system gauges seriousness of heart failure in elderly
Newswise — A simple points system may soon help guide treatment of
elderly 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.
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
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:
• advanced age
• a history of dementia (contributes to a host of conditions related
to the inability to properly care for oneself)
• coronary artery disease (arteries that supply blood to the heart
muscle are hardened and narrowed)
• peripheral vascular disease (similar to coronary artery disease
but involving blood vessels outside of the heart and brain)
• low sodium in the blood (an indication of neurohormonal imbalance)
• high urea in the blood (a reflection of poor cardiac output that
affects kidney function)
• low blood pressure (a result of weakened heart function).
The study, published in the September 25th 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
"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
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