Prospective registry of symptomatic severe aortic stenosis in octogenarians: a need for intervention.

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.

[Self-care behavior and patients' knowledge about self-care predict rehospitalization among older adults with heart failure]. / El autocuidado y el conocimiento del manejo de la enfermedad predicen la rehospitalización en ancianos con insuficiencia cardíaca.

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.

El autocuidado y el conocimiento del manejo de la enfermedad predicen la rehospitalización en ancianos con insuficiencia cardíaca / Self-care behavior and patients’ knowledge about self-care predict rehospitalization among older adults with heart failure

Introducción. Este trabajo examinó la asociacióndel autocuidado y del conocimiento de los pacientesacerca del autocuidado con la rehospitalizaciónen adultos mayores con insuficiencia cardíaca (IC).Métodos. Análisis de casos y controles (116 casos y209 controles) alojado en una cohorte prospectivade pacientes de 65 y más años de edad ingresadospor IC en 4 hospitales españoles. Los casoseran pacientes rehospitalizados de urgencia en los6 meses siguientes a la hospitalización índice.Los controles fueron pacientes que no serehospitalizaron durante esos 6 meses. Resultados. El número de actividades de autocuidado se asoció de forma inversa con la frecuencia de reingreso (p tendencia lineal: 0,006). En comparación con los pacientes que realizaron el autocuidado apropiado, el reingreso hospitalario fue más frecuente entre los que no paseaban ni realizaban actividad física a diario (hazard ratio [HR] 1,55; límites de confianza [LC] 95% 1,04-2,29), y entre los que se saltaban la visita al médico en la fecha programada (HR 1,82; LC 95% 1,10-3,02). El reingreso hospitalario también fue más frecuente entre los pacientes que no tomaban la medicación a su hora (HR 2,07; LC 95% 1,15-3,72), los quedejaban de tomarla cuando les sentaba mal (HR1,76; LC 95% 1,08-2,85), y los que no mostraronadherencia al tratamiento farmacológico (HR 1,96;LC 95% 1,29-2,98). Además, a menor número de actividades de manejo de la IC que se conocía que debían realizarse, mayor fue la frecuencia de rehospitalización (p tendencia lineal: 0,029).Conclusión. A menor autocuidado y menor conocimiento del manejo de la IC, mayor riesgo de reingreso hospitalario

Introduction. This study examined the associationof self-care behavior and patients’ knowledge aboutself-care with rehospitalization among older adultswith heart failure (HF).Methods. Case-control comparison (116 cases and209 controls) nested in a prospective cohort ofpatients aged 65 years and older admitted for HF at4 Spanish hospitals. Cases were patientsexperiencing a first emergency rehospitalization inthe 6 months following the index hospital admission.Controls were patients who did not undergo arehospitalization during such time-period.Results. The number of self-care behaviors wasinversely 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 amongpatients who: failed to take their medication at thescheduled time (HR 2.07; 95% CL 1.15-3.72);stopped taking their medication when it disagreedwith them (HR 1.76; 95% CL 1.08-2.85); andfailed to adhere to their drug treatment (HR 1.96;95% CL 1.29-2.98). Furthermore, the fewer thenumber of behaviors which patients knew to berequired for self-care, the greater the frequencyof rehospitalization (p for linear trend:0.029).Conclusions. A lower degree of self-care and ofpatients’ knowledge about self-care predicted ahigher risk of hospital readmission

Tratamiento antimicrobiano de la enfermedad pulmonar obstructiva crónica en el anciano / Antimicrobial treatment of chronic obstructive pulmonary disease in the elderly

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No disponible

Tratamiento antimicrobiano de la EPOC en el anciano / No disponible

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Infección por VIH en pacientes de edad avanzada / VIH infections in patients old advanced

No disponible