This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (2) Citing Articles via Google Scholar Google Scholar Articles by Chaudhry, S. I. Articles by Krumholz, H. M. Search for Related Content PubMed PubMed Citation Articles by Chaudhry, S. I. Articles by Krumholz, H. M. Related Collections Related Articles

QUARTERLY FOCUS ISSUE: HEART FAILURE: CLINICAL RESEARCH

Geriatric Conditions and Subsequent Mortality in Older Patients With Heart Failure

Sarwat I. Chaudhry, MD^_*,_*, Yongfei Wang, MS^,#, Thomas M. Gill, MD^, and Harlan M. Krumholz, MD, SM^,,||,¶,#

^_* Department of Internal Medicine, Section of General Medicine, Yale University School of Medicine, New Haven, Connecticut
Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
Department of Internal Medicine, Section of Geriatric Medicine, Yale University School of Medicine, New Haven, Connecticut
Department of Epidemiology and Public Health, Section of Chronic Disease Epidemiology, Yale University School of Medicine, New Haven, Connecticut
^|| Section of Health Policy and Administration, Yale University School of Medicine, New Haven, Connecticut
^¶ The Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut
^# Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut

Manuscript received February 25, 2009; revised manuscript received June 5, 2009, accepted July 6, 2009.

^_* Reprint requests and correspondence: Dr. Sarwat I. Chaudhry, Yale University School of Medicine, Harkness Office Building, Room 411, P.O. Box 208093, 367 Cedar Street, New Haven, Connecticut 06520-8093 (Email: sarwat.chaudhry{at}yale.edu).

Objectives: This study was designed to develop models for short- (30-day) and long- (5-year) term mortality after heart failure (HF) hospitalization that include geriatric conditions, specifically mobility disability and dementia, to determine whether these conditions emerge as strong and independent risk factors.

Background: Although 80% of patients with HF are 65 years of age or older, no large studies have focused on the prognostic importance of geriatric conditions.

Methods: We analyzed medical record data from a national sample of Medicare beneficiaries hospitalized for HF. To identify independent predictors of mortality, we performed stepwise selection in multivariable logistic regression models. We used net reclassification improvement to assess the incremental benefit of adding geriatric conditions to a model containing traditional risk factors for mortality.

Results: The mean age of patients included in the analysis was 80 years; 59% were women, 13% were nonwhite, 10% had dementia, and 39% had mobility disability. Mortality rates were 9.8% at 30 days and 74.7% at 5 years. Twenty-one variables were considered for inclusion in the final multivariable model. Dementia and mobility disability were among the top predictors of short- and long-term mortality, with among the top 6 largest absolute standardized estimates in the final model for 30-day mortality, and among the top 7 largest standardized estimates for 5-year mortality. The net reclassification improvement when geriatric conditions were added to traditional factors was 5.1% at 30 days and 4.2% at 5 years.

Conclusions: Geriatric conditions are strongly and independently associated with short- and long-term mortality among older patients with HF.

Key Words: heart failure • aging • mobility • dementia • prognosis

Abbreviations and Acronyms   HF = heart failure   NRI = net reclassification improvement

Related Articles

Stepping Outside of the Heart: Using Nontraditional Patient Characteristics to Understand and Improve Outcomes

Lakshmi Venkitachalam and John A. Spertus
J. Am. Coll. Cardiol. 2010 55: 317-319. [Full Text] [PDF]

This article has been cited by other articles:

				A. N. DeMaria, J. J. Bax, O. Ben-Yehuda, G. K. Feld, B. H. Greenberg, J. Hall, M. Hlatky, W. Y. W. Lew, J. A. C. Lima, A. S. Maisel, et al. Highlights of the Year in JACC 2010 J. Am. Coll. Cardiol., January 25, 2011; 57(4): 480 - 514. [Full Text] [PDF]

				L. Venkitachalam and J. A. Spertus Stepping Outside of the Heart: Using Nontraditional Patient Characteristics to Understand and Improve Outcomes J. Am. Coll. Cardiol., January 26, 2010; 55(4): 317 - 319. [Full Text] [PDF]