AIMS: To assess, according to age groups, patients' characteristics according to region of origin, the chronic therapeutic management, prognostic utility of clinical variables, and natriuretic peptides. METHODS AND RESULTS: The GREAT registry consisted of patients identified as presenting with acute heart failure at the emergency department. Four groups of patients were defined according to age: the young patient group (<65 years); 'middle-old' (65-74 years), 'old-old' (75-84 years) and the 'oldest-old' (85-94 years). Follow-up at 1 year was performed via personal contact or national data registries at 1 year. Dataset consisted of 14 758 patients aged up to 95 years, with the 'oldest-old' group being more prevalent in North America and Western Europe. The 30-day mortality rate were, respectively, 8.1%, 8.9%, 10.3%, and 16.3% among the four age groups and 1-year mortality rates were, respectively, 3.1%, 17.1%, 24.7%, and 39.9%. Chronic heart failure treatment was less frequently administered with age (percentage of the 'fully treated' group was 14% in the 'young' compared with 2% in the 'oldest-old' patient group). Reduced left ventricular ejection fraction was present in 70%, 62.3%, 52.5%, and 46.8% among the four age groups, respectively. The prognostic utility of most variables for short- and long-term outcome was attenuated with age, with the exception of natriuretic peptides. CONCLUSION: This study found a large heterogeneity in age among geographic regions and that the eldest are less likely to be treated in accordance with recommendations of current heart failure guidelines. Natriuretic peptide concentrations retained prognostic value in patients across age strata.

ANMCO Research Centre Firenze Italy

Cardiovascular Center Division of Cardiology Department of Internal Medicine Seoul National University Bundang Hospital South Korea

Department of Geriatry Hôpitaux Universitaire Saint Louis Lariboisière Assistance Publique des Hôpitaux de Paris Paris France University Paris Diderot Paris France UMR S 942 INSERM Paris France

Department of Internal Medicine and Cardiology University Hospital Brno and Faculty of Medicine Masaryk University Brno Czech Republic

Department of Internal Medicine University Hospital Basel Switzerland

Department of Medicine Helsinki University Central Hospital Helsinki Finland

Division of Cardiology Massachusetts General Hospital Boston MA USA

Division of Cardiology Towa Hospital Tokyo Japan

Emergency Department Hospital Clinic Barcelona Emergency Medicine Investigation Group 'Emergency care processes and diseases' IDIBAPS Barcelona Spain

Emergency Medicine Institute The Cleveland Clinic Cleveland Ohio USA

King Fahad Cardiac Center Department of Cardiac Sciences College of Medicine King Saud University Riyadh Saudi Arabia

Nippon Medical School Musashi Kosugi Hospital Japan

Sociedad Argentina de Cardiologia Area de Investigacion SAC Azcuenaga Buenos Aires Argentina

University Paris Diderot Paris France Emergency Department Hôpitaux Universitaire Saint Louis Lariboisière Assistance Publique des Hôpitaux de Paris Paris France

University Paris Diderot Paris France UMR S 942 INSERM Paris France Department of Anesthesiology and Critical Care Medicine Hôpitaux Universitaire Saint Louis Lariboisière Assistance Publique des Hôpitaux de Paris Paris France

University Paris Diderot Paris France UMR S 942 INSERM Paris France Department of Cardiology Hôpitaux Universitaire Saint Louis Lariboisière Assistance Publique des Hôpitaux de Paris Paris France

University Paris Diderot Paris France UMR S 942 INSERM Paris France Emergency Department Hôpitaux Universitaire Saint Louis Lariboisière Assistance Publique des Hôpitaux de Paris Paris France

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