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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.
Monday,2015-08-03 12:30 America/Los_Angeles — zdrager
| Title | 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. |
| Publication Type | Journal Article |
| Year of Publication | 2015 |
| Authors | Murad, K, Goff, DC, Morgan, TM, Burke, GL, Bartz, TM, Kizer, JR, Chaudhry, SI, Gottdiener, JS, Kitzman, DW |
| Journal | JACC Heart Fail |
| Volume | 3 |
| Issue | 7 |
| Pagination | 542-50 |
| Date Published | 2015 Jul |
| ISSN | 2213-1787 |
| Keywords | Activities of Daily Living, Aged, Aged, 80 and over, Atrial Fibrillation, Cognition Disorders, Cohort Studies, Comorbidity, Coronary Disease, Female, Heart Failure, Humans, Hypertension, Incidence, Longitudinal Studies, Male, Peripheral Arterial Disease, Physical Fitness, Prevalence, Proportional Hazards Models, Pulmonary Disease, Chronic Obstructive |
| Abstract | <p><b>OBJECTIVES: </b>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).</p><p><b>BACKGROUND: </b>Comorbidities and functional and cognitive impairments are common in the elderly and often associated with greater mortality risk.</p><p><b>METHODS: </b>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.</p><p><b>RESULTS: </b>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.</p><p><b>CONCLUSIONS: </b>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.</p> |
| DOI | 10.1016/j.jchf.2015.03.004 |
| Alternate Journal | JACC Heart Fail |
| PubMed ID | 26160370 |
| PubMed Central ID | PMC4499113 |
| Grant List | AG-023629 / AG / NIA NIH HHS / United States AG-027058 / AG / NIA NIH HHS / United States AG-15928 / AG / NIA NIH HHS / United States AG-20098 / AG / NIA NIH HHS / United States HHSN268201200036C / HL / NHLBI NIH HHS / United States HHSN268201200036C / / PHS HHS / United States HL080295 / HL / NHLBI NIH HHS / United States N01 HC-15103 / HC / NHLBI NIH HHS / United States N01 HC-55222 / HC / NHLBI NIH HHS / United States N01-HC-35129 / HC / NHLBI NIH HHS / United States N01-HC-45133 / HC / NHLBI NIH HHS / United States N01-HC-75150 / HC / NHLBI NIH HHS / United States N01-HC-85079 / HC / NHLBI NIH HHS / United States N01-HC-85080 / HC / NHLBI NIH HHS / United States N01-HC-85081 / HC / NHLBI NIH HHS / United States N01-HC-85082 / HC / NHLBI NIH HHS / United States N01-HC-85083 / HC / NHLBI NIH HHS / United States N01-HC-85084 / HC / NHLBI NIH HHS / United States N01-HC-85085 / HC / NHLBI NIH HHS / United States N01-HC-85086 / HC / NHLBI NIH HHS / United States N01-HC-85239 / HC / NHLBI NIH HHS / United States P30 AG021332 / AG / NIA NIH HHS / United States P30 AG021332 / AG / NIA NIH HHS / United States R01 AG015928 / AG / NIA NIH HHS / United States R01 AG018915 / AG / NIA NIH HHS / United States R01 AG023629 / AG / NIA NIH HHS / United States R01 AG045551 / AG / NIA NIH HHS / United States R01 AG18915 / AG / NIA NIH HHS / United States R01AG045551 / AG / NIA NIH HHS / United States T32-HL-087730 / HL / NHLBI NIH HHS / United States |