Elsevier

Journal of Cardiac Failure

Volume 10, Issue 6, December 2004, Pages 467-472
Journal of Cardiac Failure

Clinical Investigation
Impact of congestive heart failure, chronic kidney disease, and anemia on survival in the Medicare population

https://doi.org/10.1016/j.cardfail.2004.03.003Get rights and content

Abstract

Background

Congestive heart failure (CHF) is a common clinical problem in the elderly, yet few studies have focused on this population. In addition, information on mortality rates conferred by chronic kidney disease (CKD) and anemia in elderly patients with CHF is lacking.

Methods and results

A cohort of 1,136,201 patients in the 5% Medicare database, excluding those with end-stage renal disease (ESRD), was identified for a 2-year period (1996–1997). Subgroups with CHF, CKD, and anemia were identified. The effect of each disease as an independent predictor of mortality was examined in a comorbidity-adjusted Cox model, with patients followed for 2 years and censored for death or ESRD. In the study population, 61% were women; 89% were white and 7% were black. Mean ±SD age was 76.5 ± 6.9 years. The annual mortality rate for patients with no CHF, CKD, or anemia was 4%. Anemia was associated with an annual mortality of 8%, which was the same as CKD (8%). The annual mortality for CHF was 13%. The highest annual mortality was found in patients with all 3 comorbid conditions; mortality in these patients was 23%.

Conclusions

Elderly CHF patients are at high risk of death; this risk is magnified in the presence of CKD and anemia.

Section snippets

Methods

This study was a retrospective cohort study using the 5% general Medicare database. The Medicare database is maintained by the Centers for Medicare & Medicaid Services. The 5% general Medicare database is a random sample generated by selecting all Medicare beneficiaries who have 05, 20, 45, 70, or 95 in the last 2 positions of their health insurance claim number.

The study cohort was derived from the Medicare 5% Denominator Files for 1996–1999 and included patients who were continuously enrolled

Baseline characteristics

A total of 1,321,156 patients were continuously enrolled in both Medicare Part A and Part B and were not enrolled in a health maintenance organization during 1996 and 1997. Excluded from this total were 6733 (0.5%) patients who died; 10,584 (0.8%) patients who had ESRD before the follow-up started; 2293 (0.2%) patients who did not reside in the 50 states, the District of Columbia, Puerto Rico, or the territories; and 172,149 (13%) patients who were younger than 67 years old on December 31,

Discussion

This large cohort study found that CKD and anemia are independently associated with increased mortality in elderly patients. This was particularly prominent in those with CHF. The relative risk of death persisted for both anemia and CKD, even after adjusting for other comorbid conditions. Approximately 35 million US citizens are older than 65 years of age.14 On the basis of the prevalences we noted, we estimate that approximately 4.5 million of these people have CHF and approximately 5 million

Acknowledgements

The authors thank Delaney Berrini and James Kaufmann of Nephrology Analytical Services for figure creation and manuscript editing, respectively.

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    Supported by an unrestricted research grant from Amgen Inc., Thousand Oaks, California.

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