Comorbidity drives mortality in newly diagnosed heart failure: a study among geriatric outpatients.

BACKGROUND

Elderly heart failure (HF) patients frequently have multiple comorbidities. The prognostic impact of combined comorbidities is poorly quantified in these patients. We assessed the impact of comorbidities on 3-year mortality in geriatric outpatients with newly diagnosed HF.

METHODS AND RESULTS

Of 93 geriatric outpatients with HF (mean age 82.7 years, 36.6% men), 52 patients (55.9%) died within 3 years after HF was diagnosed. Comorbidity was measured with the Charlson Comorbidity Index (CCI). Age- and gender-adjusted hazard ratio (HR) for 3-year mortality was 1.6 (95% confidence interval [CI] 0.9-3.2) for patients with 3-4 CCI points and 3.2 (95% CI 1.5-6.8) for those with >4 CCI points, compared with 1-2 CCI points. After adjustment for age, gender, left ventricular ejection fraction (LVEF), and N-terminal pro-B-type natriuretic peptide, CCI remained predictive of death (CCI 3-4: HR 1.5 (95% CI 0.7-2.9); CCI >4: HR 4.0 (95% CI 1.9-8.8)). In addition to age and gender, the c-statistics for CCI and LVEF were similar (0.63 [95% CI 0.55-0.70] and 0.64 [95% CI 0.56-0.72], respectively).

CONCLUSIONS

The majority of geriatric outpatients with new HF die within 3 years. Comorbidity, summarized in the CCI, is the strongest independent predictor of mortality.