Valoración geriátrica y factores asociados a mortalidad en ancianos con insuficiencia cardíaca ingresados en una unidad de geriatría de agudos / Geriatric assessment and factors associated with mortality in elderly patients with heart failure admitted to an acute geriatric unit

Introducción y objetivos. La insuficiencia cardíaca es muy prevalente y con elevada mortalidad, sobre todo en ancianos. Predecir su curso e identificar pacientes en fase avanzada es difícil. El presente trabajo pretende identificar variables incluidas en la valoración geriátrica integral y otras variables clínicas que se asocien a un incremento de riesgo de muerte al año en ancianos ingresados por insuficiencia cardíaca. Material y métodos. Estudio prospectivo de 101 pacientes (edad media, 85,9 ± 6,3 años, 81% mujeres) que ingresaron durante el año 2006 en una unidad de geriatría de agudos con diagnóstico principal de insuficiencia cardíaca. Se registraron: datos demográficos, cardiopatía predisponente, factor precipitante de la descompensación, comorbilidad, número de fármacos al alta y tratamiento específico de la insuficiencia cardíaca, estancia media, reingresos, mortalidad al año del alta. La valoración geriátrica evaluaba: discapacidad en actividades básicas diarias (índice de Barthel) e instrumentales (índice de Lawton), función cognitiva (test de Pfeiffer), comorbilidad (índice de Charlson) y síndromes geriátricos. Resultados. En un modelo multivariante de regresión logística, los factores relacionados con la mortalidad fueron: mayor discapacidad previa (menor índice de Barthel previo) (OR [IC 95% =1,03 [1,01-1,06]; p = 0,040) y mayor número de reingresos (OR [IC 95%] = 3,53 [1,19-10,44]; p = 0,023). El sexo femenino resultó protector (OR [IC 95%] = 0,15 [0,04-0,59]; p = 0,007). Conclusiones. La discapacidad en actividades diarias y los reingresos se asociaban con mayor riesgo de muerte al año, y el sexo femenino resultó protector. Si fueran confirmados en otros estudios, estos datos podrían reforzar la necesidad de realizar una valoración geriátrica integral sistemática en ancianos con esta patología (AU)

Introduction and objectives. Heart failure (HF) is very prevalent in older adults, and is associated with a high mortality. The prediction of the outcome of HF and the identification of patients in advanced stages is difficult. The present work aims at identifying variables of the geriatric assessment and other clinical variables associated with an increased risk of death at one year in older adults with HF. Material and methods. Prospective study of 101 patients (mean age, 85.9 ± 6.3 years, 81% women) admitted during 2006 to an Acute Geriatric Unit, with principal diagnosis of HF. We recorded: demographic data, predisposing heart disease, main trigger of exacerbation, comorbidity, number of prescriptions at discharge and specific treatment of HF, average length-of-stay, readmissions, and mortality at one year after discharge. Geriatric assessment included: disability in basic (Barthel index) and instrumental (Lawton index) activities of daily living, cognitive function (Pfeiffer test), comorbidity (Charlson index), and geriatric syndromes. Results. In a multivariable logistic regression model, previous disability (lower Barthel index) (OR [95%CI] = 1.03 [1.01-1.06]; P = .040) and higher number of re-admissions (OR [95%CI] = 3.53 [1.19-10.44]; P = .023) were associated with 1-year mortality. Female sex had a protective effect (OR [95%CI] = 0.15 [0.04-0.59]; P = .007). Conclusions. Disability in the basic activities of daily living and re-admissions were associated with increased 1-year mortality in older adults, whereas female sex was protective. If confirmed in further studies, these data could reinforce the need for a systematic comprehensive geriatric assessment in older adults with HF (AU)

[Geriatric assessment and factors associated with mortality in elderly patients with heart failure admitted to an acute geriatric unit]. / Valoración geriátrica y factores asociados a mortalidad en ancianos con insuficiencia cardíaca ingresados en una unidad de geriatría de agudos.

