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Mortality Following Hip Fracture in Older Adults With and Without Coronary Heart Disease
John A Robbins1, Petra Buzkova2, Joshua I Barzilay3
1Department of Medicine, University of California, Davis, Sacramento.
Insights
Older adults with coronary heart disease (CHD) face significantly higher mortality after a hip fracture. This risk is even greater than for those with heart failure, highlighting the severe impact of comorbid CHD.
Area of Science:
- Gerontology
- Cardiology
- Orthopedics
Background:
- Osteoporotic hip fractures are common in older adults.
- Comorbidities, such as coronary heart disease (CHD), frequently coexist with hip fractures.
- The impact of CHD on mortality post-hip fracture requires further quantification.
Purpose of the Study:
- To investigate the short- and long-term mortality rates in older adults following a hip fracture.
- To compare mortality risks between hip fracture patients with and without prevalent coronary heart disease (CHD).
- To contextualize hip fracture mortality in CHD patients by comparing it to heart failure mortality in similar patients.
Main Methods:
- Examined 4092 older adults without prevalent CHD and 1173 with prevalent CHD.
- Calculated post-hip fracture mortality rates using Poisson models.
- Determined hazard ratios for mortality using Cox regression analysis.
Main Results:
- Mortality rates post-hip fracture were higher in those with prevalent CHD (32.52/100 person-years) compared to those without (21.83/100 person-years).
- Short-term mortality (first 6 months) was substantially elevated in the CHD group (79.44/100 person-years) versus the non-CHD group (49.27/100 person-years).
- Mortality following hip fracture in CHD patients was higher than mortality following incident heart failure in CHD patients.
Conclusions:
- Hip fracture in older adults with coronary heart disease (CHD) is associated with exceedingly high mortality.
- The mortality risk following hip fracture in CHD patients surpasses that of incident heart failure in CHD patients.
- Coronary heart disease significantly exacerbates the mortality risk associated with osteoporotic hip fractures.
Background:
Comorbidities like coronary heart disease are common among older people who sustain an osteoporotic hip fracture. However, their impact on short- and long-term mortality post-hip fracture is not well quantified.
Methods:
We examined 4092 and 1173 older adults without and with prevalent coronary heart disease, respectively. Post-hip fracture mortality rates were computed with Poisson models and hazard ratios with Cox regression. For perspective, we compared mortality rates among participants with prevalent coronary heart disease who had either a hip fracture or incident heart failure (but no hip fracture).
Results:
Among participants without prevalent coronary heart disease, the mortality rate post-hip fracture was 21.83 per 100 participant years, including 49.27 per 100 participant years in the first 6 months following hip fracture. Among participants with prevalent coronary heart disease, the corresponding mortality rates were 32.52 and 79.44 per 100 participant years, respectively. Participants with prevalent coronary heart disease and incident heart failure (but no hip fracture) had corresponding post-incident heart failure mortality rates per 100 participant years of 25.62 overall and 46.4 in the first 6 months. In all 3 groups, the hazard ratio for mortality was similarly elevated: 5- to 7-fold at 6 months and 1.7- to 2.5-fold beyond 5 years.
Conclusion:
As a case study in the absolute effects of a comorbidity on post-hip fracture mortality, hip fracture in a person with coronary heart disease carries an exceedingly high mortality rate, even higher than that following incident heart failure in individuals with coronary heart disease.
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