학술논문
Long-term survival following the development of heart failure in an elderly hypertensive population.
Document Type
Article
Author
Sahle, Berhe W.; Owen, Alice J.; Wing, Lindon M.H.; Beilin, Lawrence J.; Krum, Henry; Reid, Christopher M.; Wing (Chair), L.M.H.; Reid, C.M.; Beilin, L.J.; Brown, M.A.; Jennings, G.L.R.; Johnston, C.I.; McNeil, J.J.; Marley, J.E.; Morgan, T.O.; Ryan, P.; Shaw (deceased), J.; West, M.J.; MacDonald, G.
Source
Subject
*HEART failure
*THIAZIDES
*DIABETES
*HOSPITAL care
*DIURETICS
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Language
ISSN
1755-5914
Abstract
Background Available data on the prognosis of heart failure ( HF) patients are predominantly limited to patients diagnosed at time of hospitalization. Aims To describe the long-term survival of incident HF patients and identify clinical characteristics associated with mortality. Methods The Second Australian National Blood Pressure Study ( ANBP2) randomized 6083 hypertensive subjects aged 65-84 years to angiotensin-converting enzyme ( ACE) inhibitor or thiazide diuretic-based therapy and followed them for a median of 4.1 years. One hundred forty-five participants who developed HF and 5938 who remained free from HF during the trial period were followed for a median of 6.7 years during a posttrial follow-up. Results Three quarters, 110 (76%) of HF patients had died at the end of the follow-up. The five- and ten-year survival rates following HF diagnosis during the trial period were 37% and 15%, respectively, in men, compared with 60% and 33%, respectively, in women. In non-heart failure participants, the five- and ten-year survival rates, following enrollment into the study, were 92% and 76%, respectively. Mortality following HF diagnosis increased with advancing age (HR = 1.09, 95% CI: 1.04-1.33). In addition, male gender and preexisting diabetes were predictive of mortality, while ACE inhibitor-based therapy for the initial trial was associated with 39% decrease ( HR = 0.61, 95% CI: 0.41-0.91) in mortality compared with a thiazide diuretic-based regimen. Conclusions Long-term survival in elderly HF patients is poor, especially in men. Mortality in HF patients increased progressively with advancing age, while allocation to the ACE inhibitor-based regimen for the initial trial significantly improved HF outcome. [ABSTRACT FROM AUTHOR]