Characteristics and baseline clinical predictors of future fatal versus nonfatal coronary heart disease events in older adults: The cardiovascular health study

Camille A. Pearte, Curt D. Furberg, Ellen S. O'Meara, Bruce M. Psaty, Lewis Kuller, Neil R. Powe, Teri Manolio

Research output: Contribution to journalArticle

Abstract

Background - Although >80% of annual coronary heart disease (CHD) deaths occur in adults aged >65 years and the population is aging rapidly, CHD event fatality and its predictors in the elderly have not been well described. Methods and Results - The first myocardial infarction (MI) or CHD death among the 5888 adults aged ≥65 years occurring during enrollment in the Cardiovascular Health Study during 1989-2001 was identified and adjudicated. Characteristics measured at examinations before the event were examined for associations with case fatality (death before hospitalization or hospital discharge) and for differences in predictors by demographics or clinical history. During a median follow-up of 8.2 years, 985 CHD events occurred, of which 30% were fatal. Case fatality decreased slightly over time, ranging from 28% to 30% per year in the early 1990s versus 23% by 2000-2001; with adjustment for age at MI and gender, there was a 6% lower odds of fatality with each successive year (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.90 to 0.98). Case fatality was similar by race and gender but higher with age and prior CHD (MI, angina, or revascularization). When considered alone, many subclinical disease measures, such as common carotid intima-media thickness, ankle-arm index, left ventricular mass by ECG, and a major ECG abnormality, and traditional risk factors, such as diabetes and hypertension, were associated with fatality. In multivariable analysis, independent predictors of fatality were prior congestive heart failure (OR, 3.20; 95% CI, 2.32 to 4.41), prior CHD rather than only history of MI (OR, 2.51; 95% CI, 1.84 to 3.43), diabetes (OR, 1.66; 95% CI, 1.10 to 2.31), and age (OR, 1.21 per 5 years; 95% CI, 1.07 to 1.37), adjusted for gender and each other. Prior congestive heart failure, regardless of left ventricular systolic function, age, gender, or prior CHD, conferred a ≥3-fold increased risk of fatality in almost all subgroups. Conclusions - Among community-dwelling older adults, CHD case fatality remains substantial, with easily identifiable risk factors that may be different from those that predict incident disease. In the elderly in whom the risk/benefit of therapies may be influenced by multiple competing comorbidities and care needs, risk stratification possibly may be improved further by focusing more aggressive care on specific patients, especially those with a history of congestive heart failure or prior CHD.

Original languageEnglish (US)
Pages (from-to)2177-2185
Number of pages9
JournalCirculation
Volume113
Issue number18
DOIs
StatePublished - May 2006

Fingerprint

Coronary Disease
Health
Odds Ratio
Confidence Intervals
Myocardial Infarction
Heart Failure
Electrocardiography
Independent Living
Myocardial Revascularization
Carotid Intima-Media Thickness
Left Ventricular Function
Ankle
Comorbidity
Hospitalization
Arm
Demography
Hypertension
Population

Keywords

  • Aging
  • Coronary disease
  • Mortality
  • Myocardial infarction
  • Prognosis

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Characteristics and baseline clinical predictors of future fatal versus nonfatal coronary heart disease events in older adults : The cardiovascular health study. / Pearte, Camille A.; Furberg, Curt D.; O'Meara, Ellen S.; Psaty, Bruce M.; Kuller, Lewis; Powe, Neil R.; Manolio, Teri.

In: Circulation, Vol. 113, No. 18, 05.2006, p. 2177-2185.

