title: Cardiovascular and Mortality Outcomes in the Elderly With Impaired Cardiac and Pulmonary Function: The Cardiovascular Health Study (CHS).
abstract: BACKGROUND
  Impaired pulmonary function (IPF) and left ventricular systolic dysfunction (LVSD) are prevalent in the elderly and are associated with significant morbidity and mortality. The main objectives of this study were to examine the relative impact and joint association of IPF and LVSD with heart failure, cardiovascular mortality and all-cause mortality, and their impact on risk classification using a continuous net reclassification index.
  
  
  RESULTS
  We followed 2342 adults without prevalent cardiovascular disease (mean age, 76 years) from the Cardiovascular Health Study for a median of 12.6 years. LVSD was defined as LV ejection fraction <55%. IPF was defined as: forced expiratory volume in 1 second:forced vital capacity <70%, and predicted forced expiratory volume in 1 second <80%. Outcomes included heart failure hospitalization, cardiovascular mortality, all-cause mortality, and composite outcome. LVSD was detected in 128 subjects (6%), IPF in 441 (19%) and both in 38 (2%). Compared to those without LVSD or IPF, there was a significantly increased cardiovascular risk for groups of LVSD only, IPF only, and LVSD plus IPF, adjusted hazard ratio (95% CI) 2.1 (1.5-3.0), 1.7 (1.4-2.1), and 3.2 (2.0-5.1) for HF; 1.8 (1.2-2.6), 1.4 (1.1-1.8), and 2.8 (1.7-4.7) for cardiovascular mortality; 1.3 (1.0-1.8), 1.7 (1.4-1.9), and 2.1 (1.5-3.0) for all-cause mortality, and 1.6 (1.3-2.1), 1.7 (1.5-1.9), and 2.4 (1.7-3.3) for composite outcome, respectively. Risk classification improved significantly for all outcomes when IPF was added to the adjusted model with LVSD or LVSD to IPF.
  
  
  CONCLUSIONS
  While risk of cardiovascular outcomes was the highest among elderly with both LVSD and IPF, risk was comparable between subjects with IPF alone and those with LVSD alone. This observation, combined with improved risk classification by adding IPF to LVSD or LVSD to IPF, underscore the importance of comprehensive heart and lung evaluation in cardiovascular outcome assessment.
authors.affiliation: Saint Francis Hospital, Roslyn, NY (S.W., J.J.C.) University of Kansas Medical Center, Kansas City, KS (S.W.).
authors.forename: Salman
authors.initials: S
authors.lastname: Waheed
authors.affiliation: Benjamin Leon Center for Geriatric Research and Education, Florida International University, Miami, FL (P.M.C.).
authors.forename: Paulo H M
authors.initials: PH
authors.lastname: Chaves
authors.affiliation: Hackensack University Medical Center, Hackensack, NJ (J.M.G.).
authors.forename: Julius M
authors.initials: JM
authors.lastname: Gardin
authors.affiliation: Saint Francis Hospital, Roslyn, NY (S.W., J.J.C.) State University of New York at Stony Brook, NY (J.J.C.).
authors.forename: Jie Jane
authors.initials: JJ
authors.lastname: Cao
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000401:mortality / Q000503:physiopathology; D005260:Female; D006331:Heart Diseases / Q000401:mortality* / Q000503:physiopathology; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008171:Lung Diseases / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D009026:Mortality; D011446:Prospective Studies; D012129:Respiratory Function Tests; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D014481:United States / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000401:mortality* / Q000503:physiopathology
keywords: elderly; epidemiology; heart failure; left ventricular systolic dysfunction; mortality; pulmonary function