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Geriatric Assessment in Elderly Heart Failure Patients

Geriatric Unit Internal Medicine Service Hospital Universitari de Bellvitge L'Hospitalet de Llobregat Barcelona Spain

Address correspondence to Francesc Formiga, MD, Geriatric Unit, Internal Medicine Service, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat 08907, Barcelona, Spain. E-mail: fformiga{at}csub.scs.es

To the Editor:

We read with interest the article by Ahmed (1) focusing on outcomes in ambulatory older adults with chronic heart failure. Because heart failure is an important diagnosis in our habitual clinical practice, we would like to make some comments about the suitability of an extended assessment of those older patients.

We agree that many potential predictive factors (age, sex, race, duration, primary cause, comorbidities, medications, symptoms and signs, New York Heart Association functional class, heart rate, blood pressure, chest film, laboratory data, and left ventricular ejection fraction) should be included when evaluating outcomes in older adults with heart failure (1). Thus, if mortality or hospitalizations in elderly heart failure patients is the objective of a study, we think that it is necessary to collect information about geriatric assessment: functional capacity (at least), cognition, nutrition, and so forth.

Functional status was, in some studies, an independent predictor for short-term and long-term mortality in hospitalized patients with different problems (2). With respect to heart failure, we would like to make some comments related with our previously reported experience (3). We conducted a prospective study including 88 patients (>64 years old, mean age 79 years; 57% women) admitted because of symptomatic, newly diagnosed heart failure. We found that a previous low functional capacity (measured with the Barthel Index) is an independent predictor of mortality after 1 year of follow-up. Recently, in an interesting study, Rozzini and colleagues (4) reported that, in elderly ambulant patients (mean age 78 years) admitted to a geriatric ward, change in preadmission function due to acute disease (measured as the difference in Barthel Index between performances on admission and 2 weeks before the acute event) is a factor independently related to 6-month mortality.

The assessment of functional status is the cornerstone of geriatric assessment. We suggest that the inclusion of functional status information may be useful to predict outcomes in hospitalized and in community-based studies evaluating elderly patients diagnosed with heart failure, and must be added to the other well-known prognostic factors.

Footnotes

Decision Editor: Luigi Ferrucci, MD, PhD

Received November 28, 2005

Accepted December 5, 2005

References

1. Ahmed A. Association of diastolic dysfunction and outcomes in ambulatory older adults with chronic heart failure. J Gerontol A Biol Sci Med Sci. 2005;60A:1339-1344.[Abstract/Free Full Text]
2. Torres OH, Muñoz J, Ruiz D, et al. Outcome predictors of pneumonia in elderly patients: importance of functional assessment. J Am Geriatr Soc. 2004;52:1603-1609.[Medline]
3. Formiga F, Chivite D, Sole A, Manito N, Ramon JM, Pujol R. Functional outcomes of elderly patients after the first hospital admission for descompensated heart failure. A prospective study. Arch Gerontol Geriatr. Available at: http://dx.doi.org/10.1016/.j.archger.2005.10.010.
4. Rozzini R, Sabatini T, Cassinadri, , et al. Relationship between functional loss before admission and mortality in elderly persons with medical illness. J Gerontol A Biol Sci Med Sci. 2005;60A:1180-1183.[Abstract/Free Full Text]

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