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Why and how do elderly patients with heart failure die? Insights from the TIME‐CHF study
Author(s) -
Rickenbacher Peter,
Pfisterer Matthias,
Burkard Thilo,
Kiowski Wolfgang,
Follath Ferenc,
Burckhardt Dieter,
Schindler Ruth,
BrunnerLa Rocca HansPeter
Publication year - 2012
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1093/eurjhf/hfs113
Subject(s) - medicine , interquartile range , heart failure , cardiology , ejection fraction , sudden cardiac death
Aims Specific 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 results During 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). Conclusion Despite 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.