Our study aimed to identify clusters of hospitalized older COVID-19 patients according to their main comorbidities and routine laboratory parameters to evaluate their association with in-hospital mortality. We performed an observational study on 485 hospitalized older COVID-19 adults (aged 80+ years). Patients were aggregated in clusters by a K-medians cluster analysis. The primary outcome was in-hospital mortality. Medical history and laboratory parameters were collected on admission. Frailty, defined by the Clinical Frailty Scale (CFS), referred to the two weeks before hospitalization and was used as a covariate. The median age was 87 (83–91) years, with a female prevalence (59.2%). Three different clusters were identified: cluster 1 (337), cluster 2 (118), and cluster 3 (30). In-hospital mortality was 28.5%, increasing from cluster 1 to cluster 3: cluster 1 = 21.1%, cluster 2 = 40.7%, and cluster 3 = 63.3% (p < 0.001). The risk for in-hospital mortality was higher in clusters 2 [HR 1.96 (95% CI: 1.28–3.01)] and 3 [HR 2.87 (95% CI: 1.62–5.07)] compared to cluster 1, even after adjusting for age, sex, and frailty. Patients in cluster 3 were older and had a higher prevalence of atrial fibrillation, higher admission NT-proBNP and C-reactive protein levels, higher prevalence of concurrent bacterial infections, and lower estimated glomerular filtration rates. The addition of CFS significantly improved the predictive ability of the clusters for in-hospital mortality. Our cluster analysis on older COVID-19 patients provides a characterization of those subjects at higher risk for in-hospital mortality, highlighting the role played by cardio-renal impairment, higher inflammation markers, and frailty, often simultaneously present in the same patient.

Background: In common clinical practice, cardiac overload is still often overlooked in patients with chronic obstructive pulmonary disease (COPD) despite its substantial impact on clinical outcomes and mortality. This study aimed to assess the prevalence of cardiac overload and heart failure (HF) risk, using N-terminal pro-B-type natriuretic peptide (NT-proBNP), in older COPD patients eligible for single-inhaler triple therapy (SITT) and without history of overt HF. We also evaluated changes in NT-proBNP after 3 months of SITT. Methods: This multicenter observational study included 165 older outpatients with a recent moderate-to-severe acute exacerbation of COPD (AECOPD), categorized as ‘Group E’ according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Patients were stratified for the presence of cardiac overload and HF risk using age- and comorbidity-adjusted NT-proBNP thresholds, as recommended by the 2023 Clinical Consensus Statement of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). NT-proBNP was measured at baseline and after three months of SITT (116 patients with available test at three months). Results: Mean age was 80.7 ± 9.7 years. Patients with NT-proBNP levels indicative of “HF likely” and “HF very high-risk” were 43.0% and 24.2%, respectively. After 3 months of SITT, NT-proBNP significantly decreased by 7.2% (95%CI 9.0–5.4%, p < 0.001), with the largest reductions observed in younger patients [11.0% (95% CI 14.1–7.2%) ≤ 76 years old, 8.4% (95% CI −11.3–5.5%) in 77–87 years old, −3.0% (95% CI −6.1–0.0%) in ≥88 years old, p for interaction = 0.007]. Conclusions: In real-life clinical practice, a substantial proportion of older patients with GOLD Group E COPD had elevated NT-proBNP, suggestive of cardiac overload and high risk of HF. The early identification of these patients may prompt further cardiologic evaluation and management. After SITT and before cardiology evaluation, a significant NT-proBNP reduction has been observed, suggesting potential cardiovascular benefit of SITT.