Heart failure survival among older adults in the United States - A poor prognosis for an emerging epidemic in the Medicare population

Objective: To describe the 6-year probability of survival for older adults after their first hospitalization for heart failure. Setting: National Medicare hospital claims records for 1984 through 1986 an d Medicare enrollment records from 1986 through 1992. Design: We identified a national cohort of 170 239 (9% black patients) Medi care patients, 67 years or older, with no evidence of heart failure in 1984 or 1985, who were hospitalized and discharged for the first time in 1986 w ith a principal diagnosis of heart failure. For groups defined by race, sex , age, Medicaid eligibility, and comorbid conditions, we compared the proba bility of survival with Cox proportional hazards regression. Results: Only 19% of black men, 16% of white men, 25% of black women, and 2 3% of white women survived 6 years. One third died within the first year. M en had lower median survival and 38% greater risk of mortality than did wom en (P < .05). White men had 10% greater risk of mortality than did black me n (P < .05). Medicaid eligibility (white adults only) and diabetes were ass ociated with increased mortality (P < .05). Conclusions: The prognosis for older adults with heart failure underscores the importance of prevention strategies and early detection and treatment m odalities that can prevent, improve, or reverse myocardial dysfunction, par ticularly for the growing number of adults who are at increased risk for de veloping heart failure because of hypertension, diabetes, or myocardial inf arction.