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Alagiakrishnan K, Mah D, Aronow WS, Lam PH, Frishman WH, Ahmed A, Deedwania P. Considerations Regarding Management of Heart Failure in Older Adults. Cardiol Rev 2024:00045415-990000000-00223. [PMID: 38421170 DOI: 10.1097/crd.0000000000000677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Understanding noncardiovascular comorbidities and geriatric syndromes in elderly patients with heart failure (HF) is important as the average age of the population increases. Healthcare professionals need to consider these complex dynamics when managing older adults with HF, especially those older than 80. A number of small studies have described associations between HF and major geriatric domains. With information on patients' cognitive, functional decline, and ability to adhere to therapy, physicians can plan for individualized treatment goals and recommendations for these patients.
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Affiliation(s)
| | - Darren Mah
- Department of Radiology, University of Alberta, Edmonton, Alberta, Canada
| | - Wilbert S Aronow
- Departments of Cardiology and Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Phillip H Lam
- Department of Medicine, Georgetown University, MedStar Washington Hospital Center, Washington, DC
| | | | - Ali Ahmed
- Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, George Washington University, Georgetown University, Washington, DC; and
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Orlova IA, Tkacheva ON, Arutyunov GP, Kotovskaya YV, Lopatin YM, Mareev VY, Mareev YV, Runihina NK, Skvortsov AA, Strazhesko ID, Frolova EV. Features of diagnostics and treatment of chronic heart failure in elderly and senile patients. Expert opinion of the Society of Experts in Heart Failure, Russian Association of Gerontologists, and Euroasian Association of Therapists. ACTA ACUST UNITED AC 2018; 58:42-72. [PMID: 30625107 DOI: 10.18087/cardio.2560] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 12/26/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Ia A Orlova
- Lomonosov Moscow State University Medical Research and Educational Center.
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Almodares Q, Wallentin Guron C, Thurin A, Fu M, Kontogeorgos S, Thunstrom E, Johansson MC. Larger right atrium than left atrium is associated with all-cause mortality in elderly patients with heart failure. Echocardiography 2017; 34:662-667. [PMID: 28295604 DOI: 10.1111/echo.13500] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND While left atrial (LA) enlargement is known as an early sign of left heart disease with prognostic implications in heart failure (HF), the importance of right atrial (RA) enlargement is less well studied, and the prognostic implications of interatrial size comparison are insufficiently understood. The aim of this study was to test the hypothesis that RA area larger than LA area in apical four-chamber view is associated with all-cause mortality in elderly patients with HF independent of left ventricular ejection fraction (LVEF). METHODS Retrospectively, 289 patients above 65 years hospitalized for HF between April 2007 and April 2008, and who underwent an echocardiogram, were enrolled. All-cause mortality was registered during a follow-up of at least 56 months. Baseline parameters measured were RA area, LA area, LA volume, LVEF, left ventricular mass (LVM), tissue Doppler systolic velocity of right ventricular free wall (SmRV), presence of severe tricuspid regurgitation (TR), tricuspid gradient, central venous pressure, systolic pulmonary artery pressure, as well as some parameters of diastolic function. RESULTS In univariate analysis RA larger than LA was associated with all-cause mortality (hazard ratio [HR] of 1.88, P<.001). The relation of RA larger than LA to all-cause mortality remained even after adjusting for age, heart rate, LVEF, atrial fibrillation, percutaneous coronary intervention, LVM index, LA volume index, SmRV, and the presence of severe TR (HR: 1.79, P=.04). CONCLUSION RA larger than LA, independently of LVEF, is associated with all-cause mortality in elderly patients hospitalized due to HF.
