title: Identification of older patients with heart failure who may be candidates for hospice care: development of a simple four-item risk score.
abstract: OBJECTIVE
  To identify predictors of 6-month mortality in older patients with heart failure (HF) and to develop a risk score for identifying potential candidates for hospice care.
  
  
  METHODS
  Secondary data analysis of a previously conducted randomized, clinical trial.
  
  
  METHODS
  Barnes-Jewish Hospital, St. Louis, Missouri.
  
  
  METHODS
  Two hundred eighty-two patients with HF aged 70 and older.
  
  
  METHODS
  Participants were randomized to conventional care or a multidisciplinary intervention designed to reduce rehospitalization.
  
  
  METHODS
  All-cause 6-month mortality.
  
  
  RESULTS
  Patients were followed for up to 14 years; 43 (15.2%) died within 6 months of hospital discharge. Multivariate logistic regression analysis identified four independent predictors of 6-month mortality: serum urea nitrogen of 30 mg/dL or greater (odds ratio (OR)=5.78, 95% confidence interval (CI)=2.65-12.66), systolic blood pressure less than 120 mmHg (OR=4.81, 95% CI=1.94-11.91), peripheral arterial disease (OR=3.09, 95% CI=1.26-7.58), and serum sodium less than 135 mEq/L (OR=2.27, 95% CI=0.98-5.27). Patients were stratified into four risk groups based on the presence or absence of these four risk factors. Six-month mortality rates for patients with zero, one, two, or three or more risk factors were 3.7%, 16.3%, 41.0%, and 66.7%, respectively (P<.05). The presence of three or more risk factors was associated with a positive predictive value of 66.7% and a negative predictive value of 86.4%.
  
  
  CONCLUSIONS
  Although additional studies are needed, these findings suggest that a simple four-item risk score can identify older patients with HF at high risk of dying within 6 months. This may enable clinicians to better advise patients about prognosis, adjust management accordingly, and if appropriate, facilitate referral for hospice care. Conversely, patients with a more-favorable prognosis may be suitable candidates for more-aggressive interventions.
authors.affiliation: Division of Nephrology, Hypertension and Transplantation, Department of Medicine, University of Florida, Gainesville, Florida, USA.
authors.forename: Bao C
authors.initials: BC
authors.lastname: Huynh
authors.forename: Aleksandr
authors.initials: A
authors.lastname: Rovner
authors.forename: Michael W
authors.initials: MW
authors.lastname: Rich
mesh_terms: D000368:Aged; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality; D017051:Hospice Care; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D018579:Patient Selection; D011237:Predictive Value of Tests; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology