Determinants of Mortality Among Seniors Acutely Readmitted for Heart Failure: Racial and Socioeconomic Disparities Open Access

Abstract

Background: Heart failure (HF) is common and characterized by a high rate of mortality. Seniors (people 65 years and older) make up a significant proportion of the total HF population but are not well represented in many clinical trials. We aim to assess predictors of mortality among seniors acutely re-hospitalized for decompensated HF.

Methods: A single-site prospective study of seniors with HF readmitted within 30 days of discharge for HF over a six-month period (January 1, 2020, to June 10, 2020). Following the review of electronic medical records, demographic, and laboratory parameters at the time of hospitalization were extracted. Cox proportional hazards regression was used to assess predictors of mortality. Statistical significance was defined as a p-value of < 0.05 and a confidence interval of 95%.

Results: Our study included 452 patients. The age range of the cohort was 65 to 101 years (mean 78.73 ± 8.48 years). Of this, 206(46%) were males, 28% were 85 years or older. The median follow-up time was 84 days, and the observed short-term mortality was 22%. After univariate analysis, the hazards for death among seniors with HF significantly decreased by 5% for each unit increase in serum sodium. Following multivariate analysis, nonblacks who were not discharged home after the index hospitalization had lower hazards of death than blacks not discharged home at the index admission (adjusted hazards ratio (aHR) 0.32, 95% confidence interval (CI) 0.16, 0.67). Patients with the lowest tertile range for systolic blood pressure (SBP) had twice the hazard for death compared to patients with the highest tertile for SBP. Patients with access to primary care provider (PCP) had 5 times the hazards of death compared to patients without access to a PCP.

Conclusion: Seniors who are acutely re-hospitalized for decompensated HF have a very high short term mortality rate. Hyponatremia and low systolic blood pressure are independent predictors of mortality. Black seniors who were not discharged home after their index hospitalization for HF had higher hazards for all-cause mortality compared to nonblacks.

Table of Contents

1.1 Literature Review……………………………………………………………… 1

1.2 Definitions of heart failure……………………………………………………..3

 

1.3 Epidemiology of heart failure ………………………………………………….4

1.4 Diagnosis and classification of heart failure………………………………….5

1.5 Predictors of mortality among patients with heart failure…………………..6

1.6 Cost of medications and financial considerations……………………………8

1.7 Health Literacy and heart failure……………………………………………..9

1.8 Survival paradox of black seniors…………………………………………….10

1.9 Selected landmark heart failure trials………………………………………11

 2.0 Study objectives……………………………………………………………….14

 2.1 Problem Statement……………………………………………………………14

 2.2 Purpose Statement……………………………………………………………14

2.3 Approach………………………………………………………………………15

2.4 Data description……………………………………………………………….16

2.5 Statistics………………………………………………………………………..17

3.0 Results…………………………………………………………………………18

4. 0 Discussion…………………………………………………………………….26

4.1 Conclusion……………………………………………………………………30

4.2 Limitations……………………………………………………………………30

4.3 Line of future research……………………………………………………….31

List of tables and figures

Table 1 Baseline characteristics of study participants………………………….19

Table 2 Stratified Cox Proportional Hazard regression of predictors 

of mortality among seniors (stratified for age)…………………………………..21

Figure 1 Adjusted survival curves for race controlling for 

primary care provider, systolic Blood pressure, disposition, 

sodium and (age greater than 85 years)…………………………………………22

Figure 2 Adjusted survival curves for race controlling for 

primary care provider, systolic Blood pressure, disposition, 

sodium and (age 65 to 84 years)…………………………………………………23

Figure 3 Survival plot of race as a predictor of mortality among 

patients with heart failure discharged elsewhere other the home 

in the index hospitalization………………………………………………………24

Figure 4 Survival plot of systolic blood pressure as a predictor of 

mortality among patients with heart failure…………………………………..25

About this Master's Thesis

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School	Rollins School of Public Health
Department	Executive Masters of Public Health - MPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology Health Sciences, Medicine and Surgery
Keyword	race seniors mortality acute decompensation heart failure
Committee Chair / Thesis Advisor	Shah, Amit, Emory University
Committee Members	Ola, Olatunde, Mayo Clinic Health System

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