Geriatric conditions may be associated with increased risk for heart failure hospitalization

Certain geriatric conditions in older persons with heart failure may be modifiable risk factors for hospital admission, according to a new study.

Researchers used data from the population-based Cardiovascular Heart Study to determine whether and how geriatric conditions are related to long-term risk for all-cause hospitalization in patients with heart failure. Community-dwelling older patients who had a new diagnosis of heart failure were included, and data from annual exams and medical records were examined.

The authors defined geriatric conditions as those that occur in older patients, typically have multiple causes, and are not necessarily related to a specific disease. They looked at slow gait, muscle weakness (i.e., weak grip), cognitive impairment and depressive syndromes and used Anderson-Gill regression modeling to examine whether any of these were related to hospital admission after a heart failure diagnosis. The study results were published online Feb. 4 and will appear in the Feb. 12 Journal of the American College of Cardiology.

A total of 758 patients (mean age at diagnosis, 79.7 years) had a new diagnosis of heart failure, with a mean hospital admission rate of 7.9 per 10 person-years (95% CI, 7.4 to 8.4 per 10 person-years). Diabetes mellitus, New York Heart Association functional class III or IV, chronic kidney disease, slow gait, depressed ejection fraction, depression and muscle weakness were independently associated with hospitalization (hazard ratios, 1.36, 1.32, 1.32, 1.28, 1.25, 1.23 and 1.19, respectively).

The authors noted that data for the study were first collected in 1989 and that heart failure management and possibly risk factors for hospitalization have changed substantially since then. They also acknowledged that patients were censored at the time of death, that the full effect of comorbid conditions was not known, and that the mean patient age was higher than that in most heart failure registries. However, they concluded that three potentially modifiable geriatric conditions—slow gait, depression and muscle weakness—are associated with risk for hospitalization in patients with heart failure and that such risk factors should be assessed routinely at diagnosis.

The author of an accompanying editorial agreed that it is important to examine hospitalization risk factors in older patients but pointed out that the evidence to support risk factor modification is currently weak. Exercise training has only been studied in younger patients, resistance training to improve weak grip has been evaluated only in small cohort studies of exercise endurance, and no consensus has been reached on the effect of treatment for depression, he noted.

The editorialist suggested that based on the current results, it “seems reasonable” for physicians to evaluate muscle strength, gait speed and psychological status in clinically stable patients with newly diagnosed heart failure. “At this time, however, response to slow gait or weak grip is limited to risk stratification, with possible increased follow-up intensity,” he wrote. “Hopefully, future clinical trial results will provide clearer direction.”