Why and how do elderly patients with heart failure die? Insights from the TIME-CHF study

Specific causes and modes of death (COD and MOD) of patients with heart failure (HF) are not well described, particularly in those with preserved ejection fraction 45 (HFPEF) and at old age. Thus, using the database of the TIME-CHF study, patients with HFPEF were compared with those with reduced ejection fraction 45 (HFREF), and patients epsilon 75 with those 6074 years of age to identify MOD and COD, predictors of death, and event rates before death as compared with survivors. During the 18-month follow-up, 132/622 patients (21) died, with similar rates in patients with HFPEF and HFREF and a trend to higher rates in patients aged epsilon 75 years (24 vs. 17, P 0.06). COD and MOD (ACME system) were not different in the age groups. COD was more often non-cardiovascular in HFPEF patients than in HFREF patients (33 vs. 16, P 0.05) and cardiac MOD were more frequent in HFREF patients (75 vs. 56, P 0.05), mainly due to more sudden deaths (25 vs. 7, P 0.05). Patients who died experienced a median of four adverse events (interquartile range 17) and one (01) hospitalization within 60 days prior to death compared with 0.7 (0.41.4) and 0.1 (0.00.2) during a randomly selected 60 days in survivors (all P 0.0001). Despite similar 18-month mortality in patients with HFREF and those with HFPEF, important differences in COD and MOD were found which were not observed between the two age groups. A high rate of adverse events and hospitalizations preceded death. These observations may be relevant for the management of HF patients.