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Outcomes for older men and women with congestive heart failure
R B Burns1, E P McCarthy, M A Moskowitz
1Section of General Internal Medicine, Evans Department of Medicine, Boston University Medical Center Hospital, MA 02118-2334, USA.
Insights
Men hospitalized for congestive heart failure (CHF) face higher mortality than women. Survivors of CHF, regardless of sex, experience similar, significant limitations in daily activities and health status post-discharge.
Area of Science:
- Cardiology
- Geriatrics
- Public Health
Background:
- Congestive heart failure (CHF) is a major cause of hospitalization and mortality, particularly among older adults.
- Understanding sex-based differences in outcomes after CHF hospitalization is crucial for targeted interventions.
Purpose of the Study:
- To compare the clinical outcomes of men and women discharged alive after hospitalization for congestive heart failure (CHF).
Main Methods:
- Prospective cohort study involving 519 patients aged 65 or older hospitalized for CHF.
- Outcomes including Activities of Daily Living (ADLs), dyspnea, perceived health, living situation, rehospitalization, and mortality were assessed at 6 weeks, 6 months, and 1 year post-discharge.
Main Results:
- Men were younger, wealthier, and more often married than women, but had a higher prevalence of prior CHF history.
- Men exhibited significantly higher 1-year mortality compared to women, even after adjusting for multiple clinical and demographic factors.
- Surviving men and women demonstrated comparable and substantial impairments in non-fatal outcomes, including ADLs, dyspnea, perceived health, and rehospitalization rates.
Conclusions:
- Male sex is an independent predictor of higher mortality following CHF hospitalization.
- Both men and women surviving CHF hospitalization experience significant and similar functional limitations and health status impairments, underscoring the need for comprehensive post-discharge care.
Objectives:
To describe and compare outcomes for men and women discharged alive following a hospitalization for congestive heart failure (CHF).
Design:
Prospective cohort study.
Participants:
A total of 519 patients, aged > or = 65, who were discharged alive after a hospitalization for CHF (DRG = 127).
Measurements:
Outcomes (Activities of Daily Living (ADLs), shortness of breath when walking, perceived health, living situation, rehospitalization, and mortality) were measured at 3 times (6 weeks, 6 months, and 1 year) post-discharge.
Results:
The 205 men were, on average, younger (77 +/- 7 vs 80 +/- 8, P < .001), wealthier (46% vs 21% earned > or = $10,000, P < .001), and more often married (50% vs 19%, P < .001). Men were more likely than women to have a previous history of CHF (71% vs 63%, P = .052). Men also had higher 1-year mortality than women (48% vs 35%, P = .009), even after adjusting for age, comorbidity, physiological severity (APACHE II APS and RAND discharge instability), radiological evidence of CHF, prior ADLs, walking ability, living situation, and perceived health. Men and women survivors at 1-year had similar and substantial impairment for all non-fatal outcomes considered (all P values > or = .489). Their adjusted mean ADL scores were consistent with complete dependence on one essential activity (range 0-6 dependencies); 35% were short of breath walking less than 1 block; 62% had fair or poor perceived health; 32% received some formal care; and 46% were rehospitalized within 1 year of discharge.
Conclusions:
Men with CHF have a higher mortality than women with CHF. Men and women who survive have similar and substantial impairment for all non-fatal outcomes (ADLs, shortness of breath upon walking, perceived health, living situation, and rehospitalization).