Transitions between degrees of multidimensional frailty among older people admitted to intermediate care: a multicentre prospective study.

BACKGROUND: Frailty is a dynamic condition that is clinically expected to change in older individuals during and around admission to an intermediate care (IC) facility. We aimed to characterize transitions between degrees of frailty before, during, and after admission to IC and assess the impact of these transitions on health outcomes. METHODS: Multicentre observational prospective study in IC facilities in Catalonia (North-east Spain). The analysis included all individuals aged ≥ 75 years (or younger with chronic complex or advanced diseases) admitted to an IC facility. The primary outcome was frailty, measured by the Frail-VIG index and categorized into four degrees: no frailty, and mild, moderate, and advanced frailty. The Frail-VIG index was measured at baseline (i.e., 30 days before IC admission) (Frail-VIG0), on IC admission (Frail-VIG1), at discharge (Frail-VIG2), and 30 days post-discharge (Frail-VIG3). RESULTS: The study included 483 patients with a mean (SD) age of 81.3 (10.2) years. At the time of admission, 27 (5.6%) had no frailty, and 116 (24%), 161 (33.3%), and 179 (37.1%) mild, moderate, and severe frailty, respectively. Most frailty transitions occurred within the 30 days following admission to IC, particularly among patients with moderate frailty on admission. Most patients maintained their frailty status after discharge. Overall, 135 (28%) patients died during IC stay. Frailty, measured either at baseline or admission, was significantly associated with mortality, although it showed a stronger contribution when measured on admission (HR 1.16; 95%CI 1.10-1.22; p < 0.001) compared to baseline (HR 1.10; 1.05-1.15; p < 0.001). When including frailty measurements at the two time points (i.e., baseline and IC admission) in a multivariate model, frailty measured on IC admission but not at baseline significantly contributed to explaining mortality during IC stay. CONCLUSIONS: Frailty status varied before and during admission to IC. Of the serial frailty measures we collected, frailty on IC admission was the strongest predictor of mortality. Results from this observational study suggest that routine frailty measurement on IC admission could aid clinical management decisions.

Capacidad predictiva de mortalidad del índice Frágil-VIG (IF-VIG) en pacientes ancianos con fractura de fémur / Predictive capacity for mortality of the Frail-VIG index (IF-VIG) in old patients with hip fracture

Introducción: La fragilidad y la fractura de fémur están relacionadas y comportan un mayor riesgo de deterioro funcional y de mortalidad. El objetivo de este estudio es analizar si el Frágil-VIG [IF-VIG] (índice de fragilidad validado en población geriátrica) mantiene su capacidad predictiva de mortalidad en pacientes ancianos con fractura de fémur.Métodos: Estudio observacional, de cohortes, longitudinal y ambispectivo en pacientes ingresados en una unidad de geriatría de agudos con fractura de fémur. Se dividieron los pacientes según el grado de fragilidad en tres grupos según el IF-VIG: no fragilidad/fragilidad inicial (≤0,35), fragilidad intermedia (0,36-0,50) y fragilidad avanzada (>0,50). El tiempo de seguimiento fue de 24meses. Se compararon los tres grupos mediante curvas de supervivencia y se analizaron las curvas ROC para valorar la capacidad pronóstica del IF-VIG.Resultados: Se incluyeron 103 pacientes, de los que el 73,8% eran mujeres, con edad media de 87años. No hubo diferencias entre grupos en relación con el tipo de fractura, el tipo de cirugía, el tiempo de espera hasta la cirugía y la indicación de descarga. La mortalidad intrahospitalaria global fue del 7,76% y significativamente superior en el grupo con fragilidad avanzada (23,3%). También encontramos diferencias significativas en mortalidad a los 24meses de seguimiento según el IF-VIG. El área bajo la curva ROC a los 3, 6, 12 y 24meses fue de 0,90 (0,83-0,97), de 0,90 (0,82-0,97), de 0,91 (0,86-0,97) y de 0,88 (0,81-0,94), respectivamente.Conclusión: El IF-VIG parece tener una buena capacidad predictiva de mortalidad en pacientes ancianos con fractura de fémur. (AU)

