title: Why and how do elderly patients with heart failure die? Insights from the TIME-CHF study.
abstract: OBJECTIVE
  Specific causes and modes of death (COD and MOD) of patients with heart failure (HF) are not well described, particularly in those with preserved ejection fraction >45% (HFPEF) and at old age. Thus, using the database of the TIME-CHF study, patients with HFPEF were compared with those with reduced ejection fraction ≤45% (HFREF), and patients ≥75 with those 60-74 years of age to identify MOD and COD, predictors of death, and event rates before death as compared with survivors.
  
  
  RESULTS
  During the 18-month follow-up, 132/622 patients (21%) died, with similar rates in patients with HFPEF and HFREF and a trend to higher rates in patients aged ≥75 years (24% vs. 17%, P = 0.06). COD and MOD (ACME system) were not different in the age groups. COD was more often non-cardiovascular in HFPEF patients than in HFREF patients (33% vs. 16%, P < 0.05) and cardiac MOD were more frequent in HFREF patients (75% vs. 56%, P < 0.05), mainly due to more sudden deaths (25% vs. 7%, P < 0.05). Patients who died experienced a median of four adverse events (interquartile range 1-7) and one (0-1) hospitalization within 60 days prior to death compared with 0.7 (0.4-1.4) and 0.1 (0.0-0.2) during a randomly selected 60 days in survivors (all P < 0.0001).
  
  
  CONCLUSIONS
  Despite similar 18-month mortality in patients with HFREF and those with HFPEF, important differences in COD and MOD were found which were not observed between the two age groups. A high rate of adverse events and hospitalizations preceded death. These observations may be relevant for the management of HF patients.
authors: Division of Cardiology, University Hospital Basel, Switzerland. peter.rickenbacher@ksbh.ch
authors: Peter
authors: P
authors: Rickenbacher
authors: Matthias
authors: M
authors: Pfisterer
authors: Thilo
authors: T
authors: Burkard
authors: Wolfgang
authors: W
authors: Kiowski
authors: Ferenc
authors: F
authors: Follath
authors: Dieter
authors: D
authors: Burckhardt
authors: Ruth
authors: R
authors: Schindler
authors: Hans-Peter
authors: HP
authors: Brunner-La Rocca
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000473:pathology*; D002423:Cause of Death; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D006305:Health Status Indicators; D006333:Heart Failure / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011379:Prognosis; D018570:Risk Assessment; D013223:Statistics as Topic; D013318:Stroke Volume; D016277:Ventricular Function, Left