Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-10T17:44:27.343Z Has data issue: false hasContentIssue false
  • English
  • Français

The Effect of Age upon Care and Outcomes in Patients Hospitalized for Congestive Heart Failure in Alberta, Canada*

Published online by Cambridge University Press:  31 March 2010

Bibiana Cujec ,
Hude Quan ,
Yan Jin  and
David Johnson
Bibiana Cujec*
Affiliation:
Department of Medicine, University of Alberta
Hude Quan
Affiliation:
Department of Community Health Sciences, University of Calgary
Yan Jin
Affiliation:
Information Analysis, Alberta Health and Wellness
David Johnson
Affiliation:
Department of Health Sciences, University of Alberta
*
Requests for offprints should be sent to: / Les demandes de tirés-à-part doivent être adressées à : Dr. Bibiana Cujec, Division of Cardiology, University of Alberta, 2C2.39 WMC, Edmonton, AB T6G 2B7. (Bibiana.Cujec@ualberta.ca)
Get access Rights & Permissions [Opens in a new window]

Abstract

We describe the age-specific outcomes for patients hospitalized with newly diagnosed congestive heart failure using administrative hospital abstracts from Alberta, Canada, from April 1, 1994, to March 31, 2000. Seniors (aged 65 years and older) constituted about 85 per cent of the 16,162 patients. Both co-morbidity and severity of illness tended to increase with age. The use of special care unit admissions, coronary artery diagnostic services (cardiac catheterization), and revascularization procedures (percutanenous transluminal coronary angioplasty/stenting, coronary artery bypass surgery) peaked in the 50-to 64-year age group and decreased with increasing age. Specialist/sub-specialist care, prescriptions of beta blockers and angiotensin-converting enzyme inhibitors / angiotensin receptor blockers decreased with age in seniors. Adjusted in-hospital, 1-year mortality and crude, age-specific 5-year mortality were significantly greater in those 75 years and older. Outcomes and process of care in patients with newly diagnosed congestive heart failure were not uniformly distributed with age. The elderly had greater mortality but received less therapy.

Résumé

Nous décrivons les résultats par âge des patients hospitalisés après un diagnostic récent d'insuffisance cardiaque globale, pour cela nous avons analysé les dossiers administratifs de divers hôpitaux situés en Alberta, au Canada, pour la période allant du 1er avril 1994 au 31 mars 2000. Près de 85 % des 16 162 patients sur lesquels portait l'étude étaient des personnes âgées (de 65 ans et plus). La comorbidité et la gravité de la maladie tendent à augmenter avec l'âge. L'admission en unité de soins spéciaux, les services de diagnostic des artères coronaires (cathétérisation cardiaque) et les procédures de revascularisation (angioplastie coronarienne transluminale percutanée/port de stents, pontage aortocoronarien) sont le plus courants chez les personnes âgées de 50 à 64 ans, mais deviennent moins fréquents chez les patients plus âgés. La prestation de soins de spécialistes/sous-spécialistes, la prescription de béta-bloquants et d'enzymes de conversion/d'inhibiteurs de l'angiotensine diminuent à mesure que les aînés avancent en âge. Les données comparatives, à l'hôpital, entre le taux de mortalité après un an et le taux brut de mortalité (par âge) après cinq ans sont considérablement plus élevés chez les personnes âgées de 75 ans et plus. Les résultats et la prise en charge des patients ayant récemment fait l'objet d'un diagnostic d'insuffisance cardiaque globale ne sont pas répartis uniformément selon l'âge : les personnes âgées ayant un taux de mortalité plus élevé, mais recevant moins de soins.

Keywords

aginghealth service utilizationcongestive heart failureseniorsvieillissementutilisation des services de santéinsuffisance cardiaque globalepersonnes âgées
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 23 , Issue 3 , Fall/Automne 2004 , pp. 253 - 265
Copyright
Copyright © Canadian Association on Gerontology 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

This work was partially supported by the Alberta Centre for Health Service Utilization Research. The opinions and conclusions expressed in this paper are those of the authors and no endorsement by the Alberta Ministry of Health and Wellness is implied.

