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Impact of Comorbidity on Mortality Among Older Persons with Advanced Heart Failure

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An Erratum to this article was published on 09 June 2012

Abstract

BACKGROUND

Care for patients with advanced heart failure (HF) has traditionally focused on managing HF alone; however, little is known about the prevalence and contribution of comorbidity to mortality among this population. We compared the impact of comorbidity on mortality in older adults with HF with high mortality risk and those with lower mortality risk, as defined by presence or absence of a prior hospitalization for HF, respectively.

METHODS

This was a retrospective cohort study (2002–2006) of 18,322 age-matched and gender-matched Medicare beneficiaries. We used the baseline year of 2002 to ascertain HF hospitalization history, in order to identify beneficiaries at either high or low risk of future HF mortality. We calculated the prevalence of 19 comorbidities and overall comorbidity burden, defined as a count of conditions, among both high and low risk beneficiaries, in 2002. Proportional hazards regressions were used to determine the effect of individual comorbidity and comorbidity burden on mortality between 2002 and 2006 among both groups.

RESULTS

Most comorbidities were significantly more prevalent among hospitalized versus non-hospitalized beneficiaries; myocardial infarction, atrial fibrillation, kidney disease (CKD), chronic obstructive pulmonary disease (COPD), and hip fracture were more than twice as prevalent in the hospitalized group. Among hospitalized beneficiaries, myocardial infarction, diabetes, COPD, CKD, dementia, depression, hip fracture, stroke, colorectal cancer and lung cancer were each significantly associated with increased hazard of dying (hazard ratios [HRs]: 1.16-1.93), adjusting for age, gender and race. The mortality risk associated with most comorbidities was higher among non-hospitalized beneficiaries (HRs: 1.32-3.78).

CONCLUSIONS

Comorbidity confers a significantly increased mortality risk even among older adults with an overall high mortality risk due to HF. Clinicians who routinely care for this population should consider the impact of comorbidity on outcomes in their overall management of HF. Such information may also be useful when considering the risks and benefits of aggressive, high-intensity life-prolonging interventions.

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References

  1. Marengoni A, Rizzuto D, Wang HX, Winblad B, Fratiglioni L. Patterns of chronic multimorbidity in the elderly population. J Am Geriatr Soc. 2009;57:225–30.

    Article  PubMed  Google Scholar 

  2. Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA. 2005;294:716–24.

    Article  PubMed  CAS  Google Scholar 

  3. Jessup M, Abraham WT, Casey DE, et al. 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation. 2009;119:1977–2016.

    Article  PubMed  Google Scholar 

  4. Havranek EP, Masoudi FA, Westfall KA, Wolfe P, Ordin DL, Krumholz HM. Spectrum of heart failure in older patients: Results from the National Heart Failure Project. Am Heart J. 2001;143:412–7.

    Article  Google Scholar 

  5. Rusinaru D, Saaidi I, Godard S, Mahjoub H, Battle C, Tribouilloy C. Impact of chronic obstructive pulmonary disease on long-term outcome of patients hospitalized for heart failure. Am J Cardiol. 2008;101:353–8.

    Article  PubMed  Google Scholar 

  6. Bruch C, Rothenburger M, Gotzmann M, et al. Chronic kidney disease in patients with chronic heart failure–impact on intracardiac conduction, diastolic function and prognosis. Int J Cardiol. 2007;118:375–80.

    Article  PubMed  Google Scholar 

  7. Corell P, Gustafsson F, Schou M, Markenvard J, Nielsen T, Hildebrandt P. Prevalence and prognostic significance of atrial fibrillation in outpatients with heart failure due to left ventricular systolic dysfunction. Eur J Heart Fail. 2007;9:258–65.

    Article  PubMed  Google Scholar 

  8. From AM, Leibson CL, Bursi F, et al. Diabetes in heart failure: prevalence and impact on outcome in the population. Am J Med. 2006;119:591–9.

    Article  PubMed  Google Scholar 

  9. Alho OP, Hannula K, Luokkala A, Teppo H, Koivunen P, Kantola S. Differential prognostic impact of comorbidity in head and neck cancer. Head Neck. 2007;29:913–8.

    Article  PubMed  Google Scholar 

  10. Tetsche MS, Dethlefsen C, Pedersen L, Sorensen HT, Norgaard M. The impact of comorbidity and stage on ovarian cancer mortality: a nationwide Danish cohort study. BMC Cancer. 2008;8:31.

    Article  PubMed  Google Scholar 

  11. Read WL, Tierney RM, Page NC, et al. Differential prognostic impact of comorbidity. J Clin Oncol. 2004;22:3099–103.

    Article  PubMed  Google Scholar 

  12. Metra M, Ponikowski P, Dickstein K, et al. Advanced chronic heart failure: A position statement from the Study Group on Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2007;9:684–94.

