Effectiveness of a geriatric intervention in primary care: a randomized clinical trial.

OBJECTIVE: To assess the effectiveness of an intervention after comprehensive geriatric assessment (CGA) in reducing morbidity and mortality in patients over 74 years in primary care. METHODS: Randomized controlled trial with 18 months of follow-up. Patients in the control group (CG) followed usual care. Patients in the intervention group (IG) were classified as at risk or non-risk of frailty based on the CGA. Patients at non-risk of frailty in the IG were provided with recommendations about healthy habits and adherence to treatment in group sessions, while patients at risk of frailty were visited individually by a geriatrician. RESULTS: Six hundred and twenty patients were randomized to the IG (49.7%) or to the CG (50.3%), 83.2% completed follow-up. Cox's proportional hazards model showed as covariates the study group (hazard ratio [HR] 0.58; 95% confidence interval [CI] 0.28-1.22), risk of frailty (HR 1.33; 95% CI 0.71-2.51) and the interaction between both (HR 3.08; 95% CI 1.22-7.78). Forty-nine percent of the patients in the IG and 43% in the CG were at risk of frailty at baseline. At the end of the study, 27.9% of the IG and 13.5% of the CG had reversed their initial at risk of frailty status (P = 0.027). Multivariate predictors of reversible risk of frailty were younger age, not being at risk of depression, low consumption of medications and the intervention itself. CONCLUSIONS: A specific intervention in patients over 74 years attended in primary care reduces morbidity and mortality in patients at risk of frailty and increases the proportion of patients that reversed their initial status at risk of frailty.

Prognostic implication of frailty and depressive symptoms in an outpatient population with heart failure.

INTRODUCTION AND OBJECTIVES: Heart failure patients have high levels of frailty and dependence. Our aim was to determine the impact of frailty and depressive symptoms on the 1-year mortality rate and the rate of hospitalization for heart failure during a follow-up period of 1 year. METHODS: All patients underwent geriatric evaluation, and frailty and depressive symptoms were identified. The study included 622 patients (72.5% male; median age, 68 years; 92% in New York Heart Association class II or III; and median ejection fraction, 30%). RESULTS: During follow-up, 60 patients (9.5%) died and 101 (16.2%) were hospitalized for heart failure. Overall, 39.9% of patients exhibited frailty, while 25.2% had depressive symptoms. There were significant associations between mortality at 1 year and the presence of frailty (16.9% vs. 4.8%; P< .001) and depressive symptoms (15.3% vs. 7.7%; P=.006). There was also a significant relationship between heart failure hospitalization and the presence of frailty (20.5% vs. 13.3%; P=.01). No relationship was found between heart failure hospitalization and depressive symptoms. Frailty was an independent predictor of mortality but not of hospitalization. CONCLUSIONS: Univariate analysis demonstrated significant relationships between frailty and depressive symptoms and mortality at 1 year. In addition, there was a significant relationship between frailty and the need for heart failure hospitalization. However, only frailty showed prognostic value to predict mortality, which was independent of other variables strongly associated to outcome.

Implicación pronóstica de la fragilidad y los síntomas depresivos en una población ambulatoria con insuficiencia cardiaca / Prognostic Implication of Frailty and Depressive Symptoms in an Outpatient Population With Heart Failure

