title: Risk factors for hospital admission among older persons with newly diagnosed heart failure: findings from the Cardiovascular Health Study.
abstract: OBJECTIVE
  This study sought to identify risk factors for the occurrence of all-cause hospital admissions among older persons after heart failure diagnosis, and to determine whether geriatric conditions would emerge as independent risk factors for admission when evaluated in the context of other relevant clinical data.
  
  
  BACKGROUND
  Efforts to reduce costs in heart failure have focused on hospital utilization, yet few studies have examined how geriatric conditions affect the long-term risk for hospital admission after heart failure diagnosis. With the aging of the population with heart failure, geriatric conditions such as slow gait and muscle weakness are becoming increasingly common.
  
  
  METHODS
  The study population included participants with a new diagnosis of heart failure in the Cardiovascular Health Study, a longitudinal study of community-living older persons. Data were collected through annual examinations and medical-record reviews. Geriatric conditions assessed were slow gait, muscle weakness (defined as weak grip), cognitive impairment, and depressive symptoms. Anderson-Gill regression modeling was used to determine the predictors of hospital admission after heart failure diagnosis.
  
  
  RESULTS
  Of the 758 participants with a new diagnosis of heart failure, the mean rate of hospital admission was 7.9 per 10 person-years (95% CI: 7.4 to 8.4). Independent risk factors for hospital admission included diabetes mellitus (HR: 1.36; 95% CI: 1.13 to 1.64), New York Heart Association functional class III or IV (HR: 1.32; 95% CI: 1.11 to 1.57), chronic kidney disease (HR: 1.32; 95% CI: 1.14 to 1.53), slow gait (HR: 1.28; 95% CI: 1.06 to 1.55), depressed ejection fraction (HR: 1.25; 95% CI: 1.04 to 1.51), depression (HR: 1.23; 95% CI: 1.05 to 1.45), and muscle weakness (HR: 1.19; 95% CI: 1.00 to 1.42).
  
  
  CONCLUSIONS
  Geriatric conditions are important, and potentially modifiable, risk factors for hospital admission in heart failure that should be routinely assessed at the time of heart failure diagnosis.
authors: Section of General Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA. sarwat.chaudhry@yale.edu
authors: Sarwat I
authors: SI
authors: Chaudhry
authors: Gail
authors: G
authors: McAvay
authors: Shu
authors: S
authors: Chen
authors: Heather
authors: H
authors: Whitson
authors: Anne B
authors: AB
authors: Newman
authors: Harlan M
authors: HM
authors: Krumholz
authors: Thomas M
authors: TM
authors: Gill
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D015987:Effect Modifier, Epidemiologic; D005260:Female; D015577:Geriatric Assessment / Q000379:methods / Q000706:statistics & numerical data; D006306:Health Surveys; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D016743:Mental Competency; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology
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