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Predictors of Mortality in Home-Dwelling Patients with Cardiovascular Disease Aged 75 and Older

Authors

  • Timo E. Strandberg MD, PhD,

    1. From the *Department of Health Sciences/Geriatrics, Unit of General Practice, University of Oulu, and Oulu University Hospital, Oulu, Finland; and Unit of General Practice and Department of Medicine, Clinic of Internal Medicine and Geriatrics, University Central Hospital of Helsinki, Helsinki, Finland.
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  • Kaisu H. Pitkala MD, PhD,

    1. From the *Department of Health Sciences/Geriatrics, Unit of General Practice, University of Oulu, and Oulu University Hospital, Oulu, Finland; and Unit of General Practice and Department of Medicine, Clinic of Internal Medicine and Geriatrics, University Central Hospital of Helsinki, Helsinki, Finland.
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  • Reijo S. Tilvis MD, PhD

    1. From the *Department of Health Sciences/Geriatrics, Unit of General Practice, University of Oulu, and Oulu University Hospital, Oulu, Finland; and Unit of General Practice and Department of Medicine, Clinic of Internal Medicine and Geriatrics, University Central Hospital of Helsinki, Helsinki, Finland.
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  • Part of the data was presented in abstract form at the 56th Annual Scientific Session of the American College of Cardiology, March 24–27, 2007, New Orleans, Louisiana.

Address correspondence to Timo E. Strandberg, Department of Health Sciences/Geriatrics, University of Oulu, P.O. Box 5000, FIN-90014, Oulu, Finland. E-mail: timo.strandberg@oulu.fi

Abstract

OBJECTIVES: To compare the predictive value of biomarkers commonly measured in older patients with cardiovascular disease (CVD) with an indicator of cognitive function.

DESIGN: Prospective cohort study.

SETTING: Helsinki, Finland.

PARTICIPANTS: Three hundred ninety-eight home-dwelling older persons (261 women, mean age 80) with stable CVD and without a diagnosis of clinical dementia.

MEASUREMENTS: Simple laboratory and clinical measurements (including the Mini Mental State Examination (MMSE, maximum score 30 points) and New York Heart Association (NYHA) classification) were used to predict mortality. A MMSE score between 18 and 24 points was considered to indicate cognitive impairment.

RESULTS: At baseline, median MMSE score was 27 (interquartile range 25–28), with 59 individuals having a score below 24 points. During a mean follow-up of 6.0 years, 129 participants died. In the fully adjusted Cox proportional hazards model, low MMSE score was the strongest predictor of mortality, with a relative hazard of 2.38 (95% confidence interval=1.52–3.74; P<.001). Of the various clinical and laboratory variables, only creatinine, C-reactive protein, and history of congestive heart failure were significant independent predictors, whereas conventional risk factors were not.

CONCLUSION: Only a few clinical variables independently predicted 6-year mortality in older home-living patients with CVD. The strongest predictor was impaired cognitive function assessed using MMSE.

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