results: O group had significantly more female, lower hemoglobin, creatinine, uric acid, plasma rennin activity (PRA) and higher EF (P < .05). Death in hospital was 19 patients (5.3%). In Cox's proportional hazards analysis, higher BUN, logBNP, logPRA were an independent predictor of in-hospital death in all patients (HR1.014, 2.972, 1.839, P < .01). However, higher BUN was an independent predictor of in-hospital death in O group, not U group (HR1.057, 95%CI 1.033–1.081, P < .01). Conclusions: Neurohormonal activation and BUN elevation are the risk factor of in-hospital mortality in ADHF patients, but it is suggested that plasma renin is less activated and neurohormonal factor is not important for in-hospital prognosis in patients over 80 years old.