Heart failure mortality compared between elderly and non-elderly Thai patients

To investigate heart failure mortality compared between elderly and non-elderly Thai patients.

This study included patients at least 18 years of age who were admitted to the hospital with a primary diagnosis of heart failure (ICD-10-TM code: 150.9) during 2008-2012 according to three major Thailand reimbursement systems (civil servant, social security, and universal coverage systems). Patients were categorized into either the elderly group (age > 65 years) or the non-elderly group (age ≤ 65 years). Mortality rate and survival analysis were compared between groups. Demographic, underlying disease and comorbid condition data were collected. Cardiovascular and non-cardiovascular death was also analyzed.

A total of 201,709 patients were included. The average age of patients was 64.9 ± 14.8 years, and the gender proportion breakdown was 84,155 (41.7%) males and 117,554 (58.3%) females. Just over half of patients (107,325 patients; 53.2%) were elderly. Overall mortality rate was 50.8%. The mortality rate at one month, six months, one year, and three years was 11.0%, 24.5%, 32.5%, and 46.3%, respectively. Elderly patients had a higher rate of mortality compared to non-elderly patients with an adjusted odds ratio (OR) of 1.47 (95% CI: 1.46-1.49) for all-cause mortality, an OR of 1.25 (95% CI: 1.23-1.27) for cardiovascular death, and an OR of 1.72 (95% CI: 1.68-1.75) for non-cardiovascular death (all P < 0.001). After adjusting for potential confounders, elderly status remained the second strongest factor associated with increased risk of mortality after heart failure hospitalization following chronic kidney disease.

The overall mortality rate after heart failure hospitalization was a very high 50.8%. Multivariate analysis revealed elderly status to be an independent predictor of mortality after hospitalization. This finding suggests that improvements are needed related to the quality of care and follow-up given to elderly Thai heart failure patients.