Introduction: Frailty and hip fracture are closely related and are associated with high risk of functional decline and mortality. The objective of this study is to analyze whether the Frail-VIG index [IF-VIG] (fragility index validated in the geriatric population) maintains its predictive capacity for mortality in old patients with hip fracture.Methods: Observational, cohort, longitudinal and ambispective study on patients admitted to an acute geriatric unit with a hip fracture. Patients were classified according to their degree of frailty into three groups by the IF-VIG: no frailty/initial frailty (≤0.35), moderate frailty (0.36-0.50) and advanced frailty (>0.50). The follow-up period was 24months. The three groups were compared using survival curves and ROC curves were analyzed to assess the prognostic capacity of IF-VIG.Results: A total of 103 patients were included; 73.8% were women, with a mean age of 87years. There were no differences between groups in relation to the type of fracture, the kind of surgery, the waiting time until surgery and the mobilization time. Overall, in-hospital mortality was 7.76%, significantly higher in the advanced frailty group (23.3%). We also found significant differences in mortality at 24months of follow-up according to the IF-VIG. The under the ROC curve area at 3, 6, 12 and 24months was 0.90 (0.83-0.97), 0.90 (0.82-0.97), 0.91 (0.86-0.97) and 0.88 (0.81-0.94), respectively.Conclusion: The IF-VIG appears to be a good tool in predicting mortality in old patients with hip fracture. (AU)

[Predictive capacity for mortality of the Frail-VIG index (IF-VIG) in old patients with hip fracture]. / Capacidad predictiva de mortalidad del índice Frágil-VIG (IF-VIG) en pacientes ancianos con fractura de fémur.

INTRODUCTION: Frailty and hip fracture are closely related and are associated with high risk of functional decline and mortality. The objective of this study is to analyze whether the Frail-VIG index [IF-VIG] (fragility index validated in the geriatric population) maintains its predictive capacity for mortality in old patients with hip fracture. METHODS: Observational, cohort, longitudinal and ambispective study on patients admitted to an acute geriatric unit with a hip fracture. Patients were classified according to their degree of frailty into three groups by the IF-VIG: no frailty/initial frailty (≤0.35), moderate frailty (0.36-0.50) and advanced frailty (>0.50). The follow-up period was 24months. The three groups were compared using survival curves and ROC curves were analyzed to assess the prognostic capacity of IF-VIG. RESULTS: A total of 103 patients were included; 73.8% were women, with a mean age of 87years. There were no differences between groups in relation to the type of fracture, the kind of surgery, the waiting time until surgery and the mobilization time. Overall, in-hospital mortality was 7.76%, significantly higher in the advanced frailty group (23.3%). We also found significant differences in mortality at 24months of follow-up according to the IF-VIG. The under the ROC curve area at 3, 6, 12 and 24months was 0.90 (0.83-0.97), 0.90 (0.82-0.97), 0.91 (0.86-0.97) and 0.88 (0.81-0.94), respectively. CONCLUSION: The IF-VIG appears to be a good tool in predicting mortality in old patients with hip fracture.

Frailty degree and illness trajectories in older people towards the end-of-life: a prospective observational study.

