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The Average Lifespan of Patients Discharged from Hospital with Heart Failure

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ABSTRACT

BACKGROUND

There are no life-tables quantifying the average life-spans of post-hospitalized heart failure populations across various strata of risk.

OBJECTIVE

To quantify the life-expectancies (i.e., average life-spans) of heart failure patients at the time of hospital discharge according to age, gender, predictive 30-day mortality heart failure risk index, and comorbidity burden.

DESIGN

Population-based retrospective cohort study.

SETTING

Ontario, Canada.

PATIENTS

7,865 heart failure patients discharged from Ontario hospitals between 1999 and 2000.

MEASUREMENTS

Data were obtained from the Enhanced Feedback for Effective Cardiac Treatment EFFECT provincial quality improvement initiative. All patients were linked to administrative data, and tracked longitudinally until March 31, 2010. Detailed clinical variables were obtained from medical chart abstraction, and death data were obtained from vital statistics. Average life-spans were calculated using Cox Proportion Hazards models in conjunction with the Declining Exponential Approximation of Life Expectancy (D.E.A.L.E) method to extrapolate life-expectancy, adjusting for age, gender, predicted 30-day mortality, left ventricular function and comorbidity, and was reported according to key prognostic risk-strata.

RESULTS

The average life-span of the cohort was 5.5 years (STD +/− 10.0) ranging from 19.5 years for low-risk women of less than 50 years old to 2.9 years for high-risk octogenarian males. Average life-spans were lower by 0.13 years among patients with impaired as compared with preserved left ventricular function, and by approximately one year among patients with three or more as compared with no concomitant comorbidities. In total, 17.4 % and 27 % of patients had died within 6 months and 1 year respectively, despite having predicted life-spans exceeding one-year.

LIMITATIONS

Data regarding changes in patient clinical status over time were unavailable.

CONCLUSIONS

The development of risk-adjusted life-tables for heart failure populations is feasible and mirrored those with advanced malignant diseases. Average life span varied widely across clinical risk strata, and may be less accurate among those at or near their end of life.

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Acknowledgments

Funders

This project was supported by CIHR operating grant number MOP 79514. Dr. Tu is Canada Research Chair in Health Services Research and a Career Investigator with the Heart and Stroke Foundation of Ontario. Drs. Alter and Austin are supported in part by Career Investigator Awards from Heart and Stroke Foundation of Ontario. Dr. Ko is supported in part by a Canadian Institutes of Health Research (CIHR) New Investigator Award. Dr. Lee is a clinician-scientist of the Canadian Institutes of Health Research (CIHR). The Institute for Clinical Evaluative Sciences is supported in part by a grant from the Ontario Ministry of Health. The results, conclusions, and opinions are those of the authors, and no endorsement by the Ministry, the Institute, or the CIHR is intended or should be inferred.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

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Authors and Affiliations

  1. Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario, Canada, M4N 3M5

    David A. Alter MD, PhD, Dennis T. Ko MD, MSc, Jack V. Tu MD, Therese A. Stukel PhD, Douglas S. Lee MD, PhD, Andreas Laupacis MD, MSc, Alice Chong MSc & Peter C. Austin PhD

  2. Schulich Heart Centre, University of Toronto Clinical Epidemiology and Health Care Research Program, Toronto, Canada

    Dennis T. Ko MD, MSc & Jack V. Tu MD

  3. Toronto General Hospital, Toronto, Canada

    Douglas S. Lee MD, PhD

  4. Cardiac and Secondary Prevention Program, Toronto Rehabilitation Institute, Toronto, Canada

    David A. Alter MD, PhD

  5. Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Canada

    David A. Alter MD, PhD & Andreas Laupacis MD, MSc

  6. Department of Public Health Sciences, University of Toronto, Toronto, Canada

    Jack V. Tu MD, Therese A. Stukel PhD & Peter C. Austin PhD

  7. Health Policy and Evaluation, University of Toronto, Toronto, Canada

    David A. Alter MD, PhD, Dennis T. Ko MD, MSc, Jack V. Tu MD, Therese A. Stukel PhD, Douglas S. Lee MD, PhD, Andreas Laupacis MD, MSc & Peter C. Austin PhD

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  1. David A. Alter MD, PhD
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  2. Dennis T. Ko MD, MSc
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  5. Douglas S. Lee MD, PhD
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  6. Andreas Laupacis MD, MSc
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  8. Peter C. Austin PhD
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Correspondence to David A. Alter MD, PhD.

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Alter, D.A., Ko, D.T., Tu, J.V. et al. The Average Lifespan of Patients Discharged from Hospital with Heart Failure. J GEN INTERN MED 27, 1171–1179 (2012). https://doi.org/10.1007/s11606-012-2072-y

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  • DOI: https://doi.org/10.1007/s11606-012-2072-y

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