Research output: Contribution to journalArticle

Pearte, Camille A. ; Furberg, Curt D. ; O'Meara, Ellen S. ; Psaty, Bruce M. ; Kuller, Lewis ; Powe, Neil R. ; Manolio, Teri. / Characteristics and baseline clinical predictors of future fatal versus nonfatal coronary heart disease events in older adults : The cardiovascular health study. In: Circulation. 2006 ; Vol. 113, No. 18. pp. 2177-2185.
@article{92ce2bd2745a49529e8e33f052ce8050,
title = "Characteristics and baseline clinical predictors of future fatal versus nonfatal coronary heart disease events in older adults: The cardiovascular health study",
abstract = "Background - Although >80{\%} of annual coronary heart disease (CHD) deaths occur in adults aged >65 years and the population is aging rapidly, CHD event fatality and its predictors in the elderly have not been well described. Methods and Results - The first myocardial infarction (MI) or CHD death among the 5888 adults aged ≥65 years occurring during enrollment in the Cardiovascular Health Study during 1989-2001 was identified and adjudicated. Characteristics measured at examinations before the event were examined for associations with case fatality (death before hospitalization or hospital discharge) and for differences in predictors by demographics or clinical history. During a median follow-up of 8.2 years, 985 CHD events occurred, of which 30{\%} were fatal. Case fatality decreased slightly over time, ranging from 28{\%} to 30{\%} per year in the early 1990s versus 23{\%} by 2000-2001; with adjustment for age at MI and gender, there was a 6{\%} lower odds of fatality with each successive year (odds ratio [OR], 0.94; 95{\%} confidence interval [CI], 0.90 to 0.98). Case fatality was similar by race and gender but higher with age and prior CHD (MI, angina, or revascularization). When considered alone, many subclinical disease measures, such as common carotid intima-media thickness, ankle-arm index, left ventricular mass by ECG, and a major ECG abnormality, and traditional risk factors, such as diabetes and hypertension, were associated with fatality. In multivariable analysis, independent predictors of fatality were prior congestive heart failure (OR, 3.20; 95{\%} CI, 2.32 to 4.41), prior CHD rather than only history of MI (OR, 2.51; 95{\%} CI, 1.84 to 3.43), diabetes (OR, 1.66; 95{\%} CI, 1.10 to 2.31), and age (OR, 1.21 per 5 years; 95{\%} CI, 1.07 to 1.37), adjusted for gender and each other. Prior congestive heart failure, regardless of left ventricular systolic function, age, gender, or prior CHD, conferred a ≥3-fold increased risk of fatality in almost all subgroups. Conclusions - Among community-dwelling older adults, CHD case fatality remains substantial, with easily identifiable risk factors that may be different from those that predict incident disease. In the elderly in whom the risk/benefit of therapies may be influenced by multiple competing comorbidities and care needs, risk stratification possibly may be improved further by focusing more aggressive care on specific patients, especially those with a history of congestive heart failure or prior CHD.",
keywords = "Aging, Coronary disease, Mortality, Myocardial infarction, Prognosis",
author = "Pearte, {Camille A.} and Furberg, {Curt D.} and O'Meara, {Ellen S.} and Psaty, {Bruce M.} and Lewis Kuller and Powe, {Neil R.} and Teri Manolio",
year = "2006",
month = "5",
doi = "10.1161/CIRCULATIONAHA.105.610352",
language = "English (US)",
volume = "113",
pages = "2177--2185",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "18",

}

TY - JOUR

T1 - Characteristics and baseline clinical predictors of future fatal versus nonfatal coronary heart disease events in older adults

T2 - The cardiovascular health study

AU - Pearte, Camille A.

AU - Furberg, Curt D.

AU - O'Meara, Ellen S.

AU - Psaty, Bruce M.

AU - Kuller, Lewis

AU - Powe, Neil R.

