| Age, sex, and overall
health are predictors of outcome after hospitalization with first
episode of heart failure
Age, sex, and overall health predict survival in patients with an initial hospitalization for heart failure, according to an article in the Aug 12th issue of the Archives of Internal Medicine. Researchers studied data from 38,702 patients, including status at 30 days and 1 year after discharge. Mortality rates rose sharply with age both at 30 days and 1 year after discharge. Men and women had similar survival at 30 days, but women showed a roughly 20 percent higher survival rate at 1 year. The presence of comorbid conditions was strongly predictive of survival. The authors postulate that survival rates in clinical trials are higher because of selection bias, and they urge further study of the total population of patients with heart failure.
According to background information cited in the article, the mortality rate due to heart failure in patients involved in clinical trials have decreased over the past decade, but the prognosis of patients not involved in trials who have had an initial hospitalization for heart failure has not been well studied. Jack V. Tu, M.D., Ph.D., and his Canadian colleagues analyzed hospital records of 38,702 patients admitted for the first time for heart failure from April 1994 through March 1997 in Ontario, Canada. The records contained information on age, sex, and health variables of each patient including comorbid conditions. Health status at 30 days and 1 year after hospital discharge were determined through linkage with the Ontario Registered Persons Database. The information was analyzed to identify relations among survival, age, sex, and other illnesses. The 30-day and 1-year death rates after discharge for a first heart failure admission were 11.6 percent and 33.1 percent, respectively. The authors found that mortality rates rose sharply with age. The 30-day death rate rose from 4.5 percent in those younger than 50 years to 15.1 percent in patients 75 years or older. Death rates at 1 year after discharge were 13.5 percent in patients younger than 50 years compared with 40.1 percent in patients 75 years or older. Men and women had similar survival at 30 days, but women showed a roughly 20 percent higher survival rate at 1 year. Diseases such as cancer, kidney disease, dementia, cerebrovascular disease, rheumatologic diseases, and diabetes were all linked with higher mortality rates both at 30 days and 1 year after discharge. The authors write that "Only young subjects with minimal comorbidity had the low mortality rates seen in contemporary clinical trials of heart failure. For most community-dwelling subjects with heart failure who were more likely to be older women with significant comorbidities, their prognosis remained poor." They note that "The large disparity between [death] rates observed in our study and those reported in clinical trials is due to selection bias of the populations enrolled in these trials. Contemporary clinical trials of heart failure have largely been conducted in white, male populations with mean ages of about 60 years and a minimal number of comorbidities." The authors conclude
that their study indicates that "much more remains to be done
to improve the outcomes of this seriously ill population..." |