Heart failure in frail elderly resident in a nurse house: prognostic significance of a multimarker approach

BACKGROUND: Heart failure (HF) has been defined a modern pandemic. The complex array of physiologic, psychological, social and health care delivery issues makes it a challenging chronic disease to manage. Our study thus aimed to evaluate a multi-marker approach to assess prognosis of HF.METHODS: We considered 202 elderly in the nursing home in Chioggia (Venice, Italy). Each subject underwent clinical evaluation, echocardiography, determination of high sensitivity troponin I (hs-TnI), galectin-3 (GAL), cystatin C (CYS) and brain natriuretic peptides (BNP) by routine methods. These subjects were followed for 24 months after their inclusion in the study and during this period overall mortality was recorded.RESULTS: After a 24-month follow-up (FU) the overall mortality was 41.6%. In these patients’ series raised biomarkers serum concentration constituted a significant hazard ratio: 3.83 for BNP, 3.24 for CYS, 5.65 for GAL and 5,76 for hs-TnI. A poorest prognosis was observed in subjects with raised concentration for multiple biomarkers.CONCLUSIONS: In the considered population, BNP, CYS, GAL and hs-TnI were independently associated with higher risk of negative outcome. In addition, according to our experience, the simultaneous dosage of the four considered biomarkers improves the correlation with the prognosis. Further studies in similar populations are needed to confirm our results.