A propensity-matched study of the association of physical function and outcomes in geriatric heart failure

Ahmed, Ali; Aronow, Wilbert S.

doi:10.1016/j.archger.2007.03.010

Cited by 10 publications

(7 citation statements)

References 25 publications

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“…However, because propensity-matched studies can be conduced in a cost-efficient manner, these studies can be used to derive evidence for elderly patients [2, 4, 5]. Thus, the objective of this study was to determine the long-term effects of low serum potassium on mortality and hospitalization in a cohort of propensity score matched chronic systolic and diastolic HF patients 65 years of age or older.…”

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confidence: 99%

A propensity-matched study of low serum potassium and mortality in older adults with chronic heart failure

Alper

Campbell

Anker

et al. 2009

International Journal of Cardiology

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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...

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A propensity-matched study of low serum potassium and mortality in older adults with chronic heart failure

Alper

Campbell

Anker

et al. 2009

International Journal of Cardiology

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“…First, we used a non-parsimonious multivariable logistic regression model to calculate, for each patient, a propensity score for having age ≥65 years (Ahmed, 2008; Ahmed et al, 2006a,b; Ahmed et al, 2007a,b; Rosenbaum and Rubin, 1983; Rosenbaum and Rubin, 1984; Rubin, 1997; Rubin, 2001; Rubin, 2004). In the model, age ≥65 years was used as the dependent variable, and all covariates shown in Table 1, with the exception of estimated glomerular filtration rate (Levey et al, 1999) and chronic kidney disease (derived values), were entered as covariates into the model.…”

Section: Methodsmentioning

confidence: 99%

“…Although propensity scores are often used to match baseline characteristics between two treatment groups in an observational study, the method can also be used to match baseline characteristics between two groups of patients based on comorbidities or other characteristics such as age or race (Ahmed, 2008; Ahmed et al, 2006a,b; Ahmed et al, 2007a,b). Using an SPSS macro and a greedy matching protocol, each patient ≥65 years of age was matched with a younger patient based on propensity score (Levesque, 2005).…”

Section: Methodsmentioning

confidence: 99%

A propensity-matched study of outcomes of chronic heart failure (HF) in younger and older adults

Wahle

Adamopoulos

Ekundayo

et al. 2009

Archives of Gerontology and Geriatrics

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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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“…We estimated propensity scores for smoking for each of the 4060 patients using a non-parsimonious multivariable logistic regression model (Ahmed et al, 2006a,b, 2007, 2008; Ahmed and Aronow, 2008; Alper et al, 2009; Ekundayo et al, 2009a,b; Wahle et al, 2009, Bowling et al, 2010). In the model, we used baseline smoking as the dependent variable, and 46 other baseline characteristics displayed in Figure 1 were entered as covariates.…”

Section: Methodsmentioning

confidence: 99%

Association between smoking and outcomes in older adults with atrial fibrillation

Pawar

Jones

Feller

et al. 2012

Archives of Gerontology and Geriatrics

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Tobacco smoking is a risk factor for atrial fibrillation (AF), but little is known about the impact of smoking in patients with AF. Of the 4060 patients with recurrent AF in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial, 496 (12%) reported having smoked during the past two years. Propensity scores for smoking were estimated for each of the 4060 patients using a multivariable logistic regression model and were used to assemble a matched cohort of 487 pairs of smokers and nonsmokers, who were balanced on 46 baseline characteristics. Cox and logistic regression models were used to estimate the associations of smoking with all-cause mortality and all-cause hospitalization, respectively, during over 5 years of follow-up. Matched participants had a mean age of 70 ± 9 years (± S.D.), 39% were women, and 11% were non-white. All-cause mortality occurred in 21% and 16% of matched smokers and nonsmokers, respectively (when smokers were compared with nonsmokers, hazard ratio = HR = 1.35; 95% confidence interval = 95% CI = 1.01–1.81; p = 0.046). Unadjusted, multivariable-adjusted and propensity-adjusted HR (95% CI) for all-cause mortality associated with smoking in the pre-match cohort were: 1.40 (1.13–1.72; p = 0.002), 1.45 (1.16–1.81; p = 0.001), and 1.39 (1.12–1.74; p = 0.003), respectively. Smoking had no association with all-cause hospitalization (when smokers were compared with nonsmokers, odds ratio = OR = 1.21; 95% CI = 0.94–1.57, p = 0.146). Among patients with AF, a recent history of smoking was associated with an increased risk of all-cause mortality, but had no association with all-cause hospitalization.

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A propensity-matched study of the association of physical function and outcomes in geriatric heart failure

Cited by 10 publications

References 25 publications

A propensity-matched study of low serum potassium and mortality in older adults with chronic heart failure

A propensity-matched study of low serum potassium and mortality in older adults with chronic heart failure

A propensity-matched study of outcomes of chronic heart failure (HF) in younger and older adults

Association between smoking and outcomes in older adults with atrial fibrillation

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