Iatrogenic congestive heart failure in older adults: Clinical course and prognosis

OBJECTIVE: To determine the prevalence, risk factors, clinical course, and prognosis of iatrogenic congestive heart failure in older patients. DESIGN AND SETTING: Prospective observational study at a university teaching hospital. PARTICIPANTS: A total of 401 patients 70 years of age or older hospitalized with congestive heart failure. The mean age was 80 +/- 6 years; 59% were female, and 65% were white. MEASUREMENTS: Comprehensive data, including an assessment of the etiology and precipitating factors leading to the development of heart failure, were collected at the time of diagnosis. Iatrogenic heart failure was defined as heart failure precipitated by medications or excessive fluid administration, or occurring as a procedural complication. All patients were followed for 1 year, and the primary outcome measure was total mortality. RESULTS: Using strict criteria, 28 patients (7.0%) were considered to have iatrogenic heart failure. Compared with noniatrogenic patients (n = 373), iatrogenic cases had less severe premorbid cardiac disease but more marked noncardiac disability and longer hospital stays (29 +/- 24 vs 13 +/- 12 days, P < .001). Hospital mortality was 32% in iatrogenic heart failure patients compared with 9% in noniatrogenic cases (P < .001). Cumulative mortality at 1 year was 68% in iatrogenic patients versus 39% in noniatrogenic patients (P < .01). Using a Cox proportional hazards model, iatrogenic congestive heart failure was associated with a relative mortality risk during follow-up of 2.5 (95% confidence interval 1.5-4.3) after adjusting for age, sex, prior history of heart failure, New York Heart Association class, diabetes mellitus, systolic blood pressure, hemoglobin, blood urea nitrogen, and serum albumin. CONCLUSIONS: Frail, debilitated older patients are at increased risk for developing iatrogenic heart failure, even in the absence of clinically evident cardiac disease. In this population, iatrogenic heart failure serves as a marker for poor short- and long-term prognosis, but further study is required to determine the optimal approach to management of these patients.