References

1Haldeman, GA, Croft, JB, Giles, WH, Rashidee, A. Hospitalization of patients with heart failure: National Hospital Discharge Survey, 1985 to 1995. Am Heart J 1999;137:352–60.CrossRefGoogle ScholarPubMed
2Murdoch, DR, Love, MP, Robb, SD, McDonagh, TA, Davie, AP, Ford, I et al. Importance of heart failure as a cause of death: changing contribution to overall mortality and coronary heart disease mortality in Scotland 1979–1992. Eur Heart J 1998;19:1829–35.CrossRefGoogle ScholarPubMed
3Ryden-Bergsten, T, Andersson, F. The health care costs of heart failure in Sweden. J Intern Med 1999;246:275–84.CrossRefGoogle ScholarPubMed
4Mejhert, M, Persson, H, Edner, M, Kahan, T. Epidemiology of heart failure in Sweden: a national survey. Eur J Heart Fail 2001;3:97–103.CrossRefGoogle ScholarPubMed
5Owen, A, Cox, S. Diagnosis of heart failure in elderly patients in primary care. Eur J Heart Fail 2001;3:79–81.CrossRefGoogle ScholarPubMed
6Stewart, S, MacIntyre, K, MacLeod, MM, Bailey, AE, Capewell, S, McMurray, JJ. Trends in hospitalization for heart failure in Scotland, 1990–1996: an epidemic that has reached its peak? Eur Heart J 2001;22:209–17.CrossRefGoogle ScholarPubMed
7Philbin, EF, DiSalvo, TG. Prediction of hospital readmission for heart failure: development of a simple risk score based on administrative data. J Am Coll Cardiol 1999;33:1560–6.CrossRefGoogle ScholarPubMed
8Ali, AS, Rybicki, BA, Alam, M, Wulbrecht, N, Richer-Cornish, K, Khaja, F et al. Clinical predictors of heart failure in patients with first acute myocardial infarction. Am Heart J 1999;138:1133–9.CrossRefGoogle ScholarPubMed
9McCullough, PA, Philbin, EF, Spertus, JA, Kaatz, S, Sandberg, KR, Weaver, WD. Resource Utilization among Congestive Heart Failure (REACH) study: confirmation of a heart failure epidemic—findings from the Resource Utilization among Congestive Heart Failure (REACH) study. J Am Coll Cardiol 2002;39:60–9.CrossRefGoogle ScholarPubMed
10Polanczyk, CA, Rohde, LE, Dec, GW, DiSalvo, T. Ten-year trends in hospital care for congestive heart failure: improved outcomes and increased use of resources. Arch Intern Med 2000;160:325–32.CrossRefGoogle ScholarPubMed
11Feldman, DE, Thivierge, C, Guerard, L, Dery, V, Kapetanakis, C, Lavoie, G et al. Changing trends in mortality and admissions to hospital for elderly patients with congestive heart failure in Montreal. CMAJ 2001;165:1033–6.Google ScholarPubMed
12Levy, D, Kenchaiah, S, Larson, MG, Benjamin, EJ, Kupka, MJ, Ho, KK et al. Long-term trends in the incidence of and survival with heart failure. N Engl J Med 2002;347:1397–402.Google Scholar
13Liu, P, Arnold, M, Belenkie, I, Howlett, J, Huckell, V, Ignazewski, A et al. Canadian Cardiovascular Society. The 2001 Canadian Cardiovascular Society consensus guideline update for the management and prevention of heart failure. Can J Cardiol 2001;17 Suppl E:5E–25E.Google Scholar
14Gehlbach, SH, Adamache, KW, Cromwell, J. Changes in the use of diagnostic technologies among Medicare patients 1985 and 1990. Inquiry 1996–7;33:363-72b.Google ScholarPubMed
15Ashton, CM, Petersen, NJ, Souchek, J, Menke, TJ, Pietz, K, Yu, HJ et al. Rates of health services utilization and survival in patients with heart failure in the Department of Veterans Affairs medical care system. Am J Med Qual 1999;14:55–63.CrossRefGoogle ScholarPubMed
16Jong, P, Vowinckel, E, Liu, PP, Gong, Y, Tu, JV. Prognosis and determinants of survival in patients newly hospitalized for heart failure: a population-based study. Arch Intern Med 2002;162:1689–94.CrossRefGoogle ScholarPubMed
17Wolinsky, FD, Overhage, JM, Stump, TE, Lubitz, RM, Smith, DM. The risk of hospitalization for congestive heart failure among older adults. Med Care 1997;35:1031–43.CrossRefGoogle ScholarPubMed
18Valle, R, Chinellato, M, Gallo, G, Milani, L. Heart failure in nursing homes: prevalence, hospitalization, compliance to guidelines. Ital Heart J 2001;2:772–4.Google ScholarPubMed
