Abstract 11042: Heart Failure and Mortality in the Elderly With Impaired Cardiac and Pulmonary Function
Background: Both left ventricular systolic dysfunction (LVSD) and impaired pulmonary function (IPF) are prevalent in the elderly, and are associated with increased risk of adverse clinical outcomes. However, little is known about the joint association of LVSD and IPF with risk of heart failure (HF) and mortality
Methods: We followed 2342 participants free of cardiovascular disease for a median of 13 years from the Cardiovascular Health Study_a population based observational study of the elderly. LVSD was defined by echocardiogram as LV ejection fraction <55%. IPF was determined by pulmonary function test as FEV1: FVC<70% and predicted FEV1<80%. We divided the cohort into four groups: 1) No LVSD or IPF (reference), 2) LVSD only, 3) IPF only and 4) both LVSD and IPF. Outcome variables included adjudicated hospitalized HF and all-cause mortality. We used cox proportional hazards models with time to first event and adjusted for conventional cardiovascular risk factors. Risk prediction was assessed using net reclassification index (NRI) by adding IPF to the fully adjusted model with LVSD.
Results: Mean age was 76 years with 63% females. LVSD was found in 128 subjects (5.5%) while IPF in 441 (19%). The incidence rate (per 1000 person-year) and 95% CI was 21 (19, 23), 44 (32, 62), 35 (29, 41) and 72 (46, 113) for HF and 49 (46, 52), 64 (49, 82) and 103 (73, 144) for all-cause mortality for the 4 subgroups, respectively. Compared to the reference group, there was significantly increased HF risk with adjusted hazard ratio (95% CI): 2.1 (1.5, 3.0), 1.7 (1.4, 2.1) and 3.2 (2.0, 5.1) and all-cause mortality risk: 1.3 (1.0, 1.8), 1.7 (1.4, 1.9) and 2.1 (1.5, 3.0) for the groups of LVSD only, IPF only and both LVSD and IPF, respectively. Risk classification improved significantly when IPF was added to the fully adjusted model with LVSD with NRI 14.5 (p<0.001) for HF and 24.7 (p<0.001) for all-cause mortality.
Conclusions: Both LVSD and IPF are associated with increased risk of HF and all-cause mortality in the elderly, with the highest risk among those with both conditions. IPF significantly improves risk prediction among those with LVSD for adverse clinical outcomes, and should be considered for risk stratification to identify those at the highest risk.
- © 2013 by American Heart Association, Inc.