Abstract 18088: The Geriatric Assessment Score is a Proper Clinical Tool to Stratify Older Old Patients Admitted with Heart Failure for In-Hospital and Two-Year Survival

Abstract

OBJECTIVES. - To determine the influence of physical, cognitive function and other comprehensive geriatric assessment (CGA) components on in-hospital and two-year mortality of older adults admitted with acute heart failure (HF). METHODS - Prospective study of 581 individuals aged >75 years admitted due to HF. Demographic, clinical, echocardiographic and analytical data were recorded. CGA included dependence in activities of daily living (ADL), mobility, cognitive status, screening for depression, comorbidity and pharmachological prescriptions. A Geriatric Assessment Score (range 0-10 p) was constructed. Mean follow-up of 533 hospitalization survivors was 77+52 weeks. A logistic regression model to determine factors independently related with in-hospital mortality and a Cox regression model to identify those related with two years mortality were constructed. RESULTS - Mean age 85.8±5.8 y., 67% women, 75% preserved ejection fraction, mean comorbidity index 3.97±3.01. Cognitive impairment was present in 45%, depression in 49%, 66% had mobility problems and 50% dependence in >1 ADL. In-hospital fatality was 8.2%. Variables associated with in-hospital mortality included NYHA class III (OR 4.1, 95% CI 1.5-10.8) or IV (OR 19.6, 95% CI 6.3-60.9), pulmonary oedema (OR 3, 95% CI 1.3-6.6), renal failure (OR 2.8, 95% CI 1.2-6.2) and the Geriatric Assessment Score (OR per point of increment 1.2, 95% CI 1-1.4). Two-year mortality related factors included age (OR 1.06, 95% CI 1.03-1.09), Geriatric Assessment Score (OR 1.17, 95% CI 1.09-1.27), NYHA functional class III (OR 1.62, 95% CI 1.18-2.23) or IV (OR 3.02, 95% CI 1.49-6.10), left ventricle systolic dysfunction (OR 1.67, 95% CI 1.20-2.31), comnorbidity index (OR 1.07, 95% CI 1.02-1.12), AF (OR 1.57, 95% CI 1.15-2.15), ACEI or ARB treatment (OR 0.66, 95% CI 0.49-0.90) and renal failure (OR 1.01, 95% CI 1.00-1.01). COCNLUSIONS - In very elderly heart failure patients, an index incorporating comorbidities, total number of prescription drugs, cognitive, functional and mobility status predicts in-hospital and two-year survival. In addition to other variables previously known, these should be considered for a better stratification of elderly patients admitted with HF.