Long-Term Survival of Very Elderly Patients with Heart Failure Managed in a Comprehensive Heart Failure Management Unit

Abstract

Background: Heart failure (HF) is the leading cause of hospitalisation in older adults, with incidence increasing markedly with age. However, long-term outcome data in patients aged ≥85 years remain limited. We evaluated survival and predictors of mortality in this very elderly HF population enrolled in a structured outpatient programme. Methods: A retrospective observational study was conducted, including patients aged ≥85 years assessed at a Comprehensive HF Management Unit between 2012–2023. Demographic characteristics, comorbidities, functional (Barthel) and cognitive (Pfeifer) status, laboratory parameters, hospitalisations, and survival status were collected. Long-term survival was estimated using the Kaplan–Meier method, and predictors of mortality were analysed using Cox regression models. Results: A total of 514 patients were included (mean age 88.4 ± 3 years, 46.1% male); 340 (66.1%) died during follow-up. Survival was 77% at 1 year, 50% at 2.5 years, and 25% at 5 years. Mortality was associated with diabetes (p = 0.038), advanced chronic kidney disease (p = 0.008), dementia (p < 0.001), neoplasia (p = 0.007), ischaemic heart disease (p < 0.001), history of HF (p = 0.043), NYHA III–IV (p < 0.001) and elevated NT-proBNP (p < 0.001). Worse functional and cognitive status, higher comorbidity according to the Charlson Comorbidity Index and readmission at one year (all p < 0.001) were also related to mortality. In the first multivariable model, worse cognitive and functional status, a higher Charlson comorbidity index, NYHA class III–IV, and high NT-proBNP were independent predictors of mortality. When 1-year HF readmission was added to the model, the Charlson index (HR:1.10; 95%CI 1.01–1.19), high NT-proBNP (HR:1.76; 95%CI 1.30–2.38) and HF readmissions within 1 year (HR:2.68; 95%CI 1.72–4.16) remained independently associated with mortality. Conclusions: In patients aged ≥85 years with HF, survival was poor, with only half alive at 2.5 years and 25% at 5 years. Comorbidity burden, high natriuretic peptides, and early readmission independently predicted mortality, underscoring the importance of comprehensive assessment in this population.