FATE Study
Heart failure and the elderly: initial results from the FATE study
Valuable data for patients with heart failure, focusing on the Italian population. “The elderly and very elderly are a population that we need to understand better and better. The decompensated patients we characterised in the FATE study have an average age of 80, with a large proportion of women. This is a unique population that is not normally considered in scientific studies but is at high risk of mortality. In these patients, a high BMI is an indicator of a better prognosis. Another important finding is that functional capacity in this population is a crucial prognostic indicator,” explains Gaia Cattadori, High-Intensity Care Rehabilitation Cardiology Unit, H San Giuseppe IRCCS Multimedica, Milan, during the presentation of the FATE (FAiling hearT in the Elderly) study.
This is a prospective, multicentre observational study of patients aged ≥ 65 years hospitalised for acute heart failure. Coordinated by IRCCS Multimedica with the support of the Maugeri Scientific Clinical Institutes (Montescano, Dr Maria Teresa La Rovere), the study involved the participation of the Ospedale Maggiore Policlinico (Milan), the Monzino Cardiology Centre, the Italian Auxological Institute, the San Martino Polyclinic Hospital in Genoa and the Humanitas Clinical Institute.
The aim was to collect clinical and instrumental data from patients at the time of admission for acute heart failure and after 6, 12 and 18 months.
The endpoints were prognosis (hospitalisations and/or death) in the follow-up with evaluation of the prognostic power of the characteristics collected. A total of 371 patients were enrolled.
Age and gender
‘The average age of patients recruited in the FATE study is 80 years, with follow-up data up to 18 months,’ continues Cattadori. “It should be noted that, compared to international clinical trials, our population is older with a very high percentage of women (43%), while in scientific studies the female presence is usually much lower. There is also a high prevalence of comorbidity in this elderly population.”
Functional capacity
In the FATE study population, there was a reduction in overall functional capacity, especially in patients with normal left ventricular function. “Half of the patients enrolled were unable to perform a walking test due to a severe reduction in functional capacity. This accounted for 49% of our patients and they are the oldest, predominantly women. It was found that being able to walk even a few metres is an important predictor of prognosis, to a greater extent than other variables such as age. The data is truly impressive: elderly patients who are able to walk are four times more likely to survive the follow-up.
Body weight
“Another interesting finding refers to the obesity paradox, a concept very dear to those who treat patients with heart failure, whereby obesity and overweight appear to be protective factors for prognosis. In the FATE study, patients who were able to walk at least one metre and had a better prognosis at follow-up had a significantly higher body mass index than those who were unable to walk”. .
Medications
Four classes of medications are the pillars that change the prognosis in patients with heart failure. The FATE study confirms the inadequate intake of all four life-saving medications even in the elderly patient population, while diuretics are much more prevalent in the treatment regimen (85% of patients).