Impact of age on the prognostic benefit of follow-up in UMIPIC units: analysis of the RICA registry

Abstract

Multidisciplinary management programs are recommended for patients with heart failure (HF), yet it remains uncertain whether their prognostic benefits extend uniformly across all ages, particularly among the very elderly. This study evaluated whether age modifies the benefit of follow-up in UMIPIC (Comprehensive Management Unit for Patients with Heart Failure), using data from the Spanish RICA registry. We conducted a prospective, multicenter cohort study including 5644 patients (mean age 79.9±8.6 years; 52.7% women) hospitalized for acute HF and followed for one year. Patients were managed either within UMIPIC units or with conventional care. The primary outcomes were all-cause mortality and HF readmissions. Cox regression models tested the interaction between UMIPIC and age, modeled categorically (<90 vs ≥90 years), continuously, and with restricted cubic splines. During a median follow-up of 363 days, 1.419 patients (25.1%) died and 1.287 (22.8%) were rehospitalized for HF. In multivariable Cox models, UMIPIC participation was independently associated with lower mortality, with a significant age interaction (p=0.026). Among patients, 90 years, UMIPIC follow-up reduced mortality by 40% (HR 0.60; 95% CI 0.50–0.73; p<0.001), with consistent benefit across age groups (p for interaction=0.971). UMIPIC follow-up was associated with lower mortality and rehospitalization in older adults with HF. The survival benefit was most pronounced among nonagenarians, supporting the inclusion of very old patients in multidisciplinary HF programs.