Introducción y objetivos. Los pacientes con insuficienciacardiaca presentan un elevado grado de fragilidady dependencia. Durante 1 año de seguimiento, examinamosla relación de la fragilidad y los síntomas depresivoscon la mortalidad a 1 año y con la hospitalización por insuficiencia cardiaca.Métodos. Todos los pacientes fueron sometidos a unavaloración geriátrica que permitiría la detección de fragilidad y de síntomas depresivos. Se evaluó a 622 pacientes (el 72,5% varones; mediana de edad, 68 años; el 92% se hallaba en clase II o III de la NYHA; la mediana de fracción de eyección era del 30%).Resultados. Fallecieron durante el seguimiento 60(9,5%) pacientes, y 101 (16,2%) tuvieron que ser hospitalizados por insuficiencia cardiaca. Se detectó fragilidad en el 39,9% de los pacientes y síntomas depresivos en el 25,2%. La fragilidad (el 16,9 frente al 4,8%; p < 0,001) y los síntomas depresivos (el 15,3 frente al 7,7%; p = 0,006) resultaron estar relacionados con la mortalidad a 1 año de forma significativa. También se detectó una relación significativa entre la fragilidad y la hospitalización por insuficiencia cardiaca (el 20,5 frente al 13,3%; p = 0,01).No se observó relación entre síntomas depresivos y hospitalización por insuficiencia cardiaca. La fragilidad resultó tener un valor predictivo independiente de mortalidad pero no de hospitalización.Conclusiones. En el análisis univariable, la fragilidad ylos síntomas depresivos mostraron una relación significativa con la mortalidad a 1 año; además, la fragilidad mostró una relación significativa con la necesidad de hospitalización por insuficiencia cardiaca. Sin embargo, sólo la fragilidad mostró un valor predictivo de mortalidad independiente de otras variables con fuerte influencia en el pronóstico

Introduction and objectives. Heart failure patientshave high levels of frailty and dependence. Our aim wasto determine the impact of frailty and depressivesymptoms on the 1-year mortality rate and the rate ofhospitalization for heart failure during a follow-up period of 1 year.Methods. All patients underwent geriatric evaluation,and frailty and depressive symptoms were identified. Thestudy included 622 patients (72.5% male; median age, 68years; 92% in New York Heart Association class II or III;and median ejection fraction, 30%).Results. During follow-up, 60 patients (9.5%) died and101 (16.2%) were hospitalized for heart failure. Overall,39.9% of patients exhibited frailty, while 25.2% haddepressive symptoms. There were significantassociations between mortality at 1 year and thepresence of frailty (16.9% vs. 4.8%; P<.001) anddepressive symptoms (15.3% vs. 7.7%; P=.006). Therewas also a significant relationship between heart failurehospitalization and the presence of frailty (20.5% vs.13.3%; P=.01). No relationship was found between heartfailure hospitalization and depressive symptoms. Frailtywas an independent predictor of mortality but not ofhospitalization.Conclusions. Univariate analysis demonstrated significant relationships between frailty and depressivesymptoms and mortality at 1 year. In addition, there was a significant relationship between frailty and the need for heart failure hospitalization. However, only frailty showed prognostic value to predict mortality, which wasindependent of other variables strongly associated tooutcome

¿El problema social prolonga la estancia hospitalaria del paciente? / No disponible

El problema social es un reto para el médico asistencial. Uno de los comentarios más frecuentes que recibe la UFISS de Geriatría es el supuesto retraso del alta de los pacientes con problema social. Este estudio muestra que en los pacientes con un ingreso prolongado, valorados por nuestra unidad, éste no estaba directamente relacionado con problemas sociales o dificultad al alta por falta de recurso sociosanitario. Los resultados muestran que el retraso delalta hospitalaria se debe a problemas médicos: insuficiencia cardíaca, diabetes mellitus, insuficiencia renal crónica, alta complejidad médica (medida por el índice de Charlson) (AU)

The social problem is a challenge for the physician. One of the more frequent commentaries than the geriatric unit receives is the supposed delay of the discharge of patient swith social problems. This study shows that the patients with an prolonged stay were not directlyrelated with social problems or difficulty to the discharge by lack of social and sanitary resource.The results show that the delay of the hospitable discharge must to medical problems: heartfailure, diabetes mellitus, chronic renal failure, high comorbidity (measured by the index of Charlson) (AU)

Absceso hepático por Salmonella sobre metástasis de un tumor mülleriano de útero / Liver abscess by Salmonella within a metastases of müllerian uterin cancer

No disponible

Trombosis portal como primera manifestación de un síndrome mieloproliferativo crónico oculto / Recurrent meningoencephalitis caused by Eubacterium lentum

No disponible