Heart failure mortality compared between elderly and non-elderly Thai patients

Objective: To investigate heart failure mortality compared between elderly and non-elderly Thai patients. Methods: This study included patients at least 18 years of age who were admitted to the hospital with a primary diagnosis of heart failure (ICD-10-TM code: 150.9) during 2008-2012 according to three major Thailand reimbursement systems (civil servant, social security, and universal coverage systems). Patients were categorized into either the elderly group (age > 65 years) or the non-elderly group (age ≤ 65 years). Mortality rate and survival analysis were compared between groups. Demographic, underlying disease and comorbid condition data were collected. Cardiovascular and non-cardiovascular death was also analyzed. Results: A total of 201,709 patients were included. The average age of patients was 64.9 ± 14.8 years, and the gender proportion breakdown was 84,155 (41.7%) males and 117,554 (58.3%) females. Just over half of patients (107,325 patients; 53.2%) were elderly. Overall mortality rate was 50.8%. The mortality rate at one month, six months, one year, and three years was 11.0%, 24.5%, 32.5%, and 46.3%, respectively. Elderly patients had a higher rate of mortality compared to non-elderly patients with an adjusted odds ratio (OR) of 1.47 (95% CI: 1.46-1.49) for all-cause mortality, an OR of 1.25 (95% CI: 1.23-1.27) for cardiovascular death, and an OR of 1.72 (95% CI: 1.68-1.75) for non-cardiovascular death (all P < 0.001). After adjusting for potential confounders, elderly status remained the second strongest factor associated with increased risk of mortality after heart failure hospitalization following chronic kidney disease. Conclusions: The overall mortality rate after heart failure hospitalization was a very high 50.8%. Multivariate analysis revealed elderly status to be an independent predictor of mortality after hospitalization. This finding suggests that improvements are needed related to the quality of care and follow-up given to elderly Thai heart failure patients.