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JACC Heart Fail. 2015 Jul;3(7):542-550. doi: 10.1016/j.jchf.2015.03.004.

Burden of Comorbidities and Functional and Cognitive Impairments in Elderly Patients at the Initial Diagnosis of Heart Failure and Their Impact on Total Mortality: The Cardiovascular Health Study.

Author information

1
Section of Cardiovascular Diseases, University of Minnesota, Minneapolis, Minnesota.
2
Colorado School of Public Health, Denver, Colorado.
3
Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
4
Department of Biostatistics, University of Washington, Seattle, Washington.
5
Department of Medicine, and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.
6
Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
7
Division of Cardiology, University of Maryland, Baltimore, Maryland.
8
Department of Medicine, Section of Cardiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina. Electronic address: dkitzman@wakehealth.edu.

Abstract

OBJECTIVES:

The purpose of this study was to determine the prevalence of clinically relevant comorbidities and measures of physical and cognitive impairment in elderly persons with incident heart failure (HF).

BACKGROUND:

Comorbidities and functional and cognitive impairments are common in the elderly and often associated with greater mortality risk.

METHODS:

We examined the prevalence of 9 comorbidities and 4 measures of functional and cognitive impairments in 558 participants from the Cardiovascular Health Study who developed incident HF between 1990 and 2002. Participants were followed prospectively until mid-2008 to determine their mortality risk.

RESULTS:

Mean age of participants was 79.2 ± 6.3 years with 52% being men. Sixty percent of participants had ≥3 comorbidities, and only 2.5% had none. Twenty-two percent and 44% of participants had ≥1 activity of daily living (ADL) and ≥1 instrumental activity of daily living (IADL) impaired respectively. Seventeen percent of participants had cognitive impairment (modified mini-mental state exam score <80, scores range between 0 and 100). During follow up, 504 participants died, with 1-, 5-, and 10-year mortality rates of 19%, 56%, and 83%, respectively. In a multivariable-adjusted model, the following were significantly associated with greater total mortality risk: diabetes mellitus (hazard ratio [HR]: 1.64; 95% confidence interval [CI]: 1.33 to 2.03), chronic kidney disease (HR: 1.32; 95% CI: 1.07 to 1.62 for moderate disease; HR: 3.00; 95% CI: 1.82 to 4.95 for severe), cerebrovascular disease (HR: 1.53; 95% CI: 1.22 to 1.92), depression (HR: 1.44; 95% CI: 1.09 to 1.90), functional impairment (HR: 1.30; 95% CI: 1.04 to 1.63 for 1 IADL impaired; HR: 1.49; 95% CI: 1.07 to 2.04 for ≥2 IADL impaired), and cognitive impairment (HR: 1.33; 95% CI: 1.02 to 1.73). Other comorbidities (hypertension, coronary heart disease, peripheral arterial disease, atrial fibrillation, and obstructive airway disease) and measures of functional impairments (ADLs and 15-ft walk time) were not associated with mortality.

CONCLUSIONS:

Elderly patients with incident HF have a high burden of comorbidities and functional and cognitive impairments. Some of these conditions are associated with greater mortality risk.

KEYWORDS:

cognitive impairment; comorbidities; functional impairment; heart failure; outcome

PMID:
26160370
PMCID:
PMC4499113
DOI:
10.1016/j.jchf.2015.03.004
[Indexed for MEDLINE]
Free PMC Article

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