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Affiliation(s)
- Qays Almodares
- Department of Molecular and Clinical Medicine/Clinical Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Cecilia Wallentin Guron
- Department of Molecular and Clinical Medicine/Clinical Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Thurin
- Department of Molecular and Clinical Medicine/Clinical Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Michael Fu
- Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Erik Thunstrom
- Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Magnus C Johansson
- Department of Molecular and Clinical Medicine/Clinical Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Lee JO, Song R. [Symptom Management to Predict Quality of Life in Patients with Heart Failure: A Structural Equation Modeling Approach]. J Korean Acad Nurs 2016; 45:846-56. [PMID: 26805497 DOI: 10.4040/jkan.2015.45.6.846] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 05/20/2015] [Accepted: 08/12/2015] [Indexed: 11/09/2022]
Abstract
PURPOSE The focus of this study was on symptom management to predict quality of life among individuals with heart failure. The theoretical model was constructed based on situation-specific theory of heart failure self-care and literature review. METHODS For participants, 241 outpatients at a university hospital were invited to the study from May 19 to July 30, 2014. Data were collected with structured questionnaires and analyzed using SPSSWIN and AMOS 20.0. RESULTS The goodness of fit index for the hypothetical model was .93, incremental fit index, .90, and comparative fit index, .90. As the outcomes satisfied the recommended level, the hypothetical model appeared to fit the data. Seven of the eight hypotheses selected for the hypothetical model were statistically significant. The predictors of symptom management, symptom management confidence and social support together explained 32% of the variance in quality of life. The 28% of variance in symptom management was explained by symptom recognition, heart failure knowledge and symptom management confidence. The 4% of variance in symptom management confidence was explained by social support. CONCLUSION The hypothetical model of this study was confirmed to be adequate in explaining and predicting quality of life among patients with heart failure through symptom management. Effective strategies to improve quality of life among patients with heart failure should focus on symptom management. Symptom management can be enhanced by providing educational programs, encouraging social support and confidence, consequently improving quality of life among this population.
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Affiliation(s)
- Ja Ok Lee
- The Catholic University Daejeon St. Mary's Hospital, Daejeon, Korea
| | - Rhayun Song
- College of Nursing, Chungnam National University, Daejeon, Korea.
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Quality of life and palliative care needs of elderly patients with advanced heart failure. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2016; 13:420-4. [PMID: 27594869 PMCID: PMC4984566 DOI: 10.11909/j.issn.1671-5411.2016.05.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To examine the quality of life and palliative care needs of elderly patients with advanced heart failure (HF). METHODS This was a correlation descriptive study conducted at a 650-bed sub-acute hospital. Patients who were aged 65 or over, diagnosed with HF of New York Heart Association Class III or IV symptoms, and mentally sound were eligible to the study. The Edmonton Symptom Assessment Scale, the overall quality of life single item scale, and the McQill Quality of Life Questionnaire (MQoL), were used for measurement. Multiple regression analysis was performed to determine factors for predicting quality of life. RESULTS A convenience sample of 112 patients was recruited. Their age was 81.5 ± 8.5 years. The three most distressing symptoms reported by the patients were tiredness (5.96 ± 2.78), drowsiness (5.47 ± 2.93), and shortness of breath (5.34 ± 2.96). Their mean overall quality of life single item scale score was 4.72 ± 2.06 out of 10. The mean MQoL physical subscale score was the lowest (4.20 ± 1.767), whereas their mean psychological subscale was the highest (7.14 ± 2.39). However, in a multivariate analysis model, quality of life was significantly associated with existential wellbeing, physical wellbeing, psychological wellbeing and educational level. CONCLUSIONS The findings highlight that spiritual concerns are significant palliative care needs among elderly patients with advanced HF, in addition to symptom management. This is in line with the argument that palliative care that places great emphasis on holistic care should be integrated to the care of this group of patients.
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Clinical benefits of natriuretic peptides and galectin-3 are maintained in old dyspnoeic patients. Arch Gerontol Geriatr 2016; 68:33-38. [PMID: 27611369 DOI: 10.1016/j.archger.2016.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 08/24/2016] [Accepted: 08/30/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Acute dyspnoea is the leading cause of unscheduled admission of elderly patients. Several biomarkers are used to diagnose acute heart failure (AHF) and assess prognosis of dyspnoeic patients, but their value in elderly patients is unclear. OBJECTIVE To compare diagnostic and prognostic performances of conventional and novel cardiovascular biomarkers in 2 age groups: young (<75 years old) vs. old (≥75 years old) dyspnoeic patients. DESIGN Prospective observational registry. SETTING Emergency department (ED). SUBJECTS Acutely dyspnoeic adult patients. METHODS Blood samples were collected at ED admission. The diagnostic value of 4 natriuretic peptides (BNP, proBNP, NT-proBNP, MR-proANP) for AHF was tested. We also assessed the prognostic value of same natriuretic peptides and of 3 novel cardiovascular biomarkers (galectin-3, sST2 and proenkephalin), using 1-year all-cause mortality as end-point. Diagnostic or prognostic performances are expressed as area under the receiveroperating characteristic curve (AUC) with 95% confidence interval. RESULTS Two hundred one acutely dyspnoeic patients were studied. AHF was the cause of dyspnoea in 57% of old and 44% of young patients, respectively. All 4 natriuretic peptides performed well in diagnosing AHF in both age groups (all AUC>0.7). BNP showed the best diagnostic performance in both old (AUC: 0.98 [0.97-1.00]) and young (AUC 0.98 [0.95-1.00]) patients. Galectin-3 showed the best prognostic performance in both old (AUC 0.74 [0.62-0.87]) and young patients (AUC 0.75 [0.56-0.94]). CONCLUSIONS BNP and galectin-3 show good clinical benefits in both oldand young acutely dyspnoeic patients.
