Basal functional status predicts three-month mortality after a heart failure hospitalization in elderly patients - the prospective RICA study.
BACKGROUND
Many elderly heart failure (HF) patients show some degree of functional impairment. The study aim was to evaluate the functional status of oldest-old cohort of patients hospitalized with a diagnosis of decompensated (HF), and to analyze whether preadmission functional status predicts risk of 3-month mortality.


METHODS
We analyzed 1431 elderly (≥ 75 years) patients prospectively included in the Spanish National Registry on HF (RICA). We added Barthel Index (BI) to the usual HF patient assessment to measure patients' functional status, and we evaluated the relationship between preadmission BI values and 3-month mortality.


RESULTS
The mean age of patients was 82.3 (4.6) years. Patients' mean preadmission BI score was 81.3 (21.5); 802 patients (55.9%) had BI scores <61. Multivariate analysis confirmed an independent association between poor preadmission BI and older age, female sex, higher comorbidity, cognitive impairment, previous institutionalization, worse New York Heart Association (NYHA) functional class and lack of beta-blocker use. A total of 210 patients died (14.7%) after 3 months of follow-up. Cox multivariate analyses found that higher preadmission BI is correlated with reduced all-cause, 3-month postdischarge mortality [hazard ratio (HR) 0.981; CI95% 0.975-0.986, p<0.001]. Other variables independently associated with 3-month mortality were male sex, lower body mass index, lower systolic blood pressure, a diagnosis of diabetes and chronic kidney disease, worse NYHA class and not receiving treatment with beta-blockers.


CONCLUSIONS
Severe functional disability is present among more than half of older patients admitted because of a HF decompensation. For this population, preadmission BI is a strong predictor of short-term mortality.
Geriatric Unit, Internal Medicine Service, IDIBELL, Hospital Universitari de Bellvitge, L´Hospitalet de Llobregat, Barcelona, Spain. Electronic address: fformiga@bellvitgehospital.cat.
Francesc
F
Formiga
Geriatric Unit, Internal Medicine Service, IDIBELL, Hospital Universitari de Bellvitge, L´Hospitalet de Llobregat, Barcelona, Spain.
David
D
Chivite
Internal Medicine Department, Hospital Universitario de Gran Canaria Dr. Negrin, Universidad de Las Palmas de Gran Canaria, Spain.
Alicia
A
Conde
Internal Medicine Department, Hospital Universitario Lozano Blesa, Zaragoza, Spain.
Fernando
F
Ruiz-Laiglesia
Internal Medicine Department, Hospital Universitario Central de Asturias, Oviedo, Spain.
Alvaro González
AG
Franco
Internal Medicine Department, Hospital Universitario Vall d´Hebrón, Barcelona, Spain.
Carmen Pérez
CP
Bocanegra
Heart Failure and Vascular Risk Unit, Internal Medicine Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain.
Luis
L
Manzano
Internal Medicine Department, IMBIC/Hospital Reina Sofía, Universidad de Córdoba, Spain.
Manuel Montero
MM
Pérez-Barquero
D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality*; D006334:Heart Function Tests / Q000706:statistics & numerical data*; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008505:Medical Staff, Hospital / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies
Barthel Index; Elderly; Functional status; Heart failure; Mortality