The points system may steer doctors toward considering more aggressive treatments such as implantable defibrillators and pacemakers for those at low risk of death. However, elderly patients with a high risk may want to avoid stressful and unnecessary medical intervention and may benefit most from palliative or hospice care.
"It has typically been very difficult to predict how long a person hospitalized with heart failure may survive," says senior author Michael W. Rich, M.D., associate professor of medicine and a geriatric cardiologist at Barnes-Jewish Hospital. "That has made it hard for the treating physician to know how aggressive to be with therapy."
In their study, which followed 282 elderly heart failure patients for up to 14 years, the researchers identified seven factors that most affect patient survival:
• advanced age
• a history of dementia (contributes to a host of conditions related to the inability to properly care for oneself)
• coronary artery disease (arteries that supply blood to the heart muscle are hardened and narrowed)
• peripheral vascular disease (similar to coronary artery disease but involving blood vessels outside of the heart and brain)
• low sodium in the blood (an indication of neurohormonal imbalance)
• high urea in the blood (a reflection of poor cardiac output that affects kidney function)
• low blood pressure (a result of weakened heart function).
The study showed that patients with four or more of the risk factors had a low probability of surviving longer than six months. But if patients had none or just one of the factors, they had a good chance of living five years or more. Patients with two to three factors were likely to live at least a year.
MEDICA.de; Source: Washington University in St. Louis