Elderly/Long-Term Care

Deaths and rehospitalizations for elderly patients have not decreased despite advances in heart failure therapies

For patients suffering with chronic heart failure, the past 20 years have been a time of medical advances, including drug therapy with beta blockers and angiotensin-converting enzyme inhibitors. However, a new study finds that despite these strides, the rates at which elderly patients with chronic heart failure are rehospitalized or die have not changed significantly.

Researchers examined Medicare records for more than 2.5 million patients with heart failure who were hospitalized from January 2001 to December 2005. Although in-hospital deaths fell from 5.1 percent to 4.2 percent during the 4 years, deaths at 30 days, 180 days, and 1 year were constant at 11 percent, 26 percent, and 37 percent, respectively. In the short term, almost one in four patients returned to the hospital within 30 days after an initial stay for heart failure. In the longer term, one in three patients with heart failure died, and two-thirds were rehospitalized during the 1-year followup period.

These death and rehospitalization rates may reflect the fact that clinical trials for drugs to treat heart failure often exclude elderly patients from participating, so evidence about the effectiveness of drugs is limited for this group. Further, elderly patients may also have several other medical conditions that need to be managed along with heart failure. Identifying management strategies for these patients is urgent, the authors suggest, because heart failure is a leading cause of hospitalization in the steadily increasing Medicare population. This study was funded in part by the Agency for Healthcare Research and Quality (HS10548).

See "Early and long-term outcomes of heart failure in elderly persons, 2001-2005," by Lesley H. Curtis, Ph.D., Melissa A. Greiner, M.S., Bradley G. Hammill, M.S., and others in the December 8, 2008, Archives of Internal Medicine 168(22), pp. 2481-2488.

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