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Predicting mortality among a general practice-based sample of older people with heart failure

Section of Public Health, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK, s.barnes{at}sheffield.ac.uk

Merryn Gott

Sheffield Institute for Studies on Ageing, University of Sheffield, Elmfield, Northumberland Road, Sheffield, S10 2TU, UK

Sheila Payne

International Observatory on End of Life Care, Institute of Health Research, University of Lancaster, Bowland Tower East, Lancaster, LA1 4YT, UK

Chris Parker

Nottingham Primary Care Research Partnership, Research and Development Department, Hucknall Health Centre, Nottingham, NG15 5JE, UK

David Seamark

The Peninsula Medical School, University of Exeter, The John Bull Building, Tamar Science Park, Research Way, Plymouth, PL6 8BU, UK

Salah Gariballa

Faculty of Medicine, UAE University, Al Ain, United Arab Emirates

Neil Small

School of Health Studies, University of Bradford, 25 Trinity Road, Bradford, BD5 0BB, UK

Objective: To identify factors available to general practitioners (GPs) that are predictive of mortality within a general practice-based population of heart failure patients, and to report the sensitivity and specificity of prognostic information from GPs.

Methods: Five hundred and forty-two heart failure patients aged >60 years were recruited from 16 UK GP surgeries. Patients completed quality-of-life and services use questionnaires every 3 months for 24 months or until death. Factors with independent significant association with survival were identified using Cox proportional hazards regression analysis.

Results: Women had a 58% lower risk of death. Patients self-reporting New York Heart Association Classification III or IV had an 81% higher risk of death. Patients aged 85+ years had over a five-fold risk of death as compared with those aged <65 years. Patients with a co-morbidity of cancer had a 78% higher risk of death. Of the 14 patients who died in a 12-month period, the GPs identified 11 (sensitivity 79%). They identified 133 of the 217 who did not die (specificity 61%).

Discussion: Predictors readily available to GPs, such as patient characteristics, are easy to adapt to use in general practice, where most heart failure patients are diagnosed and treated. Identifying factors likely to influence death is useful in primary care, as this can initiate discussion about end-of-life care.

Key Words: General practice • Heart failure • Mortality • Older people

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