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Teixeira A, Parenica J, Park JJ, Ishihara S, AlHabib KF, Laribi S, Maggioni A, Miró Ò, Sato N, Kajimoto K, Cohen-Solal A, Fairman E, Lassus J, Mueller C, Peacock WF, Januzzi JL, Choi DJ, Plaisance P, Spinar J, Mebazaa A, Gayat E. Clinical presentation and outcome by age categories in acute heart failure: results from an international observational cohort. Eur J Heart Fail 2015; 17:1114-23. [DOI: 10.1002/ejhf.330] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 06/08/2015] [Accepted: 06/12/2015] [Indexed: 11/05/2022] Open
Affiliation(s)
- Antonio Teixeira
- Department of Geriatry; Hôpitaux Universitaire Saint Louis - Lariboisière; Assistance Publique des Hôpitaux de Paris Paris France
- University Paris Diderot; Paris France
- UMR-S 942; INSERM Paris France
| | - Jiri Parenica
- Department of Internal Medicine and Cardiology; University Hospital Brno, and Faculty of Medicine, Masaryk University; Brno Czech Republic
| | - Jin Joo Park
- Cardiovascular Center, Division of Cardiology/Department of Internal Medicine; Seoul National University Bundang Hospital; South Korea
| | | | - Khalid F. AlHabib
- King Fahad Cardiac Center, Department of Cardiac Sciences, College of Medicine; King Saud University; Riyadh Saudi Arabia
| | - Said Laribi
- University Paris Diderot; Paris France
- UMR-S 942; INSERM Paris France
- Emergency Department; Hôpitaux Universitaire Saint Louis - Lariboisière; Assistance Publique des Hôpitaux de Paris Paris France
| | | | - Òscar Miró
- Emergency Department, Hospital Clinic, Barcelona, Emergency Medicine Investigation Group ‘Emergency care: processes and diseases’; IDIBAPS; Barcelona Spain
| | - Naoki Sato
- Nippon Medical School Musashi-Kosugi Hospital; Japan
| | | | - Alain Cohen-Solal
- University Paris Diderot; Paris France
- UMR-S 942; INSERM Paris France
- Department of Cardiology; Hôpitaux Universitaire Saint Louis - Lariboisière; Assistance Publique des Hôpitaux de Paris Paris France
| | - Enrique Fairman
- Sociedad Argentina de Cardiologia; Area de Investigacion SAC Azcuenaga; Buenos Aires Argentina
| | - Johan Lassus
- Department of Medicine; Helsinki University Central Hospital; Helsinki Finland
| | - Christian Mueller
- Department of Internal Medicine; University Hospital; Basel Switzerland
| | | | - James L. Januzzi
- Division of Cardiology; Massachusetts General Hospital; Boston MA USA
| | - Dong-Ju Choi
- Cardiovascular Center, Division of Cardiology/Department of Internal Medicine; Seoul National University Bundang Hospital; South Korea
| | - Patrick Plaisance
- University Paris Diderot; Paris France
- Emergency Department; Hôpitaux Universitaire Saint Louis - Lariboisière; Assistance Publique des Hôpitaux de Paris Paris France
| | - Jindrich Spinar
- Department of Internal Medicine and Cardiology; University Hospital Brno, and Faculty of Medicine, Masaryk University; Brno Czech Republic
| | - Alexandre Mebazaa
- Department of Geriatry; Hôpitaux Universitaire Saint Louis - Lariboisière; Assistance Publique des Hôpitaux de Paris Paris France
- University Paris Diderot; Paris France
- UMR-S 942; INSERM Paris France
| | - Etienne Gayat
- University Paris Diderot; Paris France
