Lower Proportional Pulse Pressure at Hospital Arrival is Related to Lower Left Ventricular Ejection Fraction in Acute Decompensated Heart Failure

The patients of heart failure (HF) have been increasing as elderly population increasing. The pathophysiology of HF in the elderly is different from that in the young. We aimed this study to clarify the hypothesis that prognostic indicators between elderly and young patients with HF would be different. We enrolled 345 patients with HF (age, 68613 years; male sex, 60%). They were followed up for 17613 months. Re-hospitalization by HF was set as an outcome, and was seen in 67 cases. We divided the patients into two groups by 75 years old: 130 cases in the elderly and 215 cases in the young. The elderly group had more frequent female, lower body mass index, higher ejection fraction, lower left ventricular end-diastolic dimension, lower MMSE score, lower DBP and higher pulse pressure than the young group. In Cox regression analysis adjusting for covariates, nocturnal DBP [Hazard ratio (HR)50.95, 95%CI 0.92-0.99, p!0.01] was a significant predictor of HF re-hospitalization in the elderly group. In the young group, significant prognostic factors were BNP [HR52.67, 1.72-4.15, p!0.01], prior HF hospitalization [HR51.20, 95%CI 1.02-1.41, p50.03], and nocturnal SBP [HR50.97, 0.95-1.00, p!0.01). In conclusion, the indicators of HF re-hospitalization between the elderly and the young patients were different. These results reflect different pathophysiological mechanisms of HF by the age group.