Predictors of major adverse cardiac events in elderly cardiac patients with heart failure with reduced ejection fraction

Abstract

Background: HFrEF is increasingly a disease of the elderly, and older patients face higher rates of major adverse cardiac events (MACE) than younger cohorts, yet remain underrepresented in the trials that generated current predictive models [1,6].

Objective: This review synthesizes published evidence on predictors of MACE, defined as cardiovascular death, heart failure hospitalization, and recurrent ischemic events, in elderly HFrEF patients, and evaluates how well general-cohort predictors generalize to this subgroup.

Methods: We reviewed cohort studies, trial subgroup analyses, and risk-model validation studies addressing clinical, biomarker, comorbidity, and frailty-based predictors of MACE in HFrEF patients aged 65 years and older.

Findings: Ischemic etiology, impaired renal function, anemia, and low presenting blood pressure remain robust predictors across age groups [21,23], while frailty and multimorbidity add incremental predictive value specific to elderly cohorts [26,27]; natriuretic peptides and pooled risk scores retain prognostic value but show attenuated discrimination outside trial populations [12,34].

Conclusions: Accurate MACE prediction in elderly HFrEF requires integrating traditional cardiac predictors with age-specific comorbidity and frailty measures, validated prospectively in cohorts reflecting contemporary elderly heart failure populations.