- UMR-S 942; INSERM Paris France
- Department of Anesthesiology and Critical Care Medicine; Hôpitaux Universitaire Saint Louis - Lariboisière; Assistance Publique des Hôpitaux de Paris Paris France
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Postanesthetic Severe Oral Angioedema in Patient's Taking Angiotensin-Converting Enzyme Inhibitor. Case Rep Anesthesiol 2014; 2014:693191. [PMID: 25431681 PMCID: PMC4241279 DOI: 10.1155/2014/693191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 10/17/2014] [Indexed: 01/08/2023] Open
Abstract
Angiotensin-converting enzyme (ACE) inhibitors are the leading cause of a drug-induced angioedema. This occurrence is frequently underdiagnosed, but its relapse can be life-threatening. The authors' intention in reporting this clinical case is to sound a warning about reviewing attitudes and surveillance to try to improve patient perioperative safety.
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Ahmed A, Bourge RC, Fonarow GC, Patel K, Morgan CJ, Fleg JL, Aban IB, Love TE, Yancy CW, Deedwania P, van Veldhuisen DJ, Filippatos GS, Anker SD, Allman RM. Digoxin use and lower 30-day all-cause readmission for Medicare beneficiaries hospitalized for heart failure. Am J Med 2014; 127:61-70. [PMID: 24257326 PMCID: PMC3929967 DOI: 10.1016/j.amjmed.2013.08.027] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 08/07/2013] [Accepted: 08/07/2013] [Indexed: 01/05/2023]
Abstract
BACKGROUND Heart failure is the leading cause for hospital readmission, the reduction of which is a priority under the Affordable Care Act. Digoxin reduces 30-day all-cause hospital admission in chronic systolic heart failure. Whether digoxin is effective in reducing readmission after hospitalization for acute decompensation remains unknown. METHODS Of the 5153 Medicare beneficiaries hospitalized for acute heart failure and not receiving digoxin, 1054 (20%) received new discharge prescriptions for digoxin. Propensity scores for digoxin use, estimated for each of the 5153 patients, were used to assemble a matched cohort of 1842 (921 pairs) patients (mean age, 76 years; 56% women; 25% African American) receiving and not receiving digoxin, who were balanced on 55 baseline characteristics. RESULTS Thirty-day all-cause readmission occurred in 17% and 22% of matched patients receiving and not receiving digoxin, respectively (hazard ratio [HR] for digoxin, 0.77; 95% confidence interval [CI], 0.63-0.95). This beneficial association was observed only in those with ejection fraction <45% (HR 0.63; 95% CI, 0.47-0.83), but not in those with ejection fraction ≥ 45% (HR 0.91; 95% CI, 0.60-1.37; P for interaction, .145), a difference that persisted throughout the first 12 months postdischarge (P for interaction, .019). HRs (95% CIs) for 12-month heart failure readmission and all-cause mortality were 0.72 (0.61-0.86) and 0.83 (0.70-0.98), respectively. CONCLUSIONS In Medicare beneficiaries with systolic heart failure, a discharge prescription of digoxin was associated with lower 30-day all-cause hospital readmission, which was maintained at 12 months, and was not at the expense of higher mortality. Future randomized controlled trials are needed to confirm these findings.
