title: Comorbidity drives mortality in newly diagnosed heart failure: a study among geriatric outpatients.
abstract: BACKGROUND
  Elderly heart failure (HF) patients frequently have multiple comorbidities. The prognostic impact of combined comorbidities is poorly quantified in these patients. We assessed the impact of comorbidities on 3-year mortality in geriatric outpatients with newly diagnosed HF.
  
  
  RESULTS
  Of 93 geriatric outpatients with HF (mean age 82.7 years, 36.6% men), 52 patients (55.9%) died within 3 years after HF was diagnosed. Comorbidity was measured with the Charlson Comorbidity Index (CCI). Age- and gender-adjusted hazard ratio (HR) for 3-year mortality was 1.6 (95% confidence interval [CI] 0.9-3.2) for patients with 3-4 CCI points and 3.2 (95% CI 1.5-6.8) for those with >4 CCI points, compared with 1-2 CCI points. After adjustment for age, gender, left ventricular ejection fraction (LVEF), and N-terminal pro-B-type natriuretic peptide, CCI remained predictive of death (CCI 3-4: HR 1.5 (95% CI 0.7-2.9); CCI >4: HR 4.0 (95% CI 1.9-8.8)). In addition to age and gender, the c-statistics for CCI and LVEF were similar (0.63 [95% CI 0.55-0.70] and 0.64 [95% CI 0.56-0.72], respectively).
  
  
  CONCLUSIONS
  The majority of geriatric outpatients with new HF die within 3 years. Comorbidity, summarized in the CCI, is the strongest independent predictor of mortality.
authors.affiliation: Department of Geriatric Medicine, Elkerliek Hospital, Helmond, The Netherlands. ioudejans@elkerliek.nl
authors.forename: Irène
authors.initials: I
authors.lastname: Oudejans
authors.forename: Arend
authors.initials: A
authors.lastname: Mosterd
authors.forename: Nicolaas P
authors.initials: NP
authors.lastname: Zuithoff
authors.forename: Arno W
authors.initials: AW
authors.lastname: Hoes
mesh_terms: D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006299:Health Services for the Aged; D006333:Heart Failure / Q000150:complications / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D008297:Male; D009426:Netherlands; D012720:Severity of Illness Index; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology