Mortality and Readmissions in Heart Failure: an Analysis of 36,824 Elderly Patients from the Slovenian National Hospitalization Database

Background: In heart failure (HF), comorbidity burden and prognostic risks increase with age. Studies investigating outcome in elderly patients from large datasets are lacking, particularly in central and eastern European countries. We analyzed the Slovenian data on mortality and readmissions after first HF hospitalization in patients aged 65 years or over.

Methods: In this observational epidemiological study, the Slovenian national hospitalization database was searched for HF patients aged ≥65 years with first HF hospitalization between 2008 and 2012. All-cause mortality and readmissions were compared in young-olds (65-74 years), middle-olds (75-84 years), and old-olds (≥85 years) using cumulative probability plots and log rank test. The prognostic value of comorbidities on mortality and readmissions for age groups were assessed using multiple Cox proportional hazards models.

Results: Overall, 36,824 patients were included (median age 80 years, 41 % men, 20 % in-hospital mortality). The proportions of young-olds, middle-olds, and old-olds were 26, 48, and 26 %, respectively. Arterial hypertension (60 %), pulmonary disease (44 %), and atrial fibrillation (38 %) were the most prevalent comorbidities, with little variation over age. While age group was associated with higher mortality (P < 0.001), no such associations were seen for readmissions at any time points (P > 0.1 for all). Importance of comorbidities as a predictor for mortality faded with increasing age while only small decrease in hazard ratios for readmissions were seen.

Conclusions: Age is an independent predictor of mortality but not readmissions in elderly patients with first HF hospitalization. Comorbidities are important predictors for mortality and readmissions in elderly.