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Affiliation(s)
- Ali Ahmed
- University of Alabama at Birmingham, Birmingham, Ala; Veterans Affairs Medical Center, Birmingham, Ala.
| | | | | | - Kanan Patel
- University of Alabama at Birmingham, Birmingham, Ala
| | | | - Jerome L Fleg
- National Heart, Lung, and Blood Institute, Bethesda, Md
| | | | | | | | | | | | | | - Stefan D Anker
- Applied Cachexia Research, Charité, Campus Virchow-Klinikum, Berlin, Germany
| | - Richard M Allman
- University of Alabama at Birmingham, Birmingham, Ala; Veterans Affairs Medical Center, Birmingham, Ala
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Dovjak P. [Diastolic heart failure: heart failure with preserved ejection fraction]. Z Gerontol Geriatr 2013; 46:71-9; quiz 80-1. [PMID: 23329260 DOI: 10.1007/s00391-012-0345-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The prognosis for patients with diastolic heart failure--heart failure with preserved ejection fraction--has not improved in the last few decades despite improvement of prognosis for all patients with heart failure. Diastolic dysfunction is a typical finding in elderly patients with heart failure. The diagnostic process is a challenge for clinicians who are often faced with comorbidities like COPD, osteoarthritis, sarcopenia, and diabetes. Classical treatment options fail to improve patients with diastolic heart failure; thus, a comprehensive and specific treatment plan is necessary.
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Affiliation(s)
- P Dovjak
- Akutgeriatrie/Remobilisation, Landeskrankenhaus Gmunden, Miller-von-Aichholz-Str. 49, 4810, Gmunden.
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Abstract
The average human life span has markedly increased in modern society largely attributed to advances in medical and therapeutic sciences that have successfully reduced important health risks. However, advanced age results in numerous alterations to cellular and subcellular components that can impact the overall health and function of an individual. Not surprisingly, advanced age is a major risk factor for the development of heart disease in which elderly populations observe increased morbidity and mortality. Even healthy individuals that appear to have normal heart function under resting conditions, actually have an increased susceptibility and vulnerability to stress. This is confounded by the impact that stress and disease can have over time to both the heart and vessels. Although, there is a rapidly growing body of literature investigating the effects of aging on the heart and how age-related alterations affect cardiac function, the biology of aging and underlying mechanisms remain unclear. In this review, we summarize effects of aging on the heart and discuss potential theories of cellular aging with special emphasis on mitochondrial dysfunction.
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Zhang Y, Kilgore ML, Arora T, Mujib M, Ekundayo OJ, Aban IB, Feller MA, Desai RV, Love TE, Allman RM, Fonarow GC, Ahmed A. Design and rationale of studies of neurohormonal blockade and outcomes in diastolic heart failure using OPTIMIZE-HF registry linked to Medicare data. Int J Cardiol 2011; 166:230-5. [PMID: 22119116 DOI: 10.1016/j.ijcard.2011.10.089] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 10/04/2011] [Accepted: 10/18/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Heart failure (HF) is the leading cause of hospitalization for Medicare beneficiaries. Nearly half of all HF patients have diastolic HF or HF with preserved ejection fraction (HF-PEF). Because these patients were excluded from major randomized clinical trials of neurohormonal blockade in HF there is little evidence about their role in HF-PEF. METHODS The aims of the American Recovery & Reinvestment Act-funded National Heart, Lung, and Blood Institute-sponsored "Neurohormonal Blockade and Outcomes in Diastolic Heart Failure" are to study the long-term effects of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and aldosterone antagonists in four separate propensity-matched populations of HF-PEF patients in the OPTIMIZE-HF (Organized Program to Initiate Life-Saving Treatment in Hospitalized Patients with Heart Failure) registry. Of the 48,612 OPTIMIZE-HF hospitalizations occurring during 2003-2004 in 259 U.S. hospitals, 20,839 were due to HF-PEF (EF ≥40%). For mortality and hospitalization we used Medicare national claims data through December 31, 2008. RESULTS Using a two-step (hospital-level and hospitalization-level) probabilistic linking approach, we assembled a cohort of 11,997 HF-PEF patients from 238 OPTIMIZE-HF hospitals. These patients had a mean age of 75 years, mean EF of 55%, were 62% women, 15% African American, and were comparable with community-based HF-PEF cohorts in key baseline characteristics. CONCLUSIONS The assembled Medicare-linked OPTIMIZE-HF cohort of Medicare beneficiaries with HF-PEF with long-term outcomes data will provide unique opportunities to study clinical effectivenss of various neurohormonal antagonists with outcomes in HF-PEF using propensity-matched designs that allow outcome-blinded assembly of balanced cohorts, a key feature of randomized clinical trials.
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Affiliation(s)
- Yan Zhang
- University of Alabama at Birmingham, Birmingham, AL 35294–2041, USA
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