Wang R, Mouliswar M, Denman S, Kleban M
Department of Medicine, Temple University, Philadelphia, PA, USA.
Arch Intern Med. 1998;158(22):2464-8. doi: 10.1001/archinte.158.22.2464.
Congestive heart failure is a major cause of mortality and morbidity in the elderly but the disease impact on the oldest and sickest population has not been defined.
To review the mortality and hospital readmission rate of institutionalized elderly persons with congestive heart failure and to examine the relation of baseline characteristics to subsequent clinical outcomes.
This was a retrospective analysis based on chart review of 231 residents of the Philadelphia (Pa) Geriatric Center (63 congregate housing tenants and 168 nursing home residents) 80 years and older, hospitalized with congestive heart failure from 1989 to 1995. Patients' demographic data and clinical, electrocardiographic, and echocardiographic findings were obtained from their initial (index) hospitalization records. Subsequent outcomes were obtained from their outpatient (nursing home or office) records.
Thirteen percent died during the index hospitalization but the total mortality during the follow-up period was 87%. One hundred forty-six patients (63%) died in the first year with a mean +/- SD survival of 4+/-4 months and a readmission rate of 3.9 per patient-year. Eighty-five patients survived the first year with a readmission rate of 1.2 per patient-year and 54 patients subsequently died, with a mean +/- SD survival of 28+/-12 months. The first-year decedents and survivors were comparable in sex, age, medical history, and electrocardiographic findings. However, patients who died in the first year, compared with survivors, were more likely to be nursing home residents (81% vs 59%), have New York Heart Association class IV heart failure (54% vs 32%), have impaired left ventricular function by echocardiogram (53% vs 32%), and have renal insufficiency (32% vs 11%).
Very elderly persons with congestive heart failure had a guarded long-term prognosis. Nursing home residency, class IV heart failure, impaired left ventricular function, and renal insufficiency were associated with higher risk for early death and repetitive hospitalizations.
充血性心力衰竭是老年人死亡和发病的主要原因，但该疾病对年龄最大、病情最严重人群的影响尚未明确。
回顾入住机构的老年充血性心力衰竭患者的死亡率和再入院率，并研究基线特征与后续临床结局的关系。
这是一项基于病历回顾的回顾性分析，研究对象为1989年至1995年因充血性心力衰竭住院的231名80岁及以上的费城老年中心居民（63名群居房住户和168名养老院居民）。患者的人口统计学数据以及临床、心电图和超声心动图检查结果均来自其首次（索引）住院记录。后续结局则从其门诊（养老院或办公室）记录中获取。
13%的患者在索引住院期间死亡，但随访期间的总死亡率为87%。146名患者（63%）在第一年死亡，平均生存时间为4±4个月，每位患者每年的再入院率为3.9次。85名患者存活了一年，每位患者每年的再入院率为1.2次，随后有54名患者死亡，平均生存时间为28±12个月。第一年的死亡患者和存活患者在性别、年龄、病史和心电图检查结果方面具有可比性。然而，与存活患者相比，第一年死亡的患者更有可能是养老院居民（81%对59%），患有纽约心脏病协会IV级心力衰竭（54%对32%），超声心动图显示左心室功能受损（53%对32%），并且存在肾功能不全（32%对11%）。
高龄充血性心力衰竭患者的长期预后不佳。养老院居住、IV级心力衰竭、左心室功能受损和肾功能不全与早期死亡和反复住院的较高风险相关。
