03214nas a2200397 4500008004100000022001400041245014200055210006900197260001300266490000600279520204500285653000902330653002202339653002802361653001102389653001902400653001802419653002002437653001102457653002602468653001802494653000902512653001402521653002402535653003102559653002002590653001702610653001802627653001802645653003402663100001902697700002302716700002202739700001902761856003602780 2015 eng d a2047-998000aCardiovascular and Mortality Outcomes in the Elderly With Impaired Cardiac and Pulmonary Function: The Cardiovascular Health Study (CHS).0 aCardiovascular and Mortality Outcomes in the Elderly With Impair c2015 Dec0 v43 a

BACKGROUND: Impaired pulmonary function (IPF) and left ventricular systolic dysfunction (LVSD) are prevalent in the elderly and are associated with significant morbidity and mortality. The main objectives of this study were to examine the relative impact and joint association of IPF and LVSD with heart failure, cardiovascular mortality and all-cause mortality, and their impact on risk classification using a continuous net reclassification index.

METHODS AND RESULTS: We followed 2342 adults without prevalent cardiovascular disease (mean age, 76 years) from the Cardiovascular Health Study for a median of 12.6 years. LVSD was defined as LV ejection fraction <55%. IPF was defined as: forced expiratory volume in 1 second:forced vital capacity <70%, and predicted forced expiratory volume in 1 second <80%. Outcomes included heart failure hospitalization, cardiovascular mortality, all-cause mortality, and composite outcome. LVSD was detected in 128 subjects (6%), IPF in 441 (19%) and both in 38 (2%). Compared to those without LVSD or IPF, there was a significantly increased cardiovascular risk for groups of LVSD only, IPF only, and LVSD plus IPF, adjusted hazard ratio (95% CI) 2.1 (1.5-3.0), 1.7 (1.4-2.1), and 3.2 (2.0-5.1) for HF; 1.8 (1.2-2.6), 1.4 (1.1-1.8), and 2.8 (1.7-4.7) for cardiovascular mortality; 1.3 (1.0-1.8), 1.7 (1.4-1.9), and 2.1 (1.5-3.0) for all-cause mortality, and 1.6 (1.3-2.1), 1.7 (1.5-1.9), and 2.4 (1.7-3.3) for composite outcome, respectively. Risk classification improved significantly for all outcomes when IPF was added to the adjusted model with LVSD or LVSD to IPF.

CONCLUSIONS: While risk of cardiovascular outcomes was the highest among elderly with both LVSD and IPF, risk was comparable between subjects with IPF alone and those with LVSD alone. This observation, combined with improved risk classification by adding IPF to LVSD or LVSD to IPF, underscore the importance of comprehensive heart and lung evaluation in cardiovascular outcome assessment.

10aAged10aAged, 80 and over10aCardiovascular Diseases10aFemale10aHeart Diseases10aHeart Failure10aHospitalization10aHumans10aKaplan-Meier Estimate10aLung Diseases10aMale10aMortality10aProspective Studies10aRespiratory Function Tests10aRisk Assessment10aRisk Factors10aStroke Volume10aUnited States10aVentricular Dysfunction, Left1 aWaheed, Salman1 aChaves, Paulo, H M1 aGardin, Julius, M1 aCao, Jie, Jane uhttps://chs-nhlbi.org/node/6935