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Prognosis of heart failure in the elderly: not an affair of the heart?

During the past several years, prognostic instruments have been developed for patients with heart failure (HF), predicting a number of clinical outcomes, including mortality and rehospitalization.1–3 Few similar instruments for short-term prognosis have appeared designed specifically for use in the elderly with HF. Pilotto et al4 have addressed this gap by creating a prognostic instrument that places new emphasis on a whole array of geriatric tools. The Multidimensional Prognostic Index (MPI) is derived from a comprehensive geriatric assessment (CGA). This new tool demonstrates powerful predictive capabilities for 30-day mortality in elderly patients, especially for men, hospitalized for HF, in comparison with more traditional prognostic tools such as the New York Heart Association class, or indices derived from ADHERE2 or the EFFECT measure.3

Article see p 14

What is the real message here? Is there actually something new under the sun? Several major points deserve attention. How did the authors construct this new instrument? Are their observations in keeping with our general understanding of HF in the elderly population and its management? Was the instrument tested in a realistic setting? What is the potential utility of the new instrument? The construct of the new instrument departs from previous similar prognostic tools in one major way. It places particular attention on the patient’s comorbid conditions. Moreover, and with novel fashion, the MPI places high value on the CGA of the patient. This CGA comprises a group of eight scales, questionnaires, and indices selected to span the spectrum of independent function, cognitive capabilities, nutritional status, medications, social support, cumulative comorbid illnesses by system, and likelihood of developing pressure …