OBJECTIVES: To assess the degree of frailty in older people with different advanced diseases and its relationship with end-of-life illness trajectories and survival. METHODS: Prospective, observational study, including all patients admitted to the Acute Geriatric Unit of the University Hospital of Vic (Spain) during 12 consecutive months (2014-2015), followed for up to 2 years. Participants were identified as end-of-life people (EOLp) using the NECPAL (NECesidades PALiativas, palliative care needs) tool and were classified according to their dominant illness trajectory. The Frail-VIG index (Valoración Integral Geriátrica, Comprehensive Geriatric Assessment) was used to quantify frailty degree, to calculate the relationship between frailty and mortality (Receiver Operating Characteristic (ROC) curves), and to assess the combined effect of frailty degree and illness trajectories on survival (Cox proportional hazards model). Survival curves were plotted using the Kaplan-Meier estimator with participants classified into four groups (ie, no frailty, mild frailty, moderate frailty and advanced frailty) and were compared using the log-rank test. RESULTS: Of the 590 persons with a mean (SD) age of 86.4 (5.6) years recruited, 260 (44.1%) were identified as EOLp, distributed into cancer (n=31, 11.9%), organ failure (n=79, 30.4%), dementia (n=86, 33.1%) and multimorbidity (n=64, 24.6%) trajectories. All 260 EOLp had some degree of frailty, mostly advanced frailty (n=184, 70.8%), regardless of the illness trajectory, and 220 (84.6%) died within 2 years. The area under the ROC curve (95% CI) after 2 years of follow-up for EOLp was 0.87 (0.84 to 0.92) with different patterns of survival decline in the different end-of-life trajectories (p<0.0001). Cox regression analyses showed that each additional deficit of the Frail-VIG index increased the risk of death by 61.5%, 30.1%, 29.6% and 12.9% in people with dementia, organ failure, multimorbidity and cancer, respectively (p<0.01 for all the coefficients). CONCLUSIONS: All older people towards the end-of-life in this study were frail, mostly with advanced frailty. The degree of frailty is related to survival across the different illness trajectories despite the differing survival patterns among trajectories. Frailty indexes may be useful to assess end-of-life older people, regardless of their trajectory.

A nonparametric test for the association between longitudinal covariates and censored survival data.

Many biomedical studies focus on the association between a longitudinal measurement and a time-to-event outcome while quantifying this association by means of a longitudinal-survival joint model. In this article we propose using the $LLR$ test - a longitudinal extension of the log-rank test statistic given by Peto and Peto (1972) - to provide evidence of a plausible association between a time-to-event outcome (right- or interval-censored) and a time-dependent covariate. As joint model methods are complex and hard to interpret, it is wise to conduct a preliminary test such as $LLR$ for checking the association between both processes. The $LLR$ statistic can be expressed in the form of a weighted difference of hazards, yielding a broad class of weighted log-rank test statistics known as $LWLR$, which allow a specific emphasis along the time axis of the effects of the time-dependent covariate on the survival. The asymptotic distribution of $LLR$ is derived by means of a permutation approach under the assumption that the censoring mechanism is independent of the survival time and the longitudinal covariate. A simulation study is conducted to evaluate the performance of the test statistics $LLR$ and $LWLR$, showing that the empirical size is close to the nominal significance level and that the power of the test depends on the association between the covariates and the survival time. A data set together with a toy example are used to illustrate the $LLR$ test. The data set explores the study Epidemiology of Diabetes Interventions and Complications (Sparling and others, 2006) which includes interval-censored data. A software implementation of our method is available on github (https://github.com/RamonOller/LWLRtest).

Cada semana cuenta: uso de dispositivos sanitarios y costes relacionados de una cohorte comunitaria de personas con enfermedades crónicas avanzadas / Every week counts: Use of health services and related costs of a community-based cohort of people with advanced chronic diseases

Objetivo: Describir el uso de dispositivos sanitarios de las personas con cronicidad avanzada, cuantificando y caracterizando el coste de dicho consumo para sugerir mejoras en los modelos de atención. Diseño: Estudio observacional, analítico y prospectivo durante 3 años de una cohorte de personas con cronicidad avanzada. Emplazamiento: Tres equipos de atención primaria (EAP) de Osona, Cataluña. Participantes: Un total de 224 personas identificadas como enfermos avanzados mediante una estrategia poblacional sistemática. Mediciones principales: Edad, sexo, tipo de domicilio, trayectoria final de vida; uso, tipo y coste de los recursos en atención primaria, urgencias, por equipos de paliativos o de hospitalización (en agudos o atención intermedia). Resultados: Se realizaron una media de 1,1 ingresos al año (estancia media = 6 días), el 74% en hospitales de atención intermedia. El 93,4% del tiempo los pacientes vivieron en la comunidad, realizando un contacto semanal con el EAP (45,1% en domicilio). El coste medio diario fue 19,4euros, siendo los principales capítulos la hospitalización de atención intermedia (36,5%), la actividad EAP (29,4%) y los ingresos en agudos (28,6%). Los determinantes de menor coste serían la trayectoria fragilidad/demencia (p < 0,001), vivir en una residencia (p < 0,001) y el sobreenvejecimiento (p < 0,001). Hay ciertas diferencias en el comportamiento de los EAP en el coste global y en recursos comunitarios (p < 0,05). Conclusiones: Los consumos en hospitalización intermedia y atención primaria son más relevantes que las estancias en centros de agudos. Los contextos residencial y domiciliario son importantes para atender con efectividad y eficiencia, especialmente cuando los EAP se preparan para ello

