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Outcome of Congestive Heart Failure in Elderly Persons: Influence of Left Ventricular Systolic Function: The Cardiovascular Health Study

John S. Gottdiener, MD; Robyn L. McClelland, PhD; Robert Marshall, MD; Lynn Shemanski, PhD; Curt D. Furberg, MD; Dalane W. Kitzman, MD; Mary Cushman, MD; Joseph Polak, MD, MPH; Julius M. Gardin, MD; Bernard J. Gersh, MB, ChB, DPhil; Gerard P. Aurigemma, MD; and Teri A. Manolio, MD, MHS
[+] Article and Author Information

From St. Francis Hospital, Roslyn, New York; Mayo Clinic, Rochester, Minnesota; Georgetown University Hospital, Washington, D.C.; University of Washington, Seattle, Washington; Wake Forest University, Winston-Salem, North Carolina; University of Vermont, Burlington, Vermont; Tufts–New England Medical Center, Boston, Massachusetts; St. John Hospital and Medical Center, Detroit, Michigan; University of Massachusetts Medical Center, Worcester, Massachusetts; and National Heart, Lung, and Blood Institute, Bethesda, Maryland.


Grant Support: By the National Heart, Lung, and Blood Institute (contracts NO1-HC-85079-85086 and NO1-HC-15103).

Requests for Single Reprints: John S. Gottdiener, MD, Cardiology Division, St. Francis Hospital, 100 Port Washington Boulevard, Roslyn, NY 11576-1353; e-mail, gottdien@ziplink.net.

Current Author Addresses: Dr. Gottdiener: Cardiology Division, St. Francis Hospital, 100 Port Washington Boulevard, Roslyn, NY 11576-1353.

Dr. McClelland: Mayo Clinic, 200 First Street SW, Harwick 706, Rochester, MN 55905.

Dr. Marshall: Division of Cardiology, Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC 20007.

Dr. Shemanski: University of Washington, 201 Elliott Avenue West, Suite 400, Seattle, WA 98119.

Drs. Furberg and Kitzman: Department of Public Health, Wake Forest University, Bowman Gray School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157.

Dr. Cushman: University of Vermont, 208 South Park Drive, Suite 2, Colchester, VT 05446.

Dr. Polak: Department of Radiology, Brigham & Women's Hospital, 75 Francis Street, Boston, MA 02115.

Dr. Gardin: Division of Cardiology, St. John Hospital and Medical Center, 22191 Moross Road, PB 1, Suite 105, Detroit, MI 48226.

Dr. Gersh: Mayo Clinic, Division of Cardiology, 200 First Street SW, Rochester, MN 55905.

Dr. Aurigemma: Division of Cardiovascular Medicine, University of Massachusetts Medical Center, 55 Lake Avenue North, Worcester, MA 01655.

Dr. Manolio: Division of Epidemiology and Clinical Applications, National Institutes of Health, National Heart, Lung, and Blood Institute, 6701 Rockledge Drive, MSC 7934, Bethesda, MD 20892-7934.

Author Contributions: Conception and design: J.S. Gottdiener, R. Marshall, D.W. Kitzman, J.M. Gardin, B.J. Gersh, T.A. Manolio.

Analysis and interpretation of the data: J.S. Gottdiener, R.L. McClelland, R. Marshall, L. Shemanski, C.D. Furberg, D.W. Kitzman, M. Cushman, J.M. Gardin, B.J. Gersh.

Drafting of the article: J.S. Gottdiener, R. Marshall, D.W. Kitzman, J. Polak, J.M. Gardin, B.J. Gersh, G.P. Aurigemma.

Critical revision of the article for important intellectual content: J.S. Gottdiener, R. Marshall, C.D. Furberg, D.W. Kitzman, M. Cushman, J.M. Gardin, B.J. Gersh, G.P. Aurigemma, T.A. Manolio.

Final approval of the article: J.S. Gottdiener, C.D. Furberg, D.W. Kitzman, M. Cushman, J. Polak, B.J. Gersh, G.P. Aurigemma, T.A. Manolio.

Provision of study materials or patients: D.W. Kitzman.

Statistical expertise: R.L. McClelland, L. Shemanski.

Obtaining of funding: J.M. Gardin.

Administrative, technical, or logistic support: C.D. Furberg, M. Cushman.

Collection and assembly of data: J.S. Gottdiener, L. Shemanski, M. Cushman, J. Polak, J.M. Gardin.


Ann Intern Med. 2002;137(8):631-639. doi:10.7326/0003-4819-137-8-200210150-00006
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Previous reports from the Cardiovascular Health Study have demonstrated that most community-based elderly persons with congestive heart failure have normal left ventricular systolic function (34); that normal systolic function most commonly precedes incident congestive heart failure (35); and that the predictors of congestive heart failure in elderly persons (3536) with or without systolic dysfunction include clinical and subclinical coronary heart disease, systolic blood pressure, inflammation, left atrial size, and diastolic dysfunction. Our principal finding is that community-based elderly persons with congestive heart failure have a substantial risk for death, even in the presence of normal or borderline decreased left ventricular systolic function. Although the adjusted mortality risk was greatest in participants with congestive heart failure and abnormal left ventricular systolic function, only a minority of community-based elderly persons were in this category. Therefore, the mortality impact of death from any cause after a diagnosis of congestive heart failure was greater in persons with normal left ventricular systolic function than in those with borderline or impaired function. Since we excluded participants with clinically significant valvular heart disease, our findings probably represent the adverse outcome of what has commonly been termed isolated diastolic heart failure(37). However, we recognize that without measures of diastolic function, this is a diagnosis of exclusion. Of particular interest in our study was the finding that the adjusted risk for all-cause and cardiovascular death was similar in participants with no clinical congestive heart failure but impaired systolic function and participants with congestive heart failure and impaired function, although the former group included more than twice as many persons as the latter. The 6-year mortality rate of 45% in participants reporting congestive heart failure was somewhat lower than the rate of 60% to 75% reported in other epidemiologic studies (1, 15, 22) but was highly statistically significant compared with persons without congestive heart failure, in whom the 6-year mortality rate was 16%.

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Figure.
Unadjusted Kaplan–Meier survival curves for participants with no congestive heart failure (CHF) (top) and for those with CHF (bottom) based on left ventricular function (LVF).
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Summary for Patients

Heart Failure in the Elderly

The summary below is from the full report titled “Outcome of Congestive Heart Failure in Elderly Persons: Influence of Left Ventricular Systolic Function. The Cardiovascular Health Study.” It is in the 15 October 2002 issue of Annals of Internal Medicine (volume 137, pages 631-639). The authors are JS Gottdiener, RL McClelland, R Marshall, L Shemanski, CD Furberg, DW Kitzman, M Cushman, J Polak, JM Gardin, BJ Gersh, GP Aurigemma, and TA Manolio.

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