Prevalence, predictors, and prognostic implications of improvement in left ventricular systolic function and clinical status in patients >70 years of age with recently diagnosed systolic heart failure.
In recent years, several clinical trials conducted on selected middle-aged patients have documented the positive effects of new pharmacologic and nonpharmacologic treatment on chronic heart failure (HF). More recently, some investigators reported cases of elderly patients who had improved clinical conditions and left ventricular (LV) systolic function, but neither the prevalence nor the clinical variables associated with this phenomenon have ever been characterized in this population. To assess the prevalence and the predictors of "improvement" of HF, we prospectively analyzed 87 patients with a recent diagnosis of HF and LV systolic dysfunction, aged >70 years, who were consecutively admitted to our center for functional class impairment (New York Heart Association class III and IV). After discharge, patients underwent clinical and echocardiographic evaluations every 6 months. During follow-up (17 +/- 9 months) improvement was documented in 31 subjects (36%). The variables associated with improvement in the multivariate analysis were the absence of diabetes (odds ratio [OR] 5.1, 95% confidence interval [CI] 1.3 to 19.9, p = 0.007), history of arterial hypertension (OR 3.9, CI 1.3 to 11.1, p = 0.01), and beta-blocker therapy (OR 3.4, CI 1.1 to 10.8, p = 0.03). An improvement in clinical status and LV systolic function is not infrequently observed in patients >70 years of age who have a recent diagnosis of HF. This behavior occurs prevalently in patients receiving beta-blocker therapy who have a history of arterial hypertension, and is inversely related to the presence of diabetes mellitus.