19Goff, DC Jr, Pandey, DK, Chan, FA, Ortiz, C, Nichaman, MZ. Congestive heart failure in the United States: is there more than meets the ICD code? The Corpus Christi Heart Project. Arch Intern Med 2000;160:197–202.CrossRefGoogle ScholarPubMed
20Statistics Canada, Health Statistics Division, Nosology Reference Centre. Canadian classification of diagnostic, therapeutic, and surgical procedures. Rpt. Ottawa: Minister of Supply and Services; 1986. Retrieved 14 July 2004 from http://www.statcan.ca:8081/english/clf/query.html?qt=30.+Canadian+classification+of+diagnostic%2C+therapeutic%2C+and+surgical+procedures+Second+Printing+Statistics+Canada+Health+Division+Nosology&GO=Go%21&ht=0&qp=&qs=&qc=0&pw=100%25&la=en&qm=0&st=1&oq=&rq=0&si=0&rf=0&col=alle.Google Scholar
21Deyo, RA, Cherkin, DC, Ciol, MA. Adapting a clinical co-morbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 1992;45:613–9.CrossRefGoogle ScholarPubMed
22Romano, PS, Roos, LL, Jollis, JG. Adapting a clinical co-morbidity index for use with ICD-9-CM administrative data: differing perspectives. J Clin Epidemiol 1993;46:1075–9.CrossRefGoogle ScholarPubMed
23Polanczyk, CA, Rohde, LE, Philbin, EA, Di Salvo, TG. A new casemix adjustment index for hospital mortality among patients with congestive heart failure. Med Care 1998;36:1489–99.CrossRefGoogle ScholarPubMed
24Jin, Y, Quan, H, Cujec, C, Johnson, D. Rural and urban outcomes after hospitalization for congestive heart failure in Alberta, Canada. J Heart Fail 2003;9:278–85.Google Scholar
25Health Funding and Costing, Alberta Health and Wellness. Regional Health Authority global funding manual, 2000–2001. Edmonton, AB: Alberta Health and Wellness; 2000.Google Scholar
26Canadian Institute for Health Information. Guidelines for management information systems in Canadian health service organizations. Ottawa: Canadian Institute for Health Information; 1999.Google Scholar
27McKillop, I, Pink, GH, Johnson, LM. The financial management of acute care in Canada: a review of funding, performance monitoring and reporting practices. In: Canadian Institute for Health Information. Guidelines for management information systems in Canadian health service organizations. Ottawa: Canadian Institute for Health Information; 2001. p. 83.Google Scholar
28Magnus, SA, Smith, DG. Better Medicare cost report data are needed to help hospitals benchmark costs and performance. Health Care Manage Rev 2000;25:65–76.CrossRefGoogle Scholar
29Iezzoni, LI. Using risk-adjusted outcomes to assess clinical practice: an overview of issues pertaining to risk adjustment. Ann Thorac Surg 1999;58:1822–6.Google Scholar
30Soumerai, SB, McLaughlin, TJ, Ross-Degnan, D, Christiansen, CL, Gurwitz, JH. Effectiveness of thrombolytic therapy for acute myocardial infarction in the elderly: cause for concern in the old-old. Arch Intern Med 2002;162:561–8.CrossRefGoogle ScholarPubMed
31Philbin, EF, Rocco, TA Jr., Lindenmuth, NW, Ulrich, K, Jenkins, PL. Systolic versus diastolic heart failure in community practice: clinical features, outcomes, and the use of angiotensin-converting enzyme inhibitors. Am J Med 2000;109:605–13.CrossRefGoogle ScholarPubMed
32McAlister, FA, Teo, KK, Taher, M, Montague, TJ, Humen, D, Cheung, L et al. Insights into the contemporary epidemiology and outpatient management of congestive heart failure. Am Heart J 1999;138:87–94.CrossRefGoogle ScholarPubMed
33Jencks, SF, Cuerdon, T, Burwen, DR, Fleming, B, Houck, PM, Kussmaul, AE et al. Quality of medical care delivered to Medicare beneficiaries: a profile at state and national levels. JAMA 2000;284:1670–6.Google Scholar
34Johnson, D, Jin, Y, Quan, H, Cujec, B. Prescription of beta blockers and angiotensin converting enzyme inhibitors / receptor blockers after hospital discharge decreases mortality in newly diagnosed congestive heart failure in Alberta, Canada. J Am Coll Cardiol 2003;42:438–45.CrossRefGoogle ScholarPubMed
35Carriere, KC, Jin, Y, Marrie, TJ, Predy, G, Houston, C, Ness, K et al. Hospital costs and long term mortality outcomes in seniors requiring hospitalization for community acquired pneumonia in Alberta. J Am Geriatr Soc 2004;52:31–8.CrossRefGoogle Scholar
