Mortality of the institutionalized old-old hospitalized with congestive heart failure

Background: Congestive heart failure is a major cause of mortality and morb idity in the elderly but the disease impact on the oldest and sickest popul ation has not been defined. Objectives: To review the mortality and hospital readmission rate of instit utionalized elderly persons with congestive heart failure and to examine th e relation of baseline characteristics to subsequent clinical outcomes. Methods: This was a retrospective analysis based on chart review of 231 res idents of the Philadelphia (Pa) Geriatric Center (63 congregate housing ten ants and 168 nursing home residents) 80 years and older, hospitalized with congestive heart failure from 1989 to 1995. Patients' demographic data and clinical, electrocardiographic, and echocardiographic findings were obtaine d from their initial (inder) hospitalization records. Subsequent outcomes w ere obtained from their outpatient (nursing home or office) records. Results: Thirteen percent died during the index hospitalization but the tot al mortality during the follow-up period was 87%. One hundred forty-six pat ients (63%) died in the first year with a mean +/- SD survival of 4 +/- 4 m onths and a readmission rate of 3.9 per patient-year. Eighty-five patients survived the first year with a readmission rate of 1.2 per patient-year and 54 patients subsequently died, with a mean +/- SD survival of 28 +/- 12 mo nths. The first-year decedents and survivors were comparable in sex, age, m edical history, and electrocardiographic findings. However, patients who di ed in the first year, compared with survivors, were more likely to be nursi ng home residents (81% vs 59%), have New York Heart Association class IV he art failure (54% vs 32%), have impaired left ventricular function by echoca rdiogram (53% vs 32%), and have renal insufficiency (32% vs 11%). Conclusions: Very elderly persons with congestive heart failure had a guard ed long-term prognosis. Nursing home residency, class IV heart failure, imp aired left ventricular function, and renal insufficiency were associated wi th higher risk for early death and repetitive hospitalizations.