AU - Manolio, Teri

PY - 2006/5

Y1 - 2006/5

N2 - Background - Although >80% of annual coronary heart disease (CHD) deaths occur in adults aged >65 years and the population is aging rapidly, CHD event fatality and its predictors in the elderly have not been well described. Methods and Results - The first myocardial infarction (MI) or CHD death among the 5888 adults aged ≥65 years occurring during enrollment in the Cardiovascular Health Study during 1989-2001 was identified and adjudicated. Characteristics measured at examinations before the event were examined for associations with case fatality (death before hospitalization or hospital discharge) and for differences in predictors by demographics or clinical history. During a median follow-up of 8.2 years, 985 CHD events occurred, of which 30% were fatal. Case fatality decreased slightly over time, ranging from 28% to 30% per year in the early 1990s versus 23% by 2000-2001; with adjustment for age at MI and gender, there was a 6% lower odds of fatality with each successive year (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.90 to 0.98). Case fatality was similar by race and gender but higher with age and prior CHD (MI, angina, or revascularization). When considered alone, many subclinical disease measures, such as common carotid intima-media thickness, ankle-arm index, left ventricular mass by ECG, and a major ECG abnormality, and traditional risk factors, such as diabetes and hypertension, were associated with fatality. In multivariable analysis, independent predictors of fatality were prior congestive heart failure (OR, 3.20; 95% CI, 2.32 to 4.41), prior CHD rather than only history of MI (OR, 2.51; 95% CI, 1.84 to 3.43), diabetes (OR, 1.66; 95% CI, 1.10 to 2.31), and age (OR, 1.21 per 5 years; 95% CI, 1.07 to 1.37), adjusted for gender and each other. Prior congestive heart failure, regardless of left ventricular systolic function, age, gender, or prior CHD, conferred a ≥3-fold increased risk of fatality in almost all subgroups. Conclusions - Among community-dwelling older adults, CHD case fatality remains substantial, with easily identifiable risk factors that may be different from those that predict incident disease. In the elderly in whom the risk/benefit of therapies may be influenced by multiple competing comorbidities and care needs, risk stratification possibly may be improved further by focusing more aggressive care on specific patients, especially those with a history of congestive heart failure or prior CHD.

AB - Background - Although >80% of annual coronary heart disease (CHD) deaths occur in adults aged >65 years and the population is aging rapidly, CHD event fatality and its predictors in the elderly have not been well described. Methods and Results - The first myocardial infarction (MI) or CHD death among the 5888 adults aged ≥65 years occurring during enrollment in the Cardiovascular Health Study during 1989-2001 was identified and adjudicated. Characteristics measured at examinations before the event were examined for associations with case fatality (death before hospitalization or hospital discharge) and for differences in predictors by demographics or clinical history. During a median follow-up of 8.2 years, 985 CHD events occurred, of which 30% were fatal. Case fatality decreased slightly over time, ranging from 28% to 30% per year in the early 1990s versus 23% by 2000-2001; with adjustment for age at MI and gender, there was a 6% lower odds of fatality with each successive year (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.90 to 0.98). Case fatality was similar by race and gender but higher with age and prior CHD (MI, angina, or revascularization). When considered alone, many subclinical disease measures, such as common carotid intima-media thickness, ankle-arm index, left ventricular mass by ECG, and a major ECG abnormality, and traditional risk factors, such as diabetes and hypertension, were associated with fatality. In multivariable analysis, independent predictors of fatality were prior congestive heart failure (OR, 3.20; 95% CI, 2.32 to 4.41), prior CHD rather than only history of MI (OR, 2.51; 95% CI, 1.84 to 3.43), diabetes (OR, 1.66; 95% CI, 1.10 to 2.31), and age (OR, 1.21 per 5 years; 95% CI, 1.07 to 1.37), adjusted for gender and each other. Prior congestive heart failure, regardless of left ventricular systolic function, age, gender, or prior CHD, conferred a ≥3-fold increased risk of fatality in almost all subgroups. Conclusions - Among community-dwelling older adults, CHD case fatality remains substantial, with easily identifiable risk factors that may be different from those that predict incident disease. In the elderly in whom the risk/benefit of therapies may be influenced by multiple competing comorbidities and care needs, risk stratification possibly may be improved further by focusing more aggressive care on specific patients, especially those with a history of congestive heart failure or prior CHD.

KW - Aging

KW - Coronary disease

KW - Mortality

KW - Myocardial infarction

KW - Prognosis

UR - http://www.scopus.com/inward/record.url?scp=33646783252&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33646783252&partnerID=8YFLogxK

U2 - 10.1161/CIRCULATIONAHA.105.610352

DO - 10.1161/CIRCULATIONAHA.105.610352

M3 - Article

C2 - 16651468

AN - SCOPUS:33646783252

VL - 113

SP - 2177

EP - 2185

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 18

ER -