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Identification of Older Patients with Heart Failure Who May Be Candidates for Hospice Care: Development of a Simple Four‐Item Risk Score
Author(s) -
Huynh Bao C.,
Rovner Aleksandr,
Rich Michael W.
Publication year - 2008
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2008.01756.x
Subject(s) - medicine , confidence interval , odds ratio , randomized controlled trial , heart failure , logistic regression , multivariate analysis , framingham risk score , disease
OBJECTIVES: To identify predictors of 6‐month mortality in older patients with heart failure (HF) and to develop a risk score for identifying potential candidates for hospice care. DESIGN: Secondary data analysis of a previously conducted randomized, clinical trial. SETTING: Barnes‐Jewish Hospital, St. Louis, Missouri. PARTICIPANTS: Two hundred eighty‐two patients with HF aged 70 and older. INTERVENTION: Participants were randomized to conventional care or a multidisciplinary intervention designed to reduce rehospitalization. MEASUREMENTS: All‐cause 6‐month mortality. RESULTS: Patients were followed for up to 14 years; 43 (15.2%) died within 6 months of hospital discharge. Multivariate logistic regression analysis identified four independent predictors of 6‐month mortality: serum urea nitrogen of 30 mg/dL or greater (odds ratio (OR)=5.78, 95% confidence interval (CI)=2.65–12.66), systolic blood pressure less than 120 mmHg (OR=4.81, 95% CI=1.94–11.91), peripheral arterial disease (OR=3.09, 95% CI=1.26–7.58), and serum sodium less than 135 mEq/L (OR=2.27, 95% CI=0.98–5.27). Patients were stratified into four risk groups based on the presence or absence of these four risk factors. Six‐month mortality rates for patients with zero, one, two, or three or more risk factors were 3.7%, 16.3%, 41.0%, and 66.7%, respectively ( P <.05). The presence of three or more risk factors was associated with a positive predictive value of 66.7% and a negative predictive value of 86.4%. CONCLUSION: Although additional studies are needed, these findings suggest that a simple four‐item risk score can identify older patients with HF at high risk of dying within 6 months. This may enable clinicians to better advise patients about prognosis, adjust management accordingly, and if appropriate, facilitate referral for hospice care. Conversely, patients with a more‐favorable prognosis may be suitable candidates for more‐aggressive interventions.