Prognosis in patients over 75 according to Acute heart failure or other cause of respiratory failure

Acute heart failure (AHF) predominantly affects the elderly and causes significant intra-hospital mortality. To evaluate the intra-hospital and 90 days outcome of patients aged 75 or older when hospitalized for AHF, pulmonary embolism (PE) or other acute respiratory failure (OARF). We recorded 8,650 patients aged 75 years or older, hospitalized for acute dyspnea with BNP or NTproBNP measurement in the 48 hours after admission in the enlarged Assistance Publique-Hôpitaux de Paris hospitals between 2011 and 2021 in geriatric, cardiologic and pneumologic departments. Final principal diagnosis was classified with CIM 10 as “AHF”, “PE” or “OARF”, represented by COPD and pneumonia. Mean (SD) age was 85.5 (5.9) years, 55,8% of patients were women. In total, 5,604 (64.7%) patients had AHF diagnosis at discharge. Compared with OARF, patients with AHF were older (P < 0.01), had more frequent hypertension (P < 0.01), diabetes (P < 0.01), ischemic cardiomyopathy (P < 0.01), renal failure (P < 0.01), and less frequent COPD, depression and lower heartbeat (P < 0.01). AHF patients had higher levels of NTproBNP, troponin and hepatic disorders (P < 0.01), lower CRP and hemoglobin (P < 0.01). AHF patients had shorter length of stay (12.9 vs. 13.7 days) and lower intra-hospital death (7.6% vs. 10.0%) than OARF (P < 0.01). However, there is no difference between the two groups at 90 days after the initial diagnosis (15.5% vs. 16.2%). In patients over 75 yo referred for acute dyspnea with NTproBNP dosage at admission, despite more comorbidities, patients with AHF had better intra-hospital prognosis and shorter length of stay that patients with OARF but had the same prognosis at 90 days.