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A Poor Prognosis for an Emerging Epidemic in the Medicare Population

Janet B. Croft, PhD; Wayne H. Giles, MD, MS; Robert A. Pollard, MA; Nora L. Keenan, PhD; Michele L. Casper, PhD; Robert F. Anda, MD, MS

Arch Intern Med. 1999;159:505-510.

Objective  To describe the 6-year probability of survival for older adults after their first hospitalization for heart failure.

Setting  National Medicare hospital claims records for 1984 through 1986 and Medicare enrollment records from 1986 through 1992.

Design  We identified a national cohort of 170,239 (9% black patients) Medicare patients, 67 years or older, with no evidence of heart failure in 1984 or 1985, who were hospitalized and discharged for the first time in 1986 with a principal diagnosis of heart failure. For groups defined by race, sex, age, Medicaid eligibility, and comorbid conditions, we compared the probability of survival with Cox proportional hazards regression.

Results  Only 19% of black men, 16% of white men, 25% of black women, and 23% of white women survived 6 years. One third died within the first year. Men had lower median survival and 38% greater risk of mortality than did women (P<.05). White men had 10% greater risk of mortality than did black men (P<.05). Medicaid eligibility (white adults only) and diabetes were associated with increased mortality (P<.05).

Conclusions  The prognosis for older adults with heart failure underscores the importance of prevention strategies and early detection and treatment modalities that can prevent, improve, or reverse myocardial dysfunction, particularly for the growing number of adults who are at increased risk for developing heart failure because of hypertension, diabetes, or myocardial infarction.

From the Cardiovascular Health Branch (Drs Croft, Giles, Keenan, Casper, and Anda) and Community Health and Program Services Branch (Mr Pollard), Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga.

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