title: Long-term mortality in older patients discharged after acute decompensated heart failure: a prospective cohort study.
abstract: Data are available on short- and intermediate-term mortality rates after discharge for acutely decompensated heart failure (ADHF). However, few studies specifically addressed ADHF outcomes in patients aged 75 years or over, who contribute more than half of all ADHF admissions. Our objectives here were to estimate the long-term mortality of patients aged 75 years or over who were discharged after admission for ADHF and to identify factors, especially geriatric findings, independently associated with 2-year mortality.
  
  
  
  This prospective cohort study in five French hospitals included consecutive patients aged 75 years or older and discharged after emergency-department admission for ADHF meeting Framingham criteria (N = 478; median age, 85 years; 68% female). Kaplan-Meier 1-year and 2-year survival curves were plotted. Admission characteristics independently associated with overall 2-year mortality were identified using multivariable Cox proportional-hazards regression.
  
  
  
  Mortality was 41.7% (95% confidence interval [95% CI], 37.2%-53.5%) after 1 year and 56.0% (95% CI, 51.5%-60.7%) after 2 years. By multivariable analysis, independent predictors of 2-year mortality were male sex (hazard ratio [HR], 1.36; 95% CI, 1.00-1.82), age >85 years (HR, 1.57; 95% CI, 1.19-2.07), higher number of impaired activities of daily living (HR, 1.11 per impaired item; 95% CI, 1.05-1.17), recent weight loss (HR, 1.61; 95% CI, 1.14-2.28), and lower systolic blood pressure (HR, 0.86 per standard deviation increase; 95% CI, 0.74-0.99). Creatinine clearance ≤30 mL/min showed a trend toward an association with 2-year mortality (HR, 1.36; 95% CI, 0.97-2.00).
  
  
  
  Functional impairment before admission is associated with higher long-term mortality in patients ≥75 years admitted for ADHF. This study focused on geriatric markers not traditionally collected in heart-failure patients but did not analyse all cardiologic parameters associated with outcomes in other studies. Nevertheless, our findings may contribute to identify those patients admitted for ADHF who have the worst prognosis.
authors.affiliation: Université Paris Est (UPEC), A-TVB DHU, IMRB, EA7376, CEpiA Clinical Epidemiology and Ageing unit, Créteil, France. pierre.natella@hmn.aphp.fr.|AP-HP, Hôpital Henri Mondor, Service de Santé Publique, Créteil, France. pierre.natella@hmn.aphp.fr.
authors.forename: Pierre-André
authors.initials: PA
authors.lastname: Natella
authors.affiliation: Inserm, Centre d'Investigation Clinique, 1430, Créteil, France.|AP-HP, Hôpital Henri Mondor, Pôle Vigilance Recherche Méthodologie & Information Médicale, 94010, Créteil, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Le Corvoisier
authors.affiliation: Université Paris Est (UPEC), A-TVB DHU, IMRB, EA7376, CEpiA Clinical Epidemiology and Ageing unit, Créteil, France.|AP-HP, Hôpital Henri Mondor, Département de Médecine Interne et Gériatrie, Créteil, France.
authors.forename: Elena
authors.initials: E
authors.lastname: Paillaud
authors.affiliation: AP-HP, Hôpital Henri Mondor, Structure des Urgences, Créteil, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Renaud
authors.affiliation: AP-HP, Hôpital Lariboisière-Fernand Widal, Département de Médecine Interne, Paris, France.|Université Paris 7, EA REMES Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Mahé
authors.affiliation: AP-HP, Hôpital Lariboisière-Fernand Widal, Département de Médecine Interne, Paris, France.|Université Paris 7, EA REMES Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Bergmann
authors.affiliation: Centre hospitalier de Meaux, Service de Cardiologie, Meaux, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Perchet
authors.affiliation: CHU Brest, Hôpital Cavale Blanche, Département de Médecine Interne et de Pneumologie, Brest, France.|Université de Bretagne Occidentale, EA 3878 (GETBO), Brest, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Mottier
authors.affiliation: Inserm, Centre d'Investigation Clinique, 1430, Créteil, France.|AP-HP, Hôpital Henri Mondor, Pôle Vigilance Recherche Méthodologie & Information Médicale, 94010, Créteil, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Montagne
authors.affiliation: Université Paris Est (UPEC), A-TVB DHU, IMRB, EA7376, CEpiA Clinical Epidemiology and Ageing unit, Créteil, France.|AP-HP, Hôpital Henri Mondor, Service de Santé Publique, Créteil, France.|AP-HP, Hôpital Henri Mondor, Unité de Recherche Clinique, Créteil, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Bastuji-Garin
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005602:France / Q000453:epidemiology; D015577:Geriatric Assessment / Q000379:methods; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D006801:Humans; D000069451:Long Term Adverse Effects / Q000401:mortality*; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D000067251:Symptom Flare Up
keywords: Acute decompensated heart failure; Elderly; Long-term mortality