INTRODUCTION AND OBJECTIVES: Heart failure (HF) is very prevalent in older adults, and is associated with a high mortality. The prediction of the outcome of HF and the identification of patients in advanced stages is difficult. The present work aims at identifying variables of the geriatric assessment and other clinical variables associated with an increased risk of death at one year in older adults with HF. MATERIAL AND METHODS: Prospective study of 101 patients (mean age, 85.9 ± 6.3 years, 81% women) admitted during 2006 to an Acute Geriatric Unit, with principal diagnosis of HF. We recorded: demographic data, predisposing heart disease, main trigger of exacerbation, comorbidity, number of prescriptions at discharge and specific treatment of HF, average length-of-stay, readmissions, and mortality at one year after discharge. Geriatric assessment included: disability in basic (Barthel index) and instrumental (Lawton index) activities of daily living, cognitive function (Pfeiffer test), comorbidity (Charlson index), and geriatric syndromes. RESULTS: In a multivariable logistic regression model, previous disability (lower Barthel index) (OR [95%CI]=1.03 [1.01-1.06]; P=.040) and higher number of re-admissions (OR [95%CI]=3.53 [1.19-10.44]; P=.023) were associated with 1-year mortality. Female sex had a protective effect (OR [95%CI]=0.15 [0.04-0.59]; P=.007). CONCLUSIONS: Disability in the basic activities of daily living and re-admissions were associated with increased 1-year mortality in older adults, whereas female sex was protective. If confirmed in further studies, these data could reinforce the need for a systematic comprehensive geriatric assessment in older adults with HF.

Un continuun de un síndrome clínico / No disponible

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[Subacute care unit]. / Unidades de subagudos.

Subacute care is usually used to define those units that because of their characteristics are situated very close to hospitalization. Levenson et al. had defined the subacute care concept as that orientated to treat immediately after an acute hospitalization period, in which one or more complex medical problems have been treated. Postacute care is not a continuation of acute care, but must contribute to improve health results. This model would be based in a complete geriatric assessment. The admittance criteria would be based, among others, in frail patients or those with chronic and developed disease with functional impairment risk with moderate to low complications that would benefit from a specific geriatric assessment.

Unidades de subagudos / Subacute care unit

El término de subagudos se suele aplicar a aquellas unidades que por sus características se sitúan de manera inmediata muy próximas a la fase hospitalaria. Levenson et al han definido el concepto de cuidados de subagudos como aquéllos orientados a tratar de manera inmediata después de un proceso de hospitalización de agudos uno o más problemas médicos complejos. Los cuidados postagudos no son una simple prolongación de los cuidados de agudos, sino que debe contribuir a mejorar los resultados de salud. El modelo se basaría en una valoración geriátrica integral. El criterio de ingreso se basaría, entre otros, en un paciente frágil o con enfermedad crónica evolucionada con riesgo de deterioro funcional y reagudización de su enfermedad con riesgo de complicación moderado/bajo y que podría beneficiarse de una atención geriátrica específica (AU)

Subacute care is usually used to define those units that because of their characteristics are situated very close to hospitalization. Levenson et al. had defined the subacute care concept as that orientated to treat inmediatelly after an acute hospitalization period, in wich one or more complex medical problems have been treated. Postacute care is not a continuation of acute care, but must contribute to improve health results. This model would be based in a complete geriatric assessment. The admittance criteria would be based, among others, in frail patients or those with cronic and developed disease with functional impairment risk with moderate to low complications that would benefit from a specific geriatric assessment (AU)

Development and validation of an instrument to predict probability of home discharge from a geriatric convalescence unit in Spain.

OBJECTIVES: To develop and validate an instrument to predict probability of home discharge upon hospital admission. DESIGN: Prospective cohort study. SETTING: Geriatric convalescence unit (GCU) in Spain. PARTICIPANTS: Seven hundred eighty-one patients aged 65 and older consecutively admitted to a GCU over a 4-year period. The total sample was randomized and divided into two subgroups; the first (n = 575) was used to construct the predictive instrument (development subgroup) and the second (n = 206) for the validation process (validation subgroup). MEASUREMENTS: All patients were evaluated within the first 72 hours after admission. Age, sex, functional status before admission, diagnostic categories, functional status on admission, comorbidity, cognitive function, and social support were assessed. RESULTS: Logistic regression analysis identified three patient characteristics as independent predictors of home discharge in the development subgroup: higher scores on functional status at admission (Barthel index), normal Mini-Mental State Examination scores, and lower scores on Social Familial Evaluation Scale. A scoring system ranging from 0 to 5 was constructed using these variables to predict probability of home discharge (PHD). Different PHD scores (0-1, 2, 3, 4, and 5) identified patients with different probabilities of returning home on discharge in the validation subgroup (36.5%, 53.6%, 60.8%, 83.3%, and 100%, respectively). PHD scores of 4 and 5 demonstrated substantially higher posttest than pretest probability, with moderate and high clinical effect value. Scores of 0 or 1 demonstrated substantially lower posttest than pretest probability. CONCLUSION: A PHD instrument may be useful in identifying patients most likely to be discharged to home from the GCU. Patients with low probability of home discharge may also be identified early.