title: Functional status and co-morbidities are associated with in-hospital mortality among older patients with acute decompensated heart failure: a multicentre prospective cohort study.
abstract: BACKGROUND
  Among patients admitted for acute decompensated heart failure (ADHF), half are aged 75 years or over. The high prevalence of co-morbidities and functional impairments in this age group may affect patient outcomes.
  
  
  OBJECTIVE
  To assess the association between co-morbidities, functional status and in-hospital mortality in patients with ADHF aged ≥75 years.
  
  
  METHODS
  A prospective, multicentre cohort study.
  
  
  METHODS
  Five French hospitals.
  
  
  METHODS
  Five hundred and fifty-five patients aged ≥75 years admitted to the emergency department with ADHF.
  
  
  METHODS
  Baseline clinical data and co-morbidities were recorded at admission. Functional status and cognition were assessed using the Katz index and Mini-Mental Status Examination score, respectively. The primary outcome was in-hospital mortality.
  
  
  RESULTS
  We found high prevalences of co-morbidities and functional impairments including hypertension (74.0%), atrial fibrillation (40.2%), prior acute coronary syndrome (32.3%) and diabetes (18.2%). The average creatinine clearance was 56.3 ml/min/1.73 m(2) (interquartile range, 39.2-77.0). In-hospital mortality was 67/555 (12.1%; 95% confidence interval, 9.4-14.8). In multivariate analysis, in-hospital mortality showed a statistically positive association with prior loss of self-sufficiency (Odds ratio [OR]: 5.85 [2.25-12.19]), hyperglycaemia (OR: 1.80 [1.26-2.54] per 1 SD increase), prior cerebral ischaemic event (OR: 3.56 [1.51-8.44]) and troponin I elevation above upper limit of normal (OR: 2.81 [1.37-5.77]). In addition, systolic blood pressure (OR: 0.98 [0.97-0.99] per 1 mmHg increase) and creatinine clearance (OR: 0.72 [0.51-1.00] per 1 SD increase) were negatively associated with in-hospital mortality.
  
  
  CONCLUSIONS
  Co-morbidities and functional impairments are associated with a worse short-term prognosis in patients aged ≥75 years admitted for ADHF. Assessing these parameters at admission may improve patient management.
authors.affiliation: Inserm, Clinical Investigation Centre 1430, APHP, Henri Mondor Hospital, F-94010 Creteil, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Le Corvoisier
authors.affiliation: Paris Est University (UPE), LIC EA4393 and APHP, Henri Mondor hospital, Clinical Research Unit (URC Mondor), F-94010 Créteil, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Bastuji-Garin
authors.affiliation: APHP, Cochin Hospital, Emergency Department, F-75014 Paris, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Renaud
authors.affiliation: APHP, Louis Mourier Hospital, Department of Internal Medicine and Paris 7 University, EA REMES Paris Diderot University, Sorbonne Paris Cité, F-92700 Colombes, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Mahé
authors.affiliation: APHP, Lariboisière-Fernand Vidal Hospital, Department of Internal Medicine, F-75010 Paris, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Bergmann
authors.affiliation: Meaux Hospital, Department of Cardiology, F-77100 Meaux, France.
authors.forename: Herve
authors.initials: H
authors.lastname: Perchet
authors.affiliation: APHP, Henri Mondor Hospital, Department of Geriatry, F-94010 Creteil, France.
authors.forename: Elena
authors.initials: E
authors.lastname: Paillaud
authors.affiliation: Cavale Blanche Hospital, Department of Internal Medicine and Pneumology, EA 3878 (GETBO), F-29609 Brest, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Mottier
authors.affiliation: Inserm, Clinical Investigation Centre 1430, APHP, Henri Mondor Hospital, F-94010 Creteil, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Montagne
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003071:Cognition; D015897:Comorbidity; D005260:Female; D005602:France; D015577:Geriatric Assessment; D006304:Health Status; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality* / Q000503:physiopathology / Q000523:psychology; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
keywords: acute decompensated heart failure; co-morbidities; functional status; mortality; older patients