Characteristics and Outcomes of Very Elderly Patients Following First Hospitalization for Heart Failure.
Circ Heart Fail. 2011 Apr 5;
Authors: Shah RU, Tsai V, Klein L, Heidenreich PA
BACKGROUND: -The very elderly (age 80 and older) with heart failure (HF) is a growing population that is rarely included in clinical trials. The aim of this investigation was to describe the characteristics and outcomes of very elderly patients after a first HF hospitalization. METHODS AND RESULTS: -We identified very elderly patients (age 80 and older) discharged with HF from the Veteran's Administration (VA) National Patient Care Database from 1999 to 2008. Outcomes of interest were death during index admission, 30-day and one-year mortality, 30-day all cause and HF readmissions. We used generalized estimating equations to evaluate outcome differences between age groups within the very elderly cohort (ages 80-84, 85-89, 90 and older), adjusting for comorbidities, demographics, and clustering by treatment facility. We identified 21,397 very elderly veterans with a first HF hospitalization during the study period. Thirty-day mortality decreased from 14% to 7% (both p<.001) and one-year mortality decreased from 49% to 27% (p<0.001). While these improvements were most notable for patients age 90 and older (one-year mortality improved by 25.9%), the adjusted odds of death within one year were highest for the oldest veterans (OR 1.85, 95% CI 1.64-2.09, using 80-85 age group as reference). For all patients, 30-day all-cause readmissions remained largely unchanged and did not differ between age groups. CONCLUSIONS: -Mortality for very elderly HF patients has improved over time, but 30-day readmissions remain frequent. Future studies should identify interventions to reduce cardiac and non-cardiac re-hospitalization of very elderly HF patients.
PMID: 21467294 [PubMed - as supplied by publisher]