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Senior Citizen Health & Medicine
Senior Citizens' Risk of Dying from Heart Failure
Predicted by Seven-Point System
Patients with two to three factors were likely to
live at least a year
 November 10, 2006 - A simple points system may soon
help guide treatment of elderly (senior citizen) heart failure patients.
Researchers at Washington University School of Medicine in St. Louis
found that by counting how many of seven easy-to-obtain health factors a
patient has, physicians can estimate the patient's risk of dying.
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The points system may steer doctors toward
considering more aggressive treatments such as implantable
defibrillators and pacemakers for those at low risk of death. However,
elderly patients with a high risk may want to avoid stressful and
unnecessary medical intervention and may benefit most from palliative or
hospice care.
"It has typically been very difficult to predict
how long a person hospitalized with heart failure may survive," says
senior author Michael W. Rich, M.D., associate professor of medicine and
a geriatric cardiologist at Barnes-Jewish Hospital. "That has made it
hard for the treating physician to know how aggressive to be with
therapy."
Heart failure afflicts about 5 million people in
the United States, hospitalizing more than a million patients each year.
The incidence of heart failure increases with age, and with people 65
and older becoming the fastest growing segment of the population, the
personal and financial burden of heart failure will likely increase.
In their study, which followed 282 elderly heart
failure patients for up to 14 years, the researchers identified seven
factors that most affect patient survival:
1. advanced age
2. a history of dementia (contributes to a host
of conditions related to the inability to properly care for oneself)
3. coronary artery disease (arteries that
supply blood to the heart muscle are hardened and narrowed)
4. peripheral vascular disease (similar to
coronary artery disease but involving blood vessels outside of the heart
and brain)
5. low sodium in the blood (an indication of
neurohormonal imbalance)
6. high urea in the blood (a reflection of poor
cardiac output that affects kidney function)
7. low blood pressure (a result of weakened
heart function).
The study, published in the September 25 issue of
the Archives of Internal Medicine, showed that patients with four or
more of the risk factors had a low probability of surviving longer than
six months.
But if patients had none or just one of the
factors, they had a good chance of living five years or more. Patients
with two to three factors were likely to live at least a year. The
patients in the study received a variety of treatments as determined by
their physicians.
"The system is easy to use, and the variables don't
require any specialized testing -- they are part of routine medical
histories or basic lab tests," Rich says. "If the system can be
validated by further studies, it can play a role in helping physicians
tailor care to individual patients. If a person has a limited life
expectancy, it may not be in his or her best interest to recommend
invasive, uncomfortable or risky procedures. On the other hand, an
elderly person with only one risk factor could potentially be considered
a good candidate for an aggressive treatment such as a defibrillator."
Other factors that might have been expected to
affect survival, such as the amount of blood the heart can eject during
pumping or a patient's body mass index, didn't seem to influence
survival times. Rich emphasizes that each of the factors identified has
been linked in previous studies to poor prognosis in heart failure
patients.
"We didn't find any new risk factors, which means
there's good data to support that these factors truly are predictive,"
Rich says. "We've pinpointed the seven that are the most predictive and
shown that the number of risk factors can give a reasonable estimate of
the probability of living for six, 12 or 60 months."
The researchers next aim to better identify the
heart failure patients not likely to survive six months so that they can
be referred for hospice care.
"Hospice is very nurturing for both patients and
family members," Rich says. "There is considerable evidence that
patients derive significant benefit from it. If we can predict mortality
within six months, we can more easily establish eligibility for hospice
care."
Editor's Notes:
Huynh BC, Rovner A, Rich MW. Long-term survival
in elderly patients hospitalized for heart failure. Archives of Internal
Medicine September 2006;166:1892-1898.
Funding from the Washington University School of
Medicine Mentors in Medicine Program and the National Heart, Lung, and
Blood Institute supported this research.
Washington University School of Medicine's
full-time and volunteer faculty physicians also are the medical staff of
Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine
is one of the leading medical research, teaching and patient care
institutions in the nation, currently ranked fourth in the nation by
U.S. News & World Report. Through its affiliations with Barnes-Jewish
and St. Louis Children's hospitals, the School of Medicine is linked to
BJC HealthCare.
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