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.