Clinical features, treatment practices, and hospital and long-term outcomes of older patients hospitalized with decompensated heart failure: The Worcester Heart Failure Study

Abstract

OBJECTIVES: To examine age-specific differences in clinical presentation, receipt of therapeutic practices and lifestyle recommendations, and hospital and long-term survival in patients hospitalized for acute heart failure HF. DESIGN: Population-based study. SETTING: The Worcester Heart Failure Study, a population-based study of residents of the a large Central New England metropolitan area hospitalized for decompensated HF at 11 greater-Worcester medical centers. PARTICIPANTS: Four thousand five hundred thirty-four patients hospitalized for decompensated HF during 1995 and 2000. MEASUREMENTS: Medical records were reviewed for demographic, clinical, and treatment characteristics and hospital survival status. Long-term follow-up of discharged hospital patients was conducted through 2005. Patients were compared according to four age groups (<65, 65-74, 75-84, and > or =85). RESULTS: Mean age was 76; 24.0% were aged 85 and older. Patients aged 75 and older were more likely to be female and to have multiple comorbidities, a lower body mass index at the time of hospitalization, and higher ejection fraction findings. Older patients were significantly more likely to receive symptom-modifying medications and less likely to receive disease-modifying medications than younger patients. Older age was directly associated with higher in-hospital, 30-day, and 1-year death rates in crude and multivariable-adjusted analyses. CONCLUSION: The results of this community-wide study suggest that clinical, treatment, and prognostic factors differ according to age in patients hospitalized for decompensated HF. These high-risk patients warrant special attention in future studies to improve their management and long-term survival.