Clinical features, treatment practices, and hospital and long-term outcomes of older patients hospitalized with decompensated heart failure: The Worcester Heart Failure Study.
OBJECTIVE
To examine age-specific differences in clinical presentation, receipt of therapeutic practices and lifestyle recommendations, and hospital and long-term survival in patients hospitalized for acute heart failure HF.


METHODS
Population-based study.


METHODS
The Worcester Heart Failure Study, a population-based study of residents of the a large Central New England metropolitan area hospitalized for decompensated HF at 11 greater-Worcester medical centers.


METHODS
Four thousand five hundred thirty-four patients hospitalized for decompensated HF during 1995 and 2000.


METHODS
Medical records were reviewed for demographic, clinical, and treatment characteristics and hospital survival status. Long-term follow-up of discharged hospital patients was conducted through 2005. Patients were compared according to four age groups (<65, 65-74, 75-84, and > or =85).


RESULTS
Mean age was 76; 24.0% were aged 85 and older. Patients aged 75 and older were more likely to be female and to have multiple comorbidities, a lower body mass index at the time of hospitalization, and higher ejection fraction findings. Older patients were significantly more likely to receive symptom-modifying medications and less likely to receive disease-modifying medications than younger patients. Older age was directly associated with higher in-hospital, 30-day, and 1-year death rates in crude and multivariable-adjusted analyses.


CONCLUSIONS
The results of this community-wide study suggest that clinical, treatment, and prognostic factors differ according to age in patients hospitalized for decompensated HF. These high-risk patients warrant special attention in future studies to improve their management and long-term survival.
Saczynski
Jane S
JS
Department of Medicine, Division of GeriatricMedicine, University of Massachusetts Medical School, Biotech Four, Suite 315, 377 Plantation Street, Worcester, MA 01605, USA. jane.saczynski@umassmed.edu
Darling
Chad E
CE
Spencer
Frederick A
FA
Lessard
Darleen
D
Gore
Joel M
JM
Goldberg
Robert J
RJ
D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002317:Cardiovascular Agents / Q000627:therapeutic use; D015897:Comorbidity; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008019:Life Style; D008297:Male; D008404:Massachusetts; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
D002317:Cardiovascular Agents
Eur J Heart Fail. 2008 Jan;10(1):78-84
18096434
N Engl J Med. 2002 Oct 31;347(18):1397-402
12409541
Arch Intern Med. 2007 Mar 12;167(5):490-6
17353497
Circulation. 2002 Mar 12;105(10):1182-8
11889011
N Engl J Med. 1991 Aug 1;325(5):293-302
2057034
Am J Med. 2006 Jul;119(7):616.e1-7
16828634
Arch Intern Med. 2006 Sep 25;166(17):1892-8
17000947
J Gerontol A Biol Sci Med Sci. 2004 Jul;59(7):716-21
15304537
Circulation. 2000 Sep 5;102(10):1126-31
10973841
Am Heart J. 2002 Jan;143(1):45-55
11773911
Am J Med. 2005 Jul;118(7):728-34
15989906
Am Heart J. 2004 Oct;148(4):710-7
15459605
Int J Cardiol. 2005 Jun 22;102(1):55-60
15939099
JAMA. 2004 Jul 21;292(3):344-50
15265849
Circulation. 2002 Oct 22;106(17):2194-9
12390947
JAMA. 2003 Nov 19;290(19):2581-7
14625335
Circulation. 2003 Apr 1;107(12):1570-5
12668487
N Engl J Med. 2001 May 31;344(22):1651-8
11386263
Am J Med. 2007 Jan;120(1):98.e1-8
17208085
Circulation. 2006 May 16;113(19):2285-92
16682616
Arch Intern Med. 1998 May 25;158(10):1074-80
9605778
Lancet. 1999 Jan 2;353(9146):9-13
10023943
JAMA. 2000 Mar 8;283(10):1295-302
10714728