Why and how do elderly patients with heart failure die? Insights from the TIME-CHF study

Abstract

Aims: Specific causes and modes of death (COD and MOD) of patients with heart failure (HF) are not well described, particularly in those with preserved ejection fraction >45% (HFPEF) and at old age. Thus, using the database of the TIME-CHF study, patients with HFPEF were compared with those with reduced ejection fraction ≤45% (HFREF), and patients ≥75 with those 60-74 years of age to identify MOD and COD, predictors of death, and event rates before death as compared with survivors.

Methods and results: During the 18-month follow-up, 132/622 patients (21%) died, with similar rates in patients with HFPEF and HFREF and a trend to higher rates in patients aged ≥75 years (24% vs. 17%, P = 0.06). COD and MOD (ACME system) were not different in the age groups. COD was more often non-cardiovascular in HFPEF patients than in HFREF patients (33% vs. 16%, P < 0.05) and cardiac MOD were more frequent in HFREF patients (75% vs. 56%, P < 0.05), mainly due to more sudden deaths (25% vs. 7%, P < 0.05). Patients who died experienced a median of four adverse events (interquartile range 1-7) and one (0-1) hospitalization within 60 days prior to death compared with 0.7 (0.4-1.4) and 0.1 (0.0-0.2) during a randomly selected 60 days in survivors (all P < 0.0001).

Conclusion: Despite similar 18-month mortality in patients with HFREF and those with HFPEF, important differences in COD and MOD were found which were not observed between the two age groups. A high rate of adverse events and hospitalizations preceded death. These observations may be relevant for the management of HF patients.