The number of older people with heart failure (HF) has increased considerably over the past 20 years. Currently, 80% of patients with HF are 65 or older. The costs associated with HF are more than $35 billion per year in the United States, and these costs are largely driven by hospital stays. Yet, relatively little is known about the long-term risk for hospital admission after an HF diagnosis in older people. In addition, few data are available on the role that geriatric conditions—slow gait, muscle weakness, and cognitive impairment—play in driving HF hospitalizations.
Addressing Heart Failure Knowledge Gaps
My colleagues and I conducted a study in which we evaluated data from a population-based sample of people aged 65 and older who were followed for up to 20 years after being diagnosed with HF. Published in the Journal of the American College of Cardiology, the study sought to identify risk factors for lifetime hospital utilization after a new HF diagnosis and to identify risk factors for hospitalization.
Three geriatric conditions—muscle weakness, slow gait, and depression—emerged as independent risk factors for hospital admission after a diagnosis of HF, even after considering other traditional cardiovascular factors. Our analysis also found that depressed ejection fraction, New York Heart Association class III or IV symptoms, diabetes, and chronic kidney disease were other independent risk factors for admission after an HF diagnosis in older patients.
Implications for Future Care After HF Diagnosis
The prognostic information revealed by our study may be used to help with clinical decision making and to identify potential targets for interventions after an HF diagnosis in older patients. Muscle weakness, slow gait, and depressive symptoms are potentially modifiable risk factors and should be routinely assessed in older people with newly diagnosed HF. These factors, however, fall outside conventional models of clinical medicine, meaning they may be overlooked in older individuals, particularly if the risk factors are subtle.
Although HF primarily affects older patients, current guidelines for the disease do not incorporate routine assessment or management of geriatric conditions. Modifying physical impairments and depressive symptoms can be challenging but may improve outcomes in older patients. Whether assessing and managing these geriatric conditions actually improves HF outcomes should be examined in future studies.
The results from our analysis justify the need for developing strategies to routinely screen and manage geriatric conditions at the time of an HF diagnosis. By incorporating this information into care models of older patients, it may be possible to reduce the burden of hospital stays for those who are newly diagnosed with HF. In turn, this may improve quality of life and decrease healthcare costs for the disease.
Readings & Resources (click to view)
Chaudhry SI, McAvay G, Chen S, et al. Risk factors for hospital admission among older persons with newly diagnosed heart failure: findings from the Cardiovascular Health Study. J Am Coll Cardiol. 2013;61:635-642. Available at: http://content.onlinejacc.org/article.aspx?articleid=1567645.
Chaudhry SI, Wang Y, Gill TM, Krumholz HM. Geriatric conditions and subsequent mortality in older patients with heart failure. J Am Coll Cardiol. 2010;55:309-316.
Wong CY, Chaudhry SI, Desai MM, Krumholz HM. Trends in comorbidity, disability, and polypharmacy in heart failure. Am J Med. 2011;124:136-143.
Piccoliori G, Gerolimon E, Abholz HH. Geriatric assessment in general practice using a screening instrument: is it worth the effort? Results of a South Tyrol Study. Age Ageing. 2008;37:647-652.
Belardinelli R, Georgiou D, Cianci G, Purcaro A. 10-Year exercise training in chronic heart failure: a randomized controlled trial. J Am Coll Cardiol. 2012;60:1521-1528.
Dunlay SM, Redfield MM, Weston SA, et al. Hospitalizations after heart failure diagnosis a community perspective. J Am Coll Cardiol. 2009;54:1695-1702.
Heidenreich PA, Fonarow GC. Quality indicators for the care of heart failure in vulnerable elders. J Am Geriatr Soc. 2007;55(Suppl):S340-S346.