Clinical characteristics, decision-making capacity,
and resuscitation preference of elderly patients
with acute heart failure in Japan:
a single-center descriptive study
Noriyoshi Ishizuka, MD 1)※ Eiji Hiraoka, MD, PhD 1)※
Takahiro Kamio, MD 1) Shunsuke Kojima, MD 1) Junya Arai, MD 1)
Yasuhiro Norisue, MD 2) Toshihiko Suzuki, MD3) Yosuke Homma, MD 4)
Osamu Takahashi, MD, MPH, PhDMD 5)
Kotaro Obunai, MD 6) Hiroyuki Watanabe, MD 6)
1）Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center
2）Department of Critical Care and Pulmonary Medicine, Tokyo Bay Urayasu Ichikawa Medical Centere
3）Department of Nephrology, Endocrinology, and Diabetes, Tokyo Bay Urayasu Ichikawa Medical Center
4）Department of Emergency Medicine, Tokyo Bay Urayasu Ichikawa Medical Center
5）Department of Internal Medicine, St Luke’s International Hospital
6）Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center
Background:Characteristics and outcomes of elderly heart failure patients were investigated in Japan from 2004 to 2005. Since then, the aging population in Japan has increased and is one of the highest worldwide. Furthermore, the decision-making capacity and do-not-resuscitate (DNR) status have not been studied yet among elderly patients with heart failure.
Methods:We retrospectively investigated the characteristics of all patients hospitalized for acute heart failure between April 2013 and March 2015 in our hospital. We obtained data on demographics, comorbidities, laboratory and echocardiography results, social background, decision-making capacity, DNR status, and outcomes (death in the hospital and at 1 year as well as re-hospitalization from acute heart failure after 1 year). Patients were stratified according to age for comparison:elderly patients (≥ 75 years old) and younger patients ( ＜75 years old).
Result:We analyzed a total of 394 patients (median age, 76 years);the elderly group included 212 patients (54%). The elderly had a higher incidence of anemia, hypertension, aortic stenosis, and preserved ejection fraction;a higher rate of activities of daily living dependency, incomplete or equivocal decision-making capacity, and DNR status;and a higher rate of mortality (in- hospital, 1-year), and 1-year re-hospitalization due to heart failure.
Conclusions:This study was the first to demonstrate the decision-making capacity and DNR status among Japanese patients with heart failure. Elderly heart failure patients had worse outcomes as well as higher prevalence of incomplete decision-making capacity and DNR status.
Key Words：insulinoma, transient amnesia, hypoglycemia