Elsevier

American Heart Journal

Volume 164, Issue 5, November 2012, Pages 756-762
American Heart Journal

Clinical Investigation
Congestive Heart Failure
Comprehensive geriatric assessment and hospital mortality among older adults with decompensated heart failure

https://doi.org/10.1016/j.ahj.2012.08.009Get rights and content

Background

The aim of this study is to assess whether a simple comprehensive geriatric assessment (CGA) score predicts hospital mortality among very elderly patients admitted with heart failure (HF).

Methods

This is a prospective follow-up of 581 individuals aged ≥75 years admitted for decompensated HF to an acute geriatric unit from October 2006 to September 2009.

A CGA score (range, 0-10) was constructed using baseline individual data on 5 domains: dependence in activities of daily living (Katz index), mobility (qualitative mobility scale), cognition (Mini-Mental State Examination), comorbidity (Charlson index), and number of prescribed medications.

Results

Mean age of patients was 85.8 ± 5.8 years, 67% were women, and 75% had preserved ventricular function (ejection fraction >45%). Fifty percent of patients required assistance in ≥1 activities of daily living, 66% had mobility problems, 45% had cognitive impairment, the mean Charlson index was 3.97 ± 3.01, and 36% had >7 medications prescribed. As a result, the mean CGA score was 4.8 ± 2.2. Hospital mortality was 8.2%. In multivariate analysis, variables associated with hospital mortality included New York Heart Association functional class III (odds ratio [OR] 4.1, 95% CI 1.5-10.8), class IV (OR 19.6, 95% CI 6.3-61), pulmonary edema on chest radiography (OR 3.0, 95% CI 1.3-6.6), renal failure (OR 2.8, 95% 1.2-6.2), and the CGA score (OR 1.2, 95% CI 1.02-1.4 for each point of increment). The area under the receiver operating characteristic curve was 0.856 (95% CI 0.790-0.921), and the model classified 93.4% of cases correctly.

Conclusions

In our cohort of very old patients with HF, a simple CGA score predicts hospital mortality.

Section snippets

Background

Heart failure (HF) is primarily a disease of the elderly, with approximately half of these cases occurring in patients aged ≥75 years.1 Heart failure is the leading cause of hospitalization in the elderly; moreover, it worsens cognition, physical function, and quality of life; increases health care costs; and leads to higher mortality.2, 3, 4, 5

Two recent studies in older patients with HF have shown that multidimensional impairment influences clinical outcomes. In the first study, geriatric

Study population and design

We conducted a prospective follow-up of all patients admitted to an acute geriatric unit with decompensated HF from October 1, 2006 to September 30, 2009. Specifically, we included patients fulfilling the Framingham and European Society of Cardiology criteria for HF,1, 11 who were admitted due to an acute decompensation regardless of whether it was the first or a recurrent episode of a previously diagnosed HF. We excluded individuals with a high probability of noncardiovascular death within 4

Results

A total of 581 patients entered the study. Table II shows the baseline clinical characteristics of study participants. Mean age at inclusion was 85.8 ± 5.8 years (24% were ≥90 years), 67% were women, and 10.5% lived in nursing homes.

Before admission, 11% of patients were in NYHA functional class I; 46.6%, in class II; 35.6%, in class III; and 6.8%, in class IV. Transthoracic echocardiography was performed in 81% of subjects, with 75% showing preserved left ventricular function (ejection

Discussion

The main finding of our study is that a simple CGA score used at hospital admission is a good predictor of hospital mortality among very old patients with decompensated HF.

Previous studies have identified a number of predictors of in-patient mortality, such as the NYHA functional class, renal dysfunction, blood pressure, age, gender, underlying etiology, previous HF hospitalization, comorbidity, respiratory rate, anemia, serum sodium, and atrial natriuretic peptide levels, reduced left

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