Abstract P244: Comorbidities and Physical and Cognitive Impairments in Elderly Heart Failure Patients: Impact on Total Mortality: The Cardiovascular Health Study (CHS)

Abstract

Background: Comorbidities and physical and cognitive impairments are common in patients with heart failure (HF) and often associated with greater mortality. However, the prevalence of these conditions and their associated mortality risk in elderly patients with incident HF is unknown. Method: We examined the prevalence of 9 comorbidities and 4 measures of physical and cognitive impairments in 558 participants from CHS (age 79.2 ± 6.3, 52% men) with incident HF diagnosed between 1990 and 2002. Participants were followed prospectively until mid 2008 (an average follow up time of 4.7 years) to determine the associated mortality risk. Results: The burden of comorbidities was high; 60% of participants had ≥ 3 comorbidities, and only 2.5% had none. Impairment in ≥ 1 activity of daily living (ADL) and ≥ 1 instrumental activity of daily living (IADL) was present in 22.5% and 43.7% of participants, respectively. Significant cognitive impairment (modified mini-mental state exam (3MSE) score < 80) was present in 17% of participants. During follow up, 504 participants died, with 1-year and 5-year survival rates of 0.81 and 0.44 respectively. In a multivariable-adjusted model, the following were significantly associated with greater total mortality (hazard ratio: 95% confidence interval): comorbidities including diabetes mellitus (1.64: 1.33–2.03), chronic kidney disease (moderate (1.32: 1.07–1.62); severe (3.00: 1.82–4.95)), cerebrovascular disease (1.53: 1.22–1.92), and depression (1.44: 1.09–1.90); Physical impairment (1 ADL impaired (1.30: 1.04–1.63); ≥ 2 IADL impaired (1.49: 1.07–2.04)); and cognitive impairment (3MSE score < 80 (1.33: 1.02–1.73)). Conclusion: Elderly patients with incident HF have high burdens of comorbidities and physical and cognitive impairments that significantly contribute to their high mortality rates.