Heart failure survival among older adults in the United States - A poor prognosis for an emerging epidemic in the Medicare population

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.