Clinical InvestigationCongestive Heart FailureComprehensive geriatric assessment and hospital mortality among older adults with decompensated heart failure
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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