36Dominguez, LJ, Parrinello, G, Amato, P, Licata, G. Trends of congestive heart failure epidemiology: contrast with clinical trial results. Cardiologia 1999;44:801–8.Google Scholar
37Gottdiener, JS, Arnold, AM, Aurigemma, GP, Polak, JF, Tracy, RP, Kitzman, DW et al. Predictors of congestive heart failure in the elderly: the Cardiovascular Health Study. J Am Coll Cardiol 2000;35:1628–37.CrossRefGoogle ScholarPubMed
38Havranek, EP, Masoudi, FA, Westfall, KA, Wolfe, P, Ordin, DL, Krumholz, HM. Spectrum of heart failure in older patients: results from the National Heart Failure project. Am Heart J 2002;143:412–7.CrossRefGoogle ScholarPubMed
39Sheifer, SE, Rathore, SS, Gersh, BJ, Weinfurt, KP, Oetgen, WJ, Breall, JA et al. Time to presentation with acute myocardial infarction in the elderly: associations with race, sex, and socioeconomic characteristics. Circulation 2000;102:1651–6.Google Scholar
40Alder, DA, Naylor, CD, Austin, PC, Tu, JV. Biology or bias: practice patterns and long-term outcomes for men and women with acute myocardial infarction. J Am Coll Cardiol 2002;39:1909–16.CrossRefGoogle Scholar
41Health Economics Branch, Alberta Health and Wellness. Patterns of provincial government health expenditures by age and gender in Alberta and other jurisdictions, 1980–1997. Edmonton, AB: Alberta Health and Wellness; 1998.Google Scholar
42Saunders, LD, Alibhai, A, Hogan, DB, Maxwell, CJ, Quan, H, Johnson, D. Trends in the utilization of health services by seniors in Alberta. Can J Aging 2001;20:493–516.CrossRefGoogle Scholar
43Alberta Health and Wellness, Health Surveillance Branch. Population projections for Alberta and its health regions 1996–2016. Edmonton, AB: Alberta Health and Wellness; 1998.Google Scholar
44Rybarczyk, B, Haut, A, Lacey, RF, Fogg, LF, Nicholas, JJ. A multifactorial study of age bias among rehabilitation professionals. Arch Phys Med Rehabil 2001;82:625–32.CrossRefGoogle ScholarPubMed
45Madan, AK, Aliabadi-Wahle, S, Beech, DJ. Age bias: a cause of underutilization of breast conservation treatment. J Cancer Educ 2001;16:29–32.Google Scholar
46Uncapher, H, Arean, PA. Physicians are less willing to treat suicidal ideation in older patients. J Am Geriatr Soc 2000;48:188–92.Google Scholar
47Philbin, EF. Factors determining angiotensin-converting enzyme inhibitor underutilization in heart failure in a community setting. Clin Cardiol 1998;21:103–8.CrossRefGoogle Scholar
48Lubben, JE, Chi, I, Weiler, PG. Differential health screening of the well elderly by gender and age: appropriate care or bias? J Appl Gerontol 1989;8:335–54.CrossRefGoogle ScholarPubMed
49Levinsky, NG, Ash, AS, Yu, W, Moskowitz, MA. Patterns of use of common major procedures in medical care of older adults. J Am Geriatr Soc 1999;47:553–8.Google Scholar
50Smith, KM, Lamy, A, Arthur, HM, Gafni, A, Kent, R. Outcomes and costs of coronary artery bypass grafting: A comparison between octogenarians and septuagenarians at a tertiary care centre CMAJ 2001;165:759–64.Google Scholar
51Morgan, A, Smith, H, Simpson, I, Liddiard, GS, Rapheal, H, Pickering, RM et al. Prevalence and clinical characteristics of left ventricular dysfunction among elderly patients in general practice setting: a cross sectional survey. BMJ 1999;318:368–72.Google Scholar
52Akosah, KO, Moncher, K, Schaper, A, Havlik, P, Devine, S. Chronic heart failure in the community: missed diagnosis and missed opportunities. J Card Fail 2001;7:232–8.Google Scholar
53Tu, JV, Zhang, H. Congestive heart failure outcomes in Ontario. In: Naylor, CD, Slaughter, PM, editors. Cardiovascular health and services in Ontario: an ICES atlas. Toronto: Institute for Clinical Evaluative Sciences; 1999. p. 111–22.Google Scholar
54Redfield, MM, Jacobsen, SJ, Burnett, JC Jr., Mahoney, DW, Bailey, KR, Rodeheffer, RJ. Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA 2003;289:194–202.CrossRefGoogle ScholarPubMed