The predictive efficacy of multidimensional prognostic index in the elderly with heart failure and reduced ejection fraction in a real world sample: the Post-Acute Long-Term Care setting

The multidimensional prognostic index (MPI) is an accurate predictor of mortality validated in hospitalized older patients. Aim of this study was to evaluate the reliability of the MPI in predicting shortand long-term mortality in patients with heart failure (HF), particularly in those with reduced left ventricular ejection fraction (HFrEF). The study population included all patients older than 65 years admitted in a Post-Acute Long-Care Unit from 2013 to 2018. Patients were divided into two groups: patients with HF (N=143) and patients without HF as controls (N=1254). Furthermore, patients affected by HF were subdivided according to echocardiographic left ventricular ejection fraction (LVEF), i.e. reduced, mid-range and preserved LVEF (respectively HFrEF, HFmrEF, HFpEF). All patients underwent a comprehensive geriatric assessment (CGA) to calculate the MPI based on information on functional, cognitive, nutritional and mobility status, comorbidity, poli-pharmacy and co-habitation. Mortality rates in the HF group was 46% in patients MPI-1 or MPI-2 groups versus 59% in patients included in the MPI- 3 group. In particular, of 32 HF patients with HFrEF 67.7% were in the MPI-3 class compared to 43% of 14 patients with HFmrEF group and to 41% of 63 patients with HFpEF. These findings suggest that MPI is a reliable predictor of mortality in HF patients and that it was particularly useful in the subgroup of patients with HFrEF.