Diuretics use and overactive bladder syndrome are common in older adults. However, the relationship between the two has not been well studied. Data were collected by self-administered questionnaires including the Urge Urinary Distress Inventory (Urge-UDI) and the Urge Incontinence Impact Questionnaire (Urge-IIQ), and by outpatient chart abstraction. Patients (n = 172) had a mean age of 79 ± 7.5 (± S.D.), 76% were women, and 48% were African Americans; 76% had hypertension, 32% had heart failure, and 66% were receiving diuretics (57% loop diuretics). Overall, 72%, 68%, and 73% of patients respectively reported urinary frequency, urgency and urge incontinence. Diuretic use was associated with increased frequency (81% versus 55% non-diuretic; odds ratio = OR = 3.48; 95% confidence interval = CI = 1.73–7.03) and urgency (74% versus 57% non-diuretic; OR = 2.17; 95% CI = 1.11–4.24) but not with incontinence (OR = 1.74; 95% CI = 0.87–3.50). When adjusted for propensity scores, diuretic use had independent associations with frequency (adjusted OR = 3.09; 95% CI = 1.20–7.97) and urgency (adjusted OR = 2.50; 95% CI = 1.00–6.27). In addition to frequency and urgency, loop diuretic use was also associated with incontinence (OR = 2.54; 95% CI = 1.09–5.91), which lost significance after propensity adjustment (adjusted OR = 1.88; 95% CI = 0.57–6.17). Overall summary mean Urge-IIQ score was 1.83 ± 0.85 (±S.D.) with 1.75 ± 0.86, 1.68 ± 0.76, and 2.03 ± 0.88, respectively for no-diuretic, non-loop, and loop-diuretic patients (one-way ANOVA p = 0.063). Overactive bladder symptoms were common among ambulatory older adults and were associated with diuretic use, and had stronger associations with loop diuretic use.

CKD was associated with increased mortality and hospitalization in ambulatory patients with chronic HF, which increased progressively with worsening kidney function.

Objective-Most HF patients are older adults, yet the associations of low serum potassium and outcomes in these patients are unknown. We studied the effect of low serum potassium in a propensity-matched population of elderly HF patients.Methods-Of the 7788 patients in the Digitalis Investigation Group trial, 4036 were ≥65 years. Of these, 3598 had data on baseline serum potassium and 324 with potassium ≥5mEq/L were excluded. Remaining patients we categorized into low (<4 mEq/L; n=590) and normal (4-4.9 mEq/L; n=2684) potassium groups. Propensity scores for low-potassium, calculated for each patient, were used to match 561 low-potassium and 1670 normal-potassium patients. Association of low potassium and outcomes were assessed using matched Cox regression analyses.Results-Patients had a mean (±SD) age of 72 (±6) years, 29% were women and 12% were nonwhites. Of the 561 low-potassium patients, 500 had low-normal (3.5-3.9 mEq/L) potassium. Allcause mortality occurred in 37% (rate, 1338/10,000 person-years) normal-potassium and 43% (rate, 1594/10,000 person-years) low-potassium patients (hazard ratio {HR} for low-potassium, 1.22; 95% confidence interval {CI}, 1.04-1.44; p=0.014). Low-normal (3.5-3.9 mEq/L) potassium levels had a similar association with mortality (HR, 1.19, 95% CI, 1.00-1.41, p=0.049). Low (HR, 1.10; 95% CI, 0.96-1.25; p=0.175) or low-normal (HR =1.09, 95% CI =0.95-1.25, p=0.229) serum potassium levels were not associated with all-cause hospitalization.Conclusions-In a propensity-matched population of elderly ambulatory chronic HF patients, well-balanced in all measured baseline covariates, low and low-normal serum potassium were associated with increased mortality but had no association with hospitalization. KeywordsHeart failure; elderly; potassium; mortality; hospitalization; propensity score †Corresponding author. University of Alabama at Birmingham, 1530 3rd Ave South, CH-19, Ste-219, Birmingham AL 35294-2041; Telephone: 1-205-934-9632; Fax: 1-205-975-7099; Email: aahmed@uab.edu NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptHypokalemia is common in heart failure (HF) and is associated with increased mortality [1][2][3]. A recent study of propensity-matched population of ambulatory chronic HF suggested that serum potassium <4 mEq/L may be associated with increased mortality without any effect on hospitalization. Most HF patients are older adults and yet the effect of low serum potassium in older adults with HF has not been well-studied. A subgroup analysis of the above study found no difference in the effect of low serum potassium on mortality between patients <65 years and those ≥65 years [2]. However, patients in that subgroup analysis were not propensitymatched, and that subgroup analysis did not provide data on other outcomes.Older adults are often excluded from clinical trials and studies and evidence for these patients is often extrapolated from subgroup analyses. However, because propensity-matched studies can be conduced in a cost-efficient manner, thes...

The majority of heart failure patients are older adults and most heart failure-related adverse events occur in these patients. However, the independent association of age and outcomes in chronic heart failure is not clearly determined. We categorized 7788 ambulatory chronic heart failure patients who participated in the Digitalis Investigation Group trial as younger and older using the cutoff of 65 years. Propensity scores for age were calculated for each patient and used to match 2381 older patients with 2381 younger patients. The impact of age on mortality and hospitalization during a median 40 months of follow-up was assessed using matched Cox regression methods. All-cause mortality occurred in 877 older patients versus 688 younger patients (hazard ratio when older age was compared with younger age (HR) = 1.26, 95% confidence interval (CI) = 1.12-1.41, p <0.0001). Older patients, when compared with propensity-matched younger patients, also had significantly higher mortality rates due to cardiovascular causes (HR = 1.14; 95% CI = 1.00-1.30, p = 0.044) and worsening heart failure causes (HR = 1.32; 95% CI = 1.07-1.62, p = 0.009). No significant association was found between age and hospitalization due to all causes (HR = 1.08; 95% CI = 0.99-1.18, p = 0.084) and cardiovascular causes (HR = 1.03; 95% CI = 0.93-1.13, p = 0.622). However, hospitalization due to heart failure was significantly increased in older patients (HR = 1.14; 95% CI = 1.01-1.28, p = 0.041). In ambulatory chronic heart failure patients, older age although associated with increased mortality was not associated with increased hospitalizations except for those due to worsening heart failure.

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