    Article  PubMed  Google Scholar 

  13. Rudiger A, Harjola VP, Muller A, et al. Acute heart failure: clinical presentation, one-year mortality and prognostic factors. Eur J Heart Fail. 2005;7:662–70.

    Article  PubMed  Google Scholar 

  14. Setoguchi S, Stevenson LW, Schneeweiss S. Repeated hospitalizations predict mortality in the community population with heart failure. Am Heart J. 2007;154:260–6.

    Article  PubMed  Google Scholar 

  15. Dickstein K, Gleim GW, Snapinn S, James MK, Kjekshus J. The impact of morbid events on survival following hospitalization for complicated myocardial infarction. Eur J Heart Fail. 2006;8:74–80.

    Article  PubMed  Google Scholar 

  16. MacIntyre K, Capewell S, Stewart S, et al. Evidence of improving prognosis in heart failure: trends in case fatality in 66 547 patients hospitalized between 1986 and 1995. Circulation. 2000;102:1126–31.

    PubMed  CAS  Google Scholar 

  17. McCullough PA, Philbin EF, Spertus JA, Kaatz S, Sandberg KR, Weaver WD. Confirmation of a heart failure epidemic: findings from the Resource Utilization Among Congestive Heart Failure (REACH) study. J Am Coll Cardiol. 2002;39:60–9.

    Article  PubMed  Google Scholar 

  18. Braunstein JB, Anderson GF, Gerstenblith G, et al. Noncardiac comorbidity increases preventable hospitalizations and mortality among Medicare beneficiaries with chronic heart failure. J Am Coll Cardiol. 2003;42:1226–33.

    Article  PubMed  Google Scholar 

  19. Lin DY, Wei LJ. The robust inference for the Cox proportional hazards model. J Am Stat Assoc. 1989;84:1074–78.

    Google Scholar 

  20. Silverberg DS, Wexler D, Iaina A, Schwartz D. The interaction between heart failure and other heart diseases, renal failure, and anemia. Semin Nephrol. 2006;26:296–306.

    Article  PubMed  Google Scholar 

  21. Joynt KE, Whellan DJ, O'Connor CM. Why is depression bad for the failing heart?? A review of the mechanistic relationship between depression and heart failure. J Card Fail. 2004;10:258–271.

    Article  PubMed  Google Scholar 

  22. Cohen MB, Mather PJ. A review of the association between congestive heart failure and cognitive impairment. Am J Geriatr Cardiol. 2007;16:171–4.

    Article  PubMed  Google Scholar 

  23. Setoguchi S, Nohria A, Rassen JA, Stevenson LW, Schneeweiss S. Maximum potential benefit of implantable defibrillators in preventing sudden death after hospital admission because of heart failure. CMAJ. 2009;180:611–6.

    Article  PubMed  Google Scholar 

  24. Klabunde CN, Warren JL, Legler JM. Assessing comorbidity using claims data: an overview. Med Care. 2002;40(IV):26–35.

    Google Scholar 

  25. Ahmed A, Rich MW, Sanders PW, et al. Chronic kidney disease associated mortality in diastolic versus systolic heart failure: a propensity matched study. Am J Cardiol. 2007;99:393–8.

    Article  PubMed  Google Scholar 

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Acknowledgements

Dr. Ahluwalia was supported by a training grant from the National Institute on Aging (T32AG1934) and is currently supported by an Office of Academic Affiliation’s VA Associated Health Postdoctoral Fellowship Program at the VA Greater Los Angeles HSR&D Center of Excellence. Dr. Fried is a recipient of a Midcareer Investigator Award in Patient-Oriented Research from the National Institute on Aging (K24 AG028443). Dr. Chaudhry is the recipient of a Paul Beeson/K23 Career Development Award (K23AG030986) from the National Institute on Aging. Supported by the Claude D. Pepper Older Americans Independence Center at Yale University School of Medicine (#2P30AG021342-06 NIH/NIA).

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Correspondence to Sangeeta C. Ahluwalia PhD, MPH.

Appendix

Appendix

Below are Figure 2 and Figure 3.

Figure 2.
figure 2

The 1-year Kaplan–Meier survival curves of hospitalized and non-Hospitalized beneficiaries (n = 18,332).

Figure 3.
figure 3

The 1-year Kaplan–Meier survival curves of hospitalized and non-Hospitalized beneficiaries with no comorbid conditions (n = 332).

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Ahluwalia, S.C., Gross, C.P., Chaudhry, S.I. et al. Impact of Comorbidity on Mortality Among Older Persons with Advanced Heart Failure. J GEN INTERN MED 27, 513–519 (2012). https://doi.org/10.1007/s11606-011-1930-3

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  • DOI: https://doi.org/10.1007/s11606-011-1930-3

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