Predictors for hospitalizations in elderly patients with clinical symptoms of heart failure: A 10-year observational primary healthcare study

Heart failure (HF) is the most common cause of hospitalization at medical clinics for patients older than 65 years. To study the prognostic value of biomarkers, comorbidities, and verified HF diagnosis for all-cause and cardiovascular hospitalizations. Between 2000 and 2003, 170 patients with HF symptoms according to their general practitioners were recruited and referred for echocardiography, biomarker measures and a final cardiology consultation. HF diagnosis was based on the general practitioner's prespecified HF record, echocardiography, and hospital records. Records from the departments of medicine and surgery were used to identify hospitalizations. This is a 10-year longitudinal observational primary healthcare center study. During 10 years, 136 (80%) patients had 660 and 207 all-cause and cardiovascular hospitalizations, respectively. In multivariable logistic regression, age [odds ratio (OR) = 1.1, 95% confidence interval (CI) = 1.01–1.15] and underlying heart disease (OR = 3.5, 95% CI = 1.00–11.89) significantly predicted all-cause hospitalization. Age (OR = 1.1, 95% CI = 1.01–1.12), underlying heart disease (OR = 3.4, 95% CI = 1.041–1.40), and N-terminal of prohormone brain natriuretic peptide ≥ 800 ng/L (OR = 4.3, 95% CI = 1.5–12.50) significantly predicted cardiovascular hospitalizations. In Cox regression analysis, overall HF (HR = 1.8, 95% CI = 1.06–2.94) significantly predicted time to first all-cause hospitalizations while no variable independently predicted time to first cardiovascular hospitalization. In patients with HF symptoms managed in primary healthcare, age, and underlying heart diseases predicted all-cause hospitalizations. N-terminal of prohormone brain natriuretic peptide added independent prognostic information for cardiovascular hospitalizations.