National patterns of heart failure hospitalizations and mortality by sex and age.
ABSTRACT Earlier work has demonstrated significant sex and age disparities in ischemic heart disease. However, it remains unclear if an age or sex gap exists for heart failure (HF) patients.
Using data from the 2007-2008 Healthcare Cost and Utilization Project, we constructed hierarchic regression models to examine sex differences and age-sex interactions in HF hospitalizations and in-hospital mortality. Among 430,665 HF discharges, 51% were women and 0.3%, 27%, and 73% were aged <25, 25-64, and >64 years respectively. There were significant sex differences among HF risk factors, with a higher prevalence of coronary disease among men. Men had higher hospitalization rates for HF and in-hospital mortality across virtually all ages. The relationship between age and HF mortality appeared U-shaped; mortality rates for ages <25, 25-64, and >64 years were 2.9%, 1.4%, and 3.8%, respectively. No age-sex interaction was found for in-hospital mortality for adults >25 years old.
Using a large nationally representative administrative dataset we found age and sex disparities in HF outcomes. In general, men fared worse than women regardless of age. Furthermore, we found a U-shaped relationship between age and in-hospital mortality during an HF hospitalization, such that young adults have similar mortality rates to older adults. Additional studies are warranted to elucidate the patient-specific and treatment characteristics that result in these patterns.
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ABSTRACT: Previous heart failure (HF) trials suggested that age influences patient characteristics and outcome; however, under-representation of elderly patients has limited characterization of this cohort. Whether standard prognostic variables have differential utility in various age groups is unclear. The PROTECT trial investigated 2033 patients (median age 72 years) with acute HF randomized to rolofylline or placebo. Patients were divided into five groups based on the quintiles of age: ≤59, 60-68, 69-74, 75-79, and ≥80 years. Baseline characteristics, medications, and outcomes (30-day death or cardiovascular/renal hospitalization, and death at 30 and 180 days) were explored. The prognostic utility of baseline characteristics for outcomes was investigated in the different groups and in those aged <80 years vs. ≥80 years. With increasing age, patients were more likely to be women with hypertension, AF, and higher EF. Increased age was associated with increased risk of 30- and 180-day outcomes, which persisted after multivariable adjustment (hazard ratio for 180-day death = 1.17; 95% confidence interval 1.11-1.24 for each 5-year increase). The prognostic utility of baseline characteristics such as previous HF hospitalization and serum sodium, systolic blood pressure, and NYHA class was attenuated in the elderly for the endpoint of 180-day mortality. An increase in albumin was associated with a greater reduction in risk in patients aged ≥80 years vs. <80 years. In a large trial of acute HF, there were differences in baseline characteristics and outcomes amongst patients of different ages. Standard prognostic variables exhibit different utility in elderly patients. © 2014 The Authors. European Journal of Heart Failure © 2014 European Society of Cardiology.European Journal of Heart Failure 01/2015; 17(1). DOI:10.1002/ejhf.207 · 6.58 Impact Factor
Article: Mortality in heart failure patients[Show abstract] [Hide abstract]
ABSTRACT: ABSTRACT Heart failure (HF) is a clinical syndrome, which is becoming a major public health problem in recent decades, due to its increasing prevalence, especially in the developed countries, mostly due to prolonged lifespan of the general population as well as the increased of HF patients. The HF treatment, particularly, new pharmacological and non-pharmacological agents, has markedly improved clinical outcomes of patients with HF including increased life expectancy and improved quality of life. However, despite the facts that mortality in HF patients has decreased, it still remains unacceptably high. This review of summarizes the evidence to date about the mortality of HF patients. Despite the impressive achievements in the pharmacological and non-pharmacological treatment of HF patients which has undeniably improved the survival of these patients, the mortality still remains high particularly among elderly, male and African American patients. Patients with HF and reduced ejection fraction have higher mortality rates, most commonly due to cardiovascular causes, compared with patients with HF and preserved ejection fraction. Key words: heart failure, mortality, race, elderly, genderAnadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology 08/2014; DOI:10.5152/akd.2014.5731 · 0.76 Impact Factor
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ABSTRACT: AimThe purpose in the present study was to compare prognostic risk factors between older and younger chronic heart failure (CHF) patients.Methods We examined 598 consecutive CHF patients (476 men and 122 women, mean age 61.4 ± 14.3 years) who underwent cardiopulmonary exercise testing, echocardiography and blood examination. We divided the 598 patients into two groups: the elderly group (age ≥75 years, n = 123) and the young group (age <75, n = 475). We compared blood testing data, exercise capacity, cardiac function and prognosis between the two groups. Patients were followed up (median 782 days) to register cardiac deaths or rehospitalization as a result of worsening heart failure.ResultsPatients in the elderly group were associated with higher frequencies of atrial fibrillation and diuretic use than those in the young group. Patients in the elderly group had lower hemoglobin concentration, more impaired renal function, higher plasma B-type natriuretic peptide (BNP) levels, smaller left ventricular volume, longer deceleration time of early mitral wave and lower exercise capacity than those in the young group. There were 199 cardiac events during follow-up periods. As expected, Kaplan–Meier analysis showed that patients in the elderly group had higher cardiac event rates than those in the young group. In the young group, multivariable Cox hazard analysis showed that hemoglobin concentration, log BNP and peak VO2 were independent predictors related to cardiac events. In contrast, in the elderly group, estimated glomerular filtration rate, atrial fibrillation and peak VO2 were independent factors to predict adverse clinical outcomes.Conclusions Prognostic factors were different between the elderly and young patients in CHF. Geriatr Gerontol Int 2014; ●●: ●●–●●.Geriatrics & Gerontology International 05/2014; DOI:10.1111/ggi.12293 · 1.58 Impact Factor