Abstract / Summary
Abstract Background Older adults with heart failure face significant symptoms and psychosocial burdens that routine cardiology care might overlook. We assessed whether Edmonton Symptom Assessment System (ESAS) and Integrated Palliative Care Outcome Scale (IPOS) scores can predict 12-month mortality and improve risk discrimination beyond clinical covariates in a hospital cohort from a low-resource setting. Methods We conducted an observational cohort study at the National Geriatric Hospital (Vietnam). Inpatients aged 60 years or older with chronic heart failure who met the eligibility criteria were approached in the order of admission (January 2021-December 2022), and ESAS (9 items, each scored 0–10) and IPOS (17 items) were completed within 48 h of admission by trained ward nurse-researchers. Vital status at 12 months was determined through medical records and structured follow-up calls. Cox proportional hazards models evaluated associations with mortality, adjusting for age, sex, heart-failure classification, New York Heart Association (NYHA) class, comorbidities, and financial strain. Primary analyses used predefined categorical cutoffs (ESAS > 30; IPOS ≥ 20). Discrimination was further assessed with Harrell’s C-index and the 12-month area under the curve (AUC), and model fit was compared using Akaike and Bayesian information criteria. Calibration was also examined using a logistic analogue (Hosmer–Lemeshow). Results Of 327 screened patients, 304 were enrolled (mean age 71.9 ± 8.8 years; 52% men); 65 deaths (21.4%) occurred within 12 months. ESAS and IPOS were strongly correlated, but there was no multicollinearity. High symptom burden (ESAS > 30) independently predicted mortality (adjusted hazard ratio [aHR] 2.27; 95%CI 1.20–4.28), while high palliative-care needs (IPOS ≥ 20) were not associated (aHR: 1.04; 95%CI 0.47–2.30). Kaplan–Meier curves across ESAS–IPOS strata diverged. Including categorical patient-reported measures in the clinical model modestly improved discrimination and fit: Harrell’s C increased from 0.671 to 0.697 and 12-month AUC from 0.700 to 0.718 ( p = 0.034), with acceptable calibration and lower information criteria. Conclusions In hospitalized older adults with heart failure, a nurse-administered ESAS identified patients at independently higher 12-month mortality risk. IPOS, though clinically informative for care planning, added little prognostic information once symptom severity was considered. Brief, nurse-led symptom screening offers a feasible approach to risk stratification in resource-limited settings. Trial registration Not applicable.