Basal functional status predicts three-month mortality after a heart failure hospitalization in elderly patients — The prospective RICA study

Abstract Background Many elderly heart failure (HF) patients show some degree of functional impairment. The study aim was to evaluate the functional status of oldest-old cohort of patients hospitalized with a diagnosis of decompensated (HF), and to analyze whether preadmission functional status pred...

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Bibliographic Details
Published in:International journal of cardiology 2014-03, Vol.172 (1), p.127-131
Main Authors: Formiga, Francesc, Chivite, David, Conde, Alicia, Ruiz-Laiglesia, Fernando, Franco, Álvaro González, Bocanegra, Carmen Pérez, Manzano, Luis, Pérez-Barquero, Manuel Montero
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Barthel Index
Biological and medical sciences
Cardiology. Vascular system
Cardiovascular
Comorbidity
Elderly
Female
Follow-Up Studies
Functional status
Heart
Heart failure
Heart Failure - diagnosis
Heart Failure - mortality
Heart failure, cardiogenic pulmonary edema, cardiac enlargement
Heart Function Tests - statistics & numerical data
Hospitalization
Humans
Kaplan-Meier Estimate
Male
Medical sciences
Medical Staff, Hospital - statistics & numerical data
Mortality
Predictive Value of Tests
Proportional Hazards Models
Prospective Studies
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Summary:Abstract Background Many elderly heart failure (HF) patients show some degree of functional impairment. The study aim was to evaluate the functional status of oldest-old cohort of patients hospitalized with a diagnosis of decompensated (HF), and to analyze whether preadmission functional status predicts risk of 3-month mortality. Methods We analyzed 1431 elderly (≥ 75 years) patients prospectively included in the Spanish National Registry on HF (RICA). We added Barthel Index (BI) to the usual HF patient assessment to measure patients' functional status, and we evaluated the relationship between preadmission BI values and 3-month mortality. Results The mean age of patients was 82.3 (4.6) years. Patients' mean preadmission BI score was 81.3 (21.5); 802 patients (55.9%) had BI scores < 61. Multivariate analysis confirmed an independent association between poor preadmission BI and older age, female sex, higher comorbidity, cognitive impairment, previous institutionalization, worse New York Heart Association (NYHA) functional class and lack of beta-blocker use. A total of 210 patients died (14.7%) after 3 months of follow-up. Cox multivariate analyses found that higher preadmission BI is correlated with reduced all-cause, 3-month postdischarge mortality [hazard ratio (HR) 0.981; CI95% 0.975–0.986, p < 0.001]. Other variables independently associated with 3-month mortality were male sex, lower body mass index, lower systolic blood pressure, a diagnosis of diabetes and chronic kidney disease, worse NYHA class and not receiving treatment with beta-blockers. Conclusions Severe functional disability is present among more than half of older patients admitted because of a HF decompensation. For this population, preadmission BI is a strong predictor of short-term mortality.
ISSN:0167-5273
1874-1754
DOI:10.1016/j.ijcard.2013.12.169