Outcome of Congestive Heart Failure in Elderly Persons: Influence of Left Ventricular Systolic Function: The Cardiovascular Health Study

  1. John S. Gottdiener, MD;
  2. Robyn L. McClelland, PhD;
  3. Robert Marshall, MD;
  4. Lynn Shemanski, PhD;
  5. Curt D. Furberg, MD;
  6. Dalane W. Kitzman, MD;
  7. Mary Cushman, MD;
  8. Joseph Polak, MD, MPH;
  9. Julius M. Gardin, MD;
  10. Bernard J. Gersh, MB, ChB, DPhil;
  11. Gerard P. Aurigemma, MD; and
  12. Teri A. Manolio, MD, MHS
  1. From St. Francis Hospital, Roslyn, New York; Mayo Clinic, Rochester, Minnesota; Georgetown University Hospital, Washington, D.C.; University of Washington, Seattle, Washington; Wake Forest University, Winston-Salem, North Carolina; University of Vermont, Burlington, Vermont; Tufts–New England Medical Center, Boston, Massachusetts; St. John Hospital and Medical Center, Detroit, Michigan; University of Massachusetts Medical Center, Worcester, Massachusetts; and National Heart, Lung, and Blood Institute, Bethesda, Maryland.

    Abstract

    Background: Most persons with congestive heart failure are elderly, and many elderly persons with congestive heart failure have normal left ventricular systolic function.

    Objective: To evaluate the relationship between left ventricular systolic function and outcome of congestive heart failure in elderly persons.

    Design: Population-based longitudinal study of coronary heart disease and stroke.

    Setting: Four U.S. sites: Forsyth County, North Carolina; Sacramento County, California; Allegheny County, Pennsylvania; and Washington County, Maryland.

    Participants: 5888 persons who were at least 65 years of age and were recruited from the community.

    Measurements: Total mortality and cardiovascular morbidity and mortality.

    Results: Of 5532 participants, 269 (4.9%) had congestive heart failure. Among these, left ventricular function was normal in 63%, borderline decreased in 15%, and overtly impaired in 22%. The mortality rate was 25 deaths per 1000 person-years in the reference group (no congestive heart failure and normal left ventricular function at baseline); 154 deaths per 1000 person-years in participants with congestive heart failure and impaired left ventricular systolic function; 87 and 115 deaths per 1000 person-years in participants with congestive heart failure and normal or borderline systolic function, respectively; and 89 deaths per 1000 person-years in persons with impaired left ventricular function but no congestive heart failure. Although the risk for death from congestive heart failure was lower in persons with normal systolic function than in those with impaired function, more deaths were associated with normal systolic function because more persons with heart failure fall into this category.

    Conclusions: Community-dwelling elderly persons, especially those with impaired left ventricular function, have a substantial risk for death from congestive heart failure. However, more deaths occur from heart failure in persons with normal systolic function because left ventricular function is more often normal than impaired in elderly persons with heart failure.

    Article and Author Information

    • Grant Support: By the National Heart, Lung, and Blood Institute (contracts NO1-HC-85079-85086 and NO1-HC-15103).

    • Requests for Single Reprints: John S. Gottdiener, MD, Cardiology Division, St. Francis Hospital, 100 Port Washington Boulevard, Roslyn, NY 11576-1353; e-mail, gottdien{at}ziplink.net.

    • Current Author Addresses: Dr. Gottdiener: Cardiology Division, St. Francis Hospital, 100 Port Washington Boulevard, Roslyn, NY 11576-1353.

    • Dr. McClelland: Mayo Clinic, 200 First Street SW, Harwick 706, Rochester, MN 55905.

    • Dr. Marshall: Division of Cardiology, Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC 20007.

    • Dr. Shemanski: University of Washington, 201 Elliott Avenue West, Suite 400, Seattle, WA 98119.

    • Drs. Furberg and Kitzman: Department of Public Health, Wake Forest University, Bowman Gray School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157.

    • Dr. Cushman: University of Vermont, 208 South Park Drive, Suite 2, Colchester, VT 05446.

    • Dr. Polak: Department of Radiology, Brigham & Women's Hospital, 75 Francis Street, Boston, MA 02115.

    • Dr. Gardin: Division of Cardiology, St. John Hospital and Medical Center, 22191 Moross Road, PB 1, Suite 105, Detroit, MI 48226.

    • Dr. Gersh: Mayo Clinic, Division of Cardiology, 200 First Street SW, Rochester, MN 55905.

    • Dr. Aurigemma: Division of Cardiovascular Medicine, University of Massachusetts Medical Center, 55 Lake Avenue North, Worcester, MA 01655.

    • Dr. Manolio: Division of Epidemiology and Clinical Applications, National Institutes of Health, National Heart, Lung, and Blood Institute, 6701 Rockledge Drive, MSC 7934, Bethesda, MD 20892-7934.

    • Author Contributions: Conception and design: J.S. Gottdiener, R. Marshall, D.W. Kitzman, J.M. Gardin, B.J. Gersh, T.A. Manolio.

    • Analysis and interpretation of the data: J.S. Gottdiener, R.L. McClelland, R. Marshall, L. Shemanski, C.D. Furberg, D.W. Kitzman, M. Cushman, J.M. Gardin, B.J. Gersh.

    • Drafting of the article: J.S. Gottdiener, R. Marshall, D.W. Kitzman, J. Polak, J.M. Gardin, B.J. Gersh, G.P. Aurigemma.

    • Critical revision of the article for important intellectual content: J.S. Gottdiener, R. Marshall, C.D. Furberg, D.W. Kitzman, M. Cushman, J.M. Gardin, B.J. Gersh, G.P. Aurigemma, T.A. Manolio.

    • Final approval of the article: J.S. Gottdiener, C.D. Furberg, D.W. Kitzman, M. Cushman, J. Polak, B.J. Gersh, G.P. Aurigemma, T.A. Manolio.

    • Provision of study materials or patients: D.W. Kitzman.

    • Statistical expertise: R.L. McClelland, L. Shemanski.

    • Obtaining of funding: J.M. Gardin.

    • Administrative, technical, or logistic support: C.D. Furberg, M. Cushman.

    • Collection and assembly of data: J.S. Gottdiener, L. Shemanski, M. Cushman, J. Polak, J.M. Gardin.

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    1. Ann Intern Med October 15, 2002 vol. 137 no. 8 631-639
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