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Journal of Geriatric Cardiology 2023, 20(4): 247-255 https://doi.org/10.26599/1671-5411.2023.04.005
Research Article | Open Access | Issue | Published: 23 April 2023

Characteristics and in-hospital mortality of elderly patients with heart failure in Spanish hospitals

Show Author's Information Alberto Esteban-Fernández1( ),  Manuel Anguita-Sánchez2,  Juan Luis Bonilla-Palomas3,  María Anguita-Gámez4,  María García5,  José Luis Bernal5,6,  Náyade Del Prado5,  Cristina Fernández-Pérez5,7,  Julián Pérez-Villacastin4,  Juan José Gómez-Doblas8,  Francisco Javier Elola5
Cardiology Department, Hospital Universitario Severo Ochoa, Madrid, Spain
Cardiology Department, Hospital Universitario Reina Sofía, Córdoba, Spain
Cardiology Department, Hospital San Juan de la Cruz, Úbeda, Spain
Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain
Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
Management Control Department, Hospital Universitario 12 de Octubre, Madrid, Spain
Department of Preventive Medicine, Área Sanitaria de Santiago de Compostela y Barbanza, Instituto de Investigación de Santiago, Santiago de Compostela, Spain
Cardiology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain
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Esteban-Fernández A, Anguita-Sánchez M, Bonilla-Palomas JL, et al. Characteristics and in-hospital mortality of elderly patients with heart failure in Spanish hospitals. Journal of Geriatric Cardiology, 2023, 20(4): 247-255. https://doi.org/10.26599/1671-5411.2023.04.005
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Abstract Full text Electronic supplementary material About this article
BACKGROUND

The prevalence of heart failure (HF) increases with age, and it is one of the leading causes of hospitalization and death in older patients. However, there are little data on in-hospital mortality in patients with HF ≥ 75 years in Spain.

METHODS

A retrospective analysis of the Spanish Minimum Basic Data Set was performed, including all HF episodes discharged from public hospitals in Spain between 2016 and 2019. Coding was performed using the International Classification of Diseases, 10th Revision. Patients ≥ 75 years with HF as the principal diagnosis were selected. We calculated: (1) the crude in-hospital mortality rate and its distribution according to age and sex; (2) the risk-standardized in-hospital mortality ratio; and (3) the association between in-hospital mortality and the availability of an intensive cardiac care unit (ICCU) in the hospital.

RESULTS

We included 354,792 HF episodes of patients over 75 years. The mean age was 85.2 ± 5.5 years, and 59.2% of patients were women. The most frequent comorbidities were renal failure (46.1%), diabetes mellitus (35.5%), valvular disease (33.9%), cardiorespiratory failure (29.8%), and hypertension (26.9%). In-hospital mortality was 12.7%, and increased with age [odds ratio (OR) = 1.07, 95% CI: 1.07–1.07, P < 0.001] and was lower in women (OR = 0.96, 95% CI: 0.92–0.97, P < 0.001). The main predictors of mortality were the presence of cardiogenic shock (OR = 19.5, 95% CI: 16.8–22.7, P < 0.001), stroke (OR = 3.5, 95% CI: 3.0–4.0, P < 0.001) and advanced cancer (OR = 2.6, 95% CI: 2.5–2.8, P < 0.001). In hospitals with ICCU, the in-hospital risk-adjusted mortality tended to be lower (OR = 0.85, 95% CI: 0.72–1.00, P = 0.053).

CONCLUSIONS

In-hospital mortality in patients with HF ≥ 75 years between 2016 and 2019 was 12.7%, higher in males and elderly patients. The main predictors of mortality were cardiogenic shock, stroke, and advanced cancer. There was a trend toward lower mortality in centers with an ICCU.


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Abstract
Full text
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Electronic supplementary material
About this article

Characteristics and in-hospital mortality of elderly patients with heart failure in Spanish hospitals

Show Author's information Alberto Esteban-Fernández1( ), Manuel Anguita-Sánchez2, Juan Luis Bonilla-Palomas3, María Anguita-Gámez4, María García5, José Luis Bernal5,6, Náyade Del Prado5, Cristina Fernández-Pérez5,7, Julián Pérez-Villacastin4, Juan José Gómez-Doblas8, Francisco Javier Elola5
Cardiology Department, Hospital Universitario Severo Ochoa, Madrid, Spain
Cardiology Department, Hospital Universitario Reina Sofía, Córdoba, Spain
Cardiology Department, Hospital San Juan de la Cruz, Úbeda, Spain
Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain
Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
Management Control Department, Hospital Universitario 12 de Octubre, Madrid, Spain
Department of Preventive Medicine, Área Sanitaria de Santiago de Compostela y Barbanza, Instituto de Investigación de Santiago, Santiago de Compostela, Spain
Cardiology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain

Abstract

BACKGROUND

The prevalence of heart failure (HF) increases with age, and it is one of the leading causes of hospitalization and death in older patients. However, there are little data on in-hospital mortality in patients with HF ≥ 75 years in Spain.

METHODS

A retrospective analysis of the Spanish Minimum Basic Data Set was performed, including all HF episodes discharged from public hospitals in Spain between 2016 and 2019. Coding was performed using the International Classification of Diseases, 10th Revision. Patients ≥ 75 years with HF as the principal diagnosis were selected. We calculated: (1) the crude in-hospital mortality rate and its distribution according to age and sex; (2) the risk-standardized in-hospital mortality ratio; and (3) the association between in-hospital mortality and the availability of an intensive cardiac care unit (ICCU) in the hospital.

RESULTS

We included 354,792 HF episodes of patients over 75 years. The mean age was 85.2 ± 5.5 years, and 59.2% of patients were women. The most frequent comorbidities were renal failure (46.1%), diabetes mellitus (35.5%), valvular disease (33.9%), cardiorespiratory failure (29.8%), and hypertension (26.9%). In-hospital mortality was 12.7%, and increased with age [odds ratio (OR) = 1.07, 95% CI: 1.07–1.07, P < 0.001] and was lower in women (OR = 0.96, 95% CI: 0.92–0.97, P < 0.001). The main predictors of mortality were the presence of cardiogenic shock (OR = 19.5, 95% CI: 16.8–22.7, P < 0.001), stroke (OR = 3.5, 95% CI: 3.0–4.0, P < 0.001) and advanced cancer (OR = 2.6, 95% CI: 2.5–2.8, P < 0.001). In hospitals with ICCU, the in-hospital risk-adjusted mortality tended to be lower (OR = 0.85, 95% CI: 0.72–1.00, P = 0.053).

CONCLUSIONS

In-hospital mortality in patients with HF ≥ 75 years between 2016 and 2019 was 12.7%, higher in males and elderly patients. The main predictors of mortality were cardiogenic shock, stroke, and advanced cancer. There was a trend toward lower mortality in centers with an ICCU.

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Published: 23 April 2023
Issue date: April 2023

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