Grim’ prognosis for elderly hospitalized with CHF

Subjects’ age makes racial implications unclear

A study by the Centers for Disease Control and Prevention (CDC) in Atlanta paints a dark picture for elderly patients hospitalized for their first time for heart failure. Among patients who survive to be discharged, a third die within a year. And six years after the hospitalization, less than a fifth of the men and a quarter of the women will still be alive.

Lead researcher Janet B. Croft, PhD, says it’s important to consider this study’s data set. Her team looked at 170,239 Medicare patients, all 67 or older. Only patients who were hospitalized for the first time for CHF were included in the study. Because the team studied Medicare claims, there was no way of knowing the patients’ functional status or which patients may have been treated for CHF on an outpatient basis.

For this group of patients, white men had a 10% greater risk of mortality than black men. Six years after hospital discharge, the statistics show:

    • 19% of black men were still alive, compared to 16% of white men;

    • 25% of black women survived, compared to 23% of white women.

The data set selection could explain why black patients seemed to do better than white patients, Croft says. In general, blacks tend to develop CHF at a younger age than whites, she explains. It is possible that by looking only at older CHF patients who were healthy enough to stay out of the hospital until they were older than 67, the black patients could have been in better physical condition than white patients. The typical black CHF patient may have been hospitalized already (and therefore been rendered ineligible for the study) or may have died before reaching the study age.

"There has already been a mortality selection," adds George A. Mensah, MD, chief of cardiology and the head of cardiovascular care at the Veterans Affairs Medical Center in Augusta, GA. As patients live to be much older, he says, the racial differences often disappear.

But even though patients lived long enough to be in the study, the chance to survive another six years is not good.

"It may have seemed that black patients did better," Croft adds, "but survival is still bad for everyone."

Croft says greater use of ACE inhibitors and beta-blockers could help keep patients in better control of their heart disease. Using the drugs after patients have a heart attack or develop hypertension could help prevent heart failure from developing.

"That’s the main message we at the CDC are trying to give," she says, adding the agency is now working to educate physicians about using these medications in programs with managed care providers and state peer review organizations associated with the Health Care Financing Administration.

"Almost 50% of heart failure patient hospitalizations could be prevented with the right medication," she says.