Prognosis and Outcome for Elderly Patients with Acute Decompensated Heart Failure

Background: Heart failure (HF) is a multifaceted cardio-vascular condition manifested by a progressive pathophysiolo-gy and an evolving landscape of therapeutic interventions. The under representation of older adults in clinical trials results in limited certainty concerning the effectiveness and safety of ev-idence-based therapeutic interventions for HF, as findings are frequently derived from studies conducted in younger cohorts. Older adults with acute decompensated heart failure (ADHF) are at a higher risk of hospitalization and often exhibit more severe clinical presentations than younger patients. Aim of Study: This study was conducted with the objective of describing the clinical trajectory of elderly patients admitted with ADHF and to assess their prognosis and outcomes both during hospitalization and at a six-month follow-up. Patients and Methods: This study encompassed 149 hospi-talized geriatric patients aged 60 years and above presenting to Alexandria Main University Hospital with clinical manifesta-tions of ADHF throughout a six-month duration. Results: The age range of the studied patients was be-tween 60 and 88 years, with a mean ± standard deviation (SD) of 66.7±5.5 years. 120 patients (80.5%) had heart failure with reduced ejection fraction (HFrEF), 19 patients (12.7%) had heart failure with preserved ejection fraction (HFpEF), and 10 patients (6.7%) had heart failure with mildly reduced ejec-tion fraction (HFmrEF). A significant improvement in ejection fraction (EF) was observed at both discharge and follow-up (p<0.001 for both time points). During follow-up, a significant decrease in the degree of dilatation of left ventricle was ob-served (p<0.008), though this did not correspond to reverse LV remodeling. The number of patients receiving optimal medical therapy significantly increased at discharge and at a six-month follow-up (p=0.0009 and p=0.0007, respectively). Conclusion: The study indicated that elderly patients expe-rienced an elevated prevalence of complications throughout the hospitalization period with many requiring readmission within six months after discharge. HF-related mortality is high among elderly patients, and their responses to pharmacological thera-py are variable, necessitating close monitoring. The suboptimal utilization of guideline-directed medical therapy, coupled with the complexities of managing multiple comorbidities, contrib-utes to poorer long-term outcomes.