Abstract
BackgroundData are available on short- and intermediate-term mortality rates after discharge for acutely decompensated heart failure (ADHF). However, few studies specifically addressed ADHF outcomes in patients aged 75 years or over, who contribute more than half of all ADHF admissions. Our objectives here were to estimate the long-term mortality of patients aged 75 years or over who were discharged after admission for ADHF and to identify factors, especially geriatric findings, independently associated with 2-year mortality.MethodsThis prospective cohort study in five French hospitals included consecutive patients aged 75 years or older and discharged after emergency-department admission for ADHF meeting Framingham criteria (N = 478; median age, 85 years; 68% female). Kaplan-Meier 1-year and 2-year survival curves were plotted. Admission characteristics independently associated with overall 2-year mortality were identified using multivariable Cox proportional-hazards regression.ResultsMortality was 41.7% (95% confidence interval [95% CI], 37.2%–53.5%) after 1 year and 56.0% (95% CI, 51.5%–60.7%) after 2 years. By multivariable analysis, independent predictors of 2-year mortality were male sex (hazard ratio [HR], 1.36; 95% CI, 1.00–1.82), age >85 years (HR, 1.57; 95% CI, 1.19–2.07), higher number of impaired activities of daily living (HR, 1.11 per impaired item; 95% CI, 1.05–1.17), recent weight loss (HR, 1.61; 95% CI, 1.14–2.28), and lower systolic blood pressure (HR, 0.86 per standard deviation increase; 95% CI, 0.74–0.99). Creatinine clearance ≤30 mL/min showed a trend toward an association with 2-year mortality (HR, 1.36; 95% CI, 0.97–2.00).ConclusionFunctional impairment before admission is associated with higher long-term mortality in patients ≥75 years admitted for ADHF. This study focused on geriatric markers not traditionally collected in heart-failure patients but did not analyse all cardiologic parameters associated with outcomes in other studies. Nevertheless, our findings may contribute to identify those patients admitted for ADHF who have the worst prognosis.
Highlights
Data are available on short- and intermediate-term mortality rates after discharge for acutely decompensated heart failure (ADHF)
We previously reported co-morbidities and functional impairments independently associated with in-hospital mortality of older patients admitted for ADHF (ELISA survey) [21]
Our results show that recent weight loss is a major prognostic marker in elderly patients successfully treated for an episode of ADHF
Summary
Data are available on short- and intermediate-term mortality rates after discharge for acutely decompensated heart failure (ADHF). Our objectives here were to estimate the long-term mortality of patients aged 75 years or over who were discharged after admission for ADHF and to identify factors, especially geriatric findings, independently associated with 2-year mortality. Only two of these studies reported the associations linking geriatric syndromes to 1-year mortality in elderly patients with HF [6, 16], and none investigated clinical and laboratory variables concomitantly with geriatric findings. These knowledge gaps need to be filled, as the prevalence of chronic diseases increases with age, so that most patients older than 75 years have multiple co-morbidities [20]. Better knowledge of risk factors for long-term mortality may help to define follow-up and management goals and may improve treatment decision-making
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