CLINICAL DETERMINANTS OF LONG-TERM MORTALITY IN ELDERLY PATIENTS WITHHEART-DISEASE

To determine which of the many clinical parameters routinely collected influence mortality in patients with low left ventricular ejection fr action (LVEF) (< 45% at radionuclide ventriculography), 128 elderly pa tients (mean age 79 +/- 3 years) with various heart diseases were pros pectively followed for 3 years. Twenty-eight-percent had coronary hear t disease, 16% hypertensive heart disease, 7% valvular heart disease. The remaining 62 patients (48%) made up a group comprising patients wi th primitive cardiomyopathy, cor pulmonare with no evidence of coronar y heart disease, valvular disease or hypertensive heart disease. Thirt y-four-percent of all patients were classified as having congestive he art failure (CHF). Age, sex and 37 clinical variables were analyzed us ing a Cox proportional model. Forty-four patients died, 36 (82%) of su dden cardiac death. Ten characteristics at study entry predicted an in creased mortality risk: S-3 gallop, number of clinical signs greater t han or equal to 3, LVEF less than or equal to 25%, New York Heart Asso ciation (NYHA) class greater than or equal to III, dyspnea, digoxin tr eatment, rales, number of symptoms greater than or equal to 4, astheni a, associated pulmonary disease. Long-term survival of very elderly pa tients with low ejection fraction is related to the functional capacit y, the severity of symptoms and the number of clinical signs. Moreover a LVEF less than or equal to 25% selects a subgroup of patients at hi gher risk. Our results suggest that these variables may influence the long-term survival of elderly patients with heart disease. Further stu dies with a greater number of patients are necessary to better delinea te the prognostic value of the clinical and instrumental variables rou tinely collected in these patients.