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1.
J Intern Med ; 275(6): 608-20, 2014 Jun.
Article in English | MEDLINE | ID: mdl-24320176

ABSTRACT

OBJECTIVE: To study the factors associated with choice of therapy and prognosis in octogenarians with severe symptomatic aortic stenosis (AS). STUDY DESIGN: Prospective, observational, multicenter registry. Centralized follow-up included survival status and, if possible, mode of death and Katz index. SETTING: Transnational registry in Spain. SUBJECTS: We included 928 patients aged ≥80 years with severe symptomatic AS. INTERVENTIONS: Aortic-valve replacement (AVR), transcatheter aortic-valve implantation (TAVI) or conservative therapy. MAIN OUTCOME MEASURES: All-cause death. RESULTS: Mean age was 84.2 ± 3.5 years, and only 49.0% were independent (Katz index A). The most frequent planned management was conservative therapy in 423 (46%) patients, followed by TAVI in 261 (28%) and AVR in 244 (26%). The main reason against recommending AVR in 684 patients was high surgical risk [322 (47.1%)], other medical motives [193 (28.2%)], patient refusal [134 (19.6%)] and family refusal in the case of incompetent patients [35 (5.1%)]. The mean time from treatment decision to AVR was 4.8 ± 4.6 months and to TAVI 2.1 ± 3.2 months, P < 0.001. During follow-up (11.2-38.9 months), 357 patients (38.5%) died. Survival rates at 6, 12, 18 and 24 months were 81.8%, 72.6%, 64.1% and 57.3%, respectively. Planned intervention, adjusted for multiple propensity score, was associated with lower mortality when compared with planned conservative treatment: TAVI Hazard ratio (HR) 0.68 (95% confidence interval [CI] 0.49-0.93; P = 0.016) and AVR HR 0.56 (95% CI 0.39-0.8; P = 0.002). CONCLUSION: Octogenarians with symptomatic severe AS are frequently managed conservatively. Planned conservative management is associated with a poor prognosis.


Subject(s)
Aortic Valve Stenosis , Cardiac Catheterization/methods , Cardiovascular Agents/therapeutic use , Heart Valve Prosthesis Implantation/methods , Registries , Risk Adjustment , Aged, 80 and over , Aortic Valve/surgery , Aortic Valve Stenosis/mortality , Aortic Valve Stenosis/physiopathology , Aortic Valve Stenosis/surgery , Comparative Effectiveness Research , Female , Geriatric Assessment , Humans , Male , Patient Selection , Prognosis , Prospective Studies , Risk Adjustment/methods , Risk Adjustment/organization & administration , Severity of Illness Index , Spain/epidemiology , Survival Rate , Treatment Outcome
5.
Rev Clin Esp ; 208(6): 269-75, 2008 Jun.
Article in Spanish | MEDLINE | ID: mdl-18620650

ABSTRACT

INTRODUCTION: This study examined the association of self-care behavior and patients' knowledge about self-care with rehospitalization among older adults with heart failure (HF). METHODS: Case-control comparison (116 cases and 209 controls) nested in a prospective cohort of patients aged 65 years and older admitted for HF at 4 Spanish hospitals. Cases were patients experiencing a first emergency rehospitalization in the 6 months following the index hospital admission. Controls were patients who did not undergo a rehospitalization during such time-period. RESULTS: The number of self-care behaviors was inversely associated with the frequency of readmission (p for linear trend: 0.006). Compared with patients showing the appropriate self-care behavior, hospital readmission was more frequent among those who did no go for a walk daily or did not engage in any daily physical activity (hazard ratio [HR] 1.55; 95% confidence limits [CL] 1.04-2.29), and among those who did not keep their medical appointments (HR 1.82; 95% CL 1.10-3.02). Hospital readmission was also more frequent among patients who: failed to take their medication at the scheduled time (HR 2.07; 95% CL 1.15-3.72); stopped taking their medication when it disagreed with them (HR 1.76; 95% CL 1.08-2.85); and failed to adhere to their drug treatment (HR 1.96; 95% CL 1.29-2.98). Furthermore, the fewer the number of behaviors which patients knew to be required for self-care, the greater the frequency of rehospitalization (p for linear trend:0.029). CONCLUSIONS: A lower degree of self-care and of patients' knowledge about self-care predicted a higher risk of hospital readmission.


Subject(s)
Health Knowledge, Attitudes, Practice , Heart Failure/therapy , Patient Readmission/statistics & numerical data , Self Care , Aged , Aged, 80 and over , Case-Control Studies , Female , Humans , Male , Prognosis , Prospective Studies
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