Why and how do elderly patients with heart failure die? Insights from the TIME-CHF study


    loading  Checking for direct PDF access through Ovid

Abstract

AimsSpecific causes and modes of death (COD and MOD) of patients with heart failure (HF) are not well described, particularly in those with preserved ejection fraction >45% (HFPEF) and at old age. Thus, using the database of the TIME-CHF study, patients with HFPEF were compared with those with reduced ejection fraction ≤45% (HFREF), and patients ≥75 with those 60–74 years of age to identify MOD and COD, predictors of death, and event rates before death as compared with survivors.Methods and resultsDuring the 18-month follow-up, 132/622 patients (21%) died, with similar rates in patients with HFPEF and HFREF and a trend to higher rates in patients aged ≥75 years (24% vs. 17%, P = 0.06). COD and MOD (ACME system) were not different in the age groups. COD was more often non-cardiovascular in HFPEF patients than in HFREF patients (33% vs. 16%, P < 0.05) and cardiac MOD were more frequent in HFREF patients (75% vs. 56%, P < 0.05), mainly due to more sudden deaths (25% vs. 7%, P < 0.05). Patients who died experienced a median of four adverse events (interquartile range 1–7) and one (0–1) hospitalization within 60 days prior to death compared with 0.7 (0.4–1.4) and 0.1 (0.0–0.2) during a randomly selected 60 days in survivors (all P < 0.0001).ConclusionDespite similar 18-month mortality in patients with HFREF and those with HFPEF, important differences in COD and MOD were found which were not observed between the two age groups. A high rate of adverse events and hospitalizations preceded death. These observations may be relevant for the management of HF patients.

    loading  Loading Related Articles