Objective: To describe the use of health resources of people with advanced chronicity, quantifying and characterizing its cost to suggest improvements in health care models. Design: Observational, analytical and prospective study during 3 years of a cohort of people with advanced chronicity. Location: Three primary care teams (EAP) of Osona, Cataluña. Participants: 224 people identified as advanced patients through a systematic population strategy. Main measurements: Age, sex, type of home, end-of-life trajectory; use, type and cost of resources in primary care, emergencies, palliative teams or hospitalization (in acute or intermediate care). Results: Patients made an average of 1.1 admissions per year (average stay = 6 days), 74% in intermediate care hospitals. They lived in the community 93.4% of time, carrying out 1 weekly contact with the EAP (45.1% home care). The average daily cost was 19.4 euros, the main chapters were intermediate care hospitalizations (36.5%), EAP activity (29.4%) and admissions in acute hospitals (28.6%). Factors determining a potential lower cost are frailty/dementia as trajectory (p < 0.001), living in a nursing-home facility (p < 0.001) and over-aging (p < 0.001). There are certain differences in the behavior of the EAP related to the global cost and to community resources (p < 0.05). Conclusions: Consumption in intermediate hospitalization and primary care is more relevant than stays in acute care centers. Nursing-homes and home-care strategies are important to attend effectively and efficiently, especially when primary care teams get ready for it

Busca tu 1%: prevalencia y mortalidad de una cohorte comunitaria de personas con enfermedad crónica avanzada y necesidades paliativas / Find your 1%: prevalence and mortality of a community cohort of people with advanced chronic disease and palliative needs

Objetivo: Determinar prevalencias y perfiles de las personas con enfermedades crónicas avanzadas en atención primaria y analizar elementos relacionados con su mortalidad para orientar estrategias de mejora. Diseño: Estudio observacional, analítico y prospectivo durante 3 años de una cohorte de personas con necesidades paliativas. Emplazamiento: Tres equipos de atención primaria del Área de Gestión Asistencial de Osona (Cataluña). Participantes: Un total de 251 personas identificadas como enfermos avanzados mediante una estrategia poblacional sistemática que incluye el test NECPAL. Mediciones principales: Perfil demográfico y clínico básico (edad, sexo, tipo de domicilio, nivel de estratificación y enfermedad principal); fecha, lugar y causa de los eventuales fallecimientos. Resultados: El 1% de la población adulta analizada presenta enfermedades avanzadas. El 56,6% son mujeres, con una mediana de edad de 85 años. El 49,3% son personas con demencia o fragilidad avanzada, el 13,7% tienen cáncer. El 24,3% viven en residencias. La mortalidad acumulada a los 3 años es del 62,1%, con una mediana de supervivencia de 23 meses. Los factores significativamente relacionados con la probabilidad de morir son tener cáncer, el sexo femenino y el sobreenvejecimiento. Los pacientes fallecen en su domicilio (47,3%), en un hospital de atención intermedia (37,2%) o en un hospital de agudos (15,5%) en función de determinados factores explicativos. Conclusiones: En la población analizada la prevalencia y características de la enfermedad avanzada comunitaria coinciden con la reportada en la literatura. La atención primaria es el nivel de atención potencialmente referente de estos pacientes, especialmente si incorpora el entorno residencial en su ámbito de actuación