Geriatric conditions and subsequent mortality in older patients with heart failure.
OBJECTIVE
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.
Chaudhry
Sarwat I
SI
Department of Internal Medicine, Section of General Medicine, Yale University School of Medicine, New Haven, Connecticut 06520-8093, USA. sarwat.chaudhry@yale.edu
Wang
Yongfei
Y
Gill
Thomas M
TM
Krumholz
Harlan M
HM
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D000544:Alzheimer Disease / Q000150:complications; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D008297:Male; D051346:Mobility Limitation; D008962:Models, Theoretical; D011379:Prognosis; D012307:Risk Factors