title: Burden of Comorbidities and Functional and Cognitive Impairments in Elderly Patients at the Initial Diagnosis of Heart Failure and Their Impact on Total Mortality: The Cardiovascular Health Study.
abstract: OBJECTIVE
  The purpose of this study was to determine the prevalence of clinically relevant comorbidities and measures of physical and cognitive impairment in elderly persons with incident heart failure (HF).
  
  
  BACKGROUND
  Comorbidities and functional and cognitive impairments are common in the elderly and often associated with greater mortality risk.
  
  
  METHODS
  We examined the prevalence of 9 comorbidities and 4 measures of functional and cognitive impairments in 558 participants from the Cardiovascular Health Study who developed incident HF between 1990 and 2002. Participants were followed prospectively until mid-2008 to determine their mortality risk.
  
  
  RESULTS
  Mean age of participants was 79.2 ± 6.3 years with 52% being men. Sixty percent of participants had ≥3 comorbidities, and only 2.5% had none. Twenty-two percent and 44% of participants had ≥1 activity of daily living (ADL) and ≥1 instrumental activity of daily living (IADL) impaired respectively. Seventeen percent of participants had cognitive impairment (modified mini-mental state exam score <80, scores range between 0 and 100). During follow up, 504 participants died, with 1-, 5-, and 10-year mortality rates of 19%, 56%, and 83%, respectively. In a multivariable-adjusted model, the following were significantly associated with greater total mortality risk: diabetes mellitus (hazard ratio [HR]: 1.64; 95% confidence interval [CI]: 1.33 to 2.03), chronic kidney disease (HR: 1.32; 95% CI: 1.07 to 1.62 for moderate disease; HR: 3.00; 95% CI: 1.82 to 4.95 for severe), cerebrovascular disease (HR: 1.53; 95% CI: 1.22 to 1.92), depression (HR: 1.44; 95% CI: 1.09 to 1.90), functional impairment (HR: 1.30; 95% CI: 1.04 to 1.63 for 1 IADL impaired; HR: 1.49; 95% CI: 1.07 to 2.04 for ≥2 IADL impaired), and cognitive impairment (HR: 1.33; 95% CI: 1.02 to 1.73). Other comorbidities (hypertension, coronary heart disease, peripheral arterial disease, atrial fibrillation, and obstructive airway disease) and measures of functional impairments (ADLs and 15-ft walk time) were not associated with mortality.
  
  
  CONCLUSIONS
  Elderly patients with incident HF have a high burden of comorbidities and functional and cognitive impairments. Some of these conditions are associated with greater mortality risk.
authors.affiliation: Section of Cardiovascular Diseases, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Khalil
authors.initials: K
authors.lastname: Murad
authors.affiliation: Colorado School of Public Health, Denver, Colorado.
authors.forename: David C
authors.initials: DC
authors.lastname: Goff
authors.affiliation: Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Morgan
authors.affiliation: Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Burke
authors.affiliation: Department of Biostatistics, University of Washington, Seattle, Washington.
authors.forename: Traci M
authors.initials: TM
authors.lastname: Bartz
authors.affiliation: Department of Medicine, and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Jorge R
authors.initials: JR
authors.lastname: Kizer
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Sarwat I
authors.initials: SI
authors.lastname: Chaudhry
authors.affiliation: Division of Cardiology, University of Maryland, Baltimore, Maryland.
authors.forename: John S
authors.initials: JS
authors.lastname: Gottdiener
authors.affiliation: Department of Medicine, Section of Cardiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina. Electronic address: dkitzman@wakehealth.edu.
authors.forename: Dalane W
authors.initials: DW
authors.lastname: Kitzman
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000453:epidemiology; D003072:Cognition Disorders / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D058729:Peripheral Arterial Disease / Q000453:epidemiology; D010809:Physical Fitness; D015995:Prevalence; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology
keywords: cognitive impairment; comorbidities; functional impairment; heart failure; outcome