Author + information
- Received July 9, 2012
- Revision received October 12, 2012
- Accepted November 12, 2012
- Published online February 12, 2013.
- Sarwat I. Chaudhry, MD⁎,⁎ (, )
- Gail McAvay, PhD†,
- Shu Chen, MS†,
- Heather Whitson, MD‡,
- Anne B. Newman, MD, MPH§,
- Harlan M. Krumholz, MD, MS∥,¶ and
- Thomas M. Gill, MD†,#
- ↵⁎Reprint requests and correspondence:
Dr. Sarwat I. Chaudhry, Yale University School of Medicine, PO Box 208093, New Haven, Connecticut 06520-8093
Objectives This study sought to identify risk factors for the occurrence of all-cause hospital admissions among older persons after heart failure diagnosis, and to determine whether geriatric conditions would emerge as independent risk factors for admission when evaluated in the context of other relevant clinical data.
Background Efforts to reduce costs in heart failure have focused on hospital utilization, yet few studies have examined how geriatric conditions affect the long-term risk for hospital admission after heart failure diagnosis. With the aging of the population with heart failure, geriatric conditions such as slow gait and muscle weakness are becoming increasingly common.
Methods The study population included participants with a new diagnosis of heart failure in the Cardiovascular Health Study, a longitudinal study of community-living older persons. Data were collected through annual examinations and medical-record reviews. Geriatric conditions assessed were slow gait, muscle weakness (defined as weak grip), cognitive impairment, and depressive symptoms. Anderson-Gill regression modeling was used to determine the predictors of hospital admission after heart failure diagnosis.
Results Of the 758 participants with a new diagnosis of heart failure, the mean rate of hospital admission was 7.9 per 10 person-years (95% CI: 7.4 to 8.4). Independent risk factors for hospital admission included diabetes mellitus (HR: 1.36; 95% CI: 1.13 to 1.64), New York Heart Association functional class III or IV (HR: 1.32; 95% CI: 1.11 to 1.57), chronic kidney disease (HR: 1.32; 95% CI: 1.14 to 1.53), slow gait (HR: 1.28; 95% CI: 1.06 to 1.55), depressed ejection fraction (HR: 1.25; 95% CI: 1.04 to 1.51), depression (HR: 1.23; 95% CI: 1.05 to 1.45), and muscle weakness (HR: 1.19; 95% CI: 1.00 to 1.42).
Conclusions Geriatric conditions are important, and potentially modifiable, risk factors for hospital admission in heart failure that should be routinely assessed at the time of heart failure diagnosis.
The research reported in this paper was supported by contracts HHSN268201200036C, N01-HC-85239, N01-HC-85079 through N01-HC-85086, N01-HC-35129, N01 HC-15103, N01 HC-55222, N01-HC-75150, N01-HC-45133, and grant HL080295 from the National Heart, Lung, and Blood Institute (NHLBI), with additional contribution from the National Institute of Neurological Disorders and Stroke (NINDS). Additional support was provided through AG-023629, AG-15928, AG-20098, and AG-027058 from the National Institute on Aging (NIA). The funding sources had no role in the design, conduct, or analysis of the study or in the decision to submit the manuscript for publication. The study was conducted at the Yale Claude D. Pepper Older Americans Independence Center (P30AG21342). A full list of principal CHS investigators and institutions can be found at http://www.chs-nhlbi.org/pi.htm. The manuscript was reviewed and approved by the Publications and Presentations committee of the Cardiovascular Health Study. Dr. Gill is the recipient of a Midcareer Investigator Award in Patient-Oriented Research (K24AG021507) from the National Institute on Aging. Dr. Chaudhry is the recipient of a Paul Beeson/K23 Career Development Award (K23AG030986) from the National Institute on Aging. Dr. Krumholz is funded by grant 1U01HL105270-03 (Center for Cardiovascular Outcomes Research at Yale University) from the National Heart, Lung, and Blood Institute.
- Received July 9, 2012.
- Revision received October 12, 2012.
- Accepted November 12, 2012.
- American College of Cardiology Foundation