Predictors of mortality in home-dwelling patients with cardiovascular disease aged 75 and older.
OBJECTIVE
To compare the predictive value of biomarkers commonly measured in older patients with cardiovascular disease (CVD) with an indicator of cognitive function.


METHODS
Prospective cohort study.


METHODS
Helsinki, Finland.


METHODS
Three hundred ninety-eight home-dwelling older persons (261 women, mean age 80) with stable CVD and without a diagnosis of clinical dementia.


METHODS
Simple laboratory and clinical measurements (including the Mini Mental State Examination (MMSE, maximum score 30 points) and New York Heart Association (NYHA) classification) were used to predict mortality. A MMSE score between 18 and 24 points was considered to indicate cognitive impairment.


RESULTS
At baseline, median MMSE score was 27 (interquartile range 25-28), with 59 individuals having a score below 24 points. During a mean follow-up of 6.0 years, 129 participants died. In the fully adjusted Cox proportional hazards model, low MMSE score was the strongest predictor of mortality, with a relative hazard of 2.38 (95% confidence interval=1.52-3.74; P<.001). Of the various clinical and laboratory variables, only creatinine, C-reactive protein, and history of congestive heart failure were significant independent predictors, whereas conventional risk factors were not.


CONCLUSIONS
Only a few clinical variables independently predicted 6-year mortality in older home-living patients with CVD. The strongest predictor was impaired cognitive function assessed using MMSE.
Strandberg
Timo E
TE
Department of Health Sciences/Geriatrics, University of Oulu, Oulu University Hospital, Finland. timo.strandberg@oulu.fi
Pitkala
Kaisu H
KH
Tilvis
Reijo S
RS
D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality*; D003072:Cognition Disorders / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008609:Mental Status Schedule