title: Mortality and readmissions in heart failure: an analysis of 36,824 elderly patients from the Slovenian national hospitalization database.
abstract: BACKGROUND
  In heart failure (HF), comorbidity burden and prognostic risks increase with age. Studies investigating outcome in elderly patients from large datasets are lacking, particularly in central and eastern European countries. We analyzed the Slovenian data on mortality and readmissions after first HF hospitalization in patients aged 65 years or over.
  
  
  METHODS
  In this observational epidemiological study, the Slovenian national hospitalization database was searched for HF patients aged ≥65 years with first HF hospitalization between 2008 and 2012. All-cause mortality and readmissions were compared in young-olds (65-74 years), middle-olds (75-84 years), and old-olds (≥85 years) using cumulative probability plots and log rank test. The prognostic value of comorbidities on mortality and readmissions for age groups were assessed using multiple Cox proportional hazards models.
  
  
  RESULTS
  Overall, 36,824 patients were included (median age 80 years, 41 % men, 20 % in-hospital mortality). The proportions of young-olds, middle-olds, and old-olds were 26, 48, and 26 %, respectively. Arterial hypertension (60 %), pulmonary disease (44 %), and atrial fibrillation (38 %) were the most prevalent comorbidities, with little variation over age. While age group was associated with higher mortality (P < 0.001), no such associations were seen for readmissions at any time points (P > 0.1 for all). Importance of comorbidities as a predictor for mortality faded with increasing age while only small decrease in hazard ratios for readmissions were seen.
  
  
  CONCLUSIONS
  Age is an independent predictor of mortality but not readmissions in elderly patients with first HF hospitalization. Comorbidities are important predictors for mortality and readmissions in elderly.
authors.affiliation: National Institute of Public Health, Ljubljana, Slovenia.
authors.forename: Daniel
authors.identifier: http://orcid.org/0000-0002-8467-6053
authors.initials: D
authors.lastname: Omersa
authors.affiliation: Department of Cardiology, Department of Research and Education, General Hospital Celje, Celje, Slovenia.|Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
authors.forename: Mitja
authors.initials: M
authors.lastname: Lainscak
authors.affiliation: National Institute of Public Health, Ljubljana, Slovenia.
authors.forename: Ivan
authors.initials: I
authors.lastname: Erzen
authors.affiliation: National Institute of Public Health, Ljubljana, Slovenia. jerneja.farkas-lainscak@nijz.si.
authors.forename: Jerneja
authors.initials: J
authors.lastname: Farkas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D017524:Slovenia / Q000453:epidemiology; D015996:Survival Rate
keywords: Comorbidities; Elderly; Heart failure; Mortality; Readmissions