title: Baseline characteristics, quality of care, and outcomes of younger and older Medicare beneficiaries hospitalized with heart failure: findings from the Alabama Heart Failure Project.
abstract: BACKGROUND
  Most studies of heart failure (HF) in Medicare beneficiaries have excluded patients age <65 years. We examined baseline characteristics, quality of care, and outcomes among younger and older Medicare beneficiaries hospitalized with HF in the Alabama Heart Failure Project.
  
  
  METHODS
  Of the 8049 Medicare beneficiaries discharged alive with a primary discharge diagnosis of HF in 1998-2001 from 106 Alabama hospitals, 991 (12%) were younger (age <65 years). After excluding 171 patients discharge to hospice care, 7867 patients were considered eligible for left ventricular systolic function (LVSF) evaluation and 2211 patients with left ventricular ejection fraction <45% and without contraindications were eligible for angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy.
  
  
  RESULTS
  Nearly half of the younger HF patients (45% versus 22% for ≥65 years; p<0.001) were African American. LVSF was evaluated in 72%, 72%, 70% and 60% (overall p<0.001) and discharge prescriptions of ACE inhibitors or ARBs were given to 83%, 77%, 75% and 75% of eligible patients (overall p=0.013) among those <65, 65-74, 75-84 and ≥85 years respectively. During 9 years of follow-up, all-cause mortality occurred in 54%, 61%, 71% and 80% (overall p<0.001) and hospital readmission due to worsening HF occurred in 65%, 60%, 55% and 48% (overall p<0.001) of those <65, 65-74, 75-84 and ≥85 years respectively.
  
  
  CONCLUSIONS
  Medicare beneficiaries <65 years with HF, nearly half of whom were African American generally received better quality of care, had lower mortality, but had higher re-hospitalizations due to HF.
authors.affiliation: University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Feller
authors.forename: Marjan
authors.initials: M
authors.lastname: Mujib
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhang
authors.forename: O James
authors.initials: OJ
authors.lastname: Ekundayo
authors.forename: Inmaculada B
authors.initials: IB
authors.lastname: Aban
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.forename: Richard M
authors.initials: RM
authors.lastname: Allman
authors.forename: Ali
authors.initials: A
authors.lastname: Ahmed
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000407:Alabama; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D006278:Medicare; D008875:Middle Aged; D011787:Quality of Health Care; D016896:Treatment Outcome; D014481:United States