Martin-Pfitzenmeyer et al identified prognostic factors for a very old patient with severe heart failure. These can help to identify a patient who may require more aggressive management. The authors are from multiple hospitals in France.


Patient selection: age >= 75 years of age AND Stage D refractory heart failure (marked symptoms at rest despite maximal medical therapy)


Factors associated with a poor prognosis:

(1) chronic renal insufficiency

(2) chronic use of nitrates

(3) past neuropsychological disorder (dementia, etc)

(4) presence of edema

(5) low cutaneous blood flow (poor skin perfusion)

(6) pain


Several of these factors reflect a low left ventricular ejection fraction.


Factors associated with a good prognosis:

(1) able to sit on a chair


Pain control can have an important impact on the patient's quality of life. In addition to controlling pain the management must minimize adverse effects of the analgesics.


Other problems that need to be looked for:

(1) anxiety and/or depression

(2) sleep disorders

(3) delirium

(4) loss of muscle strength (asthenia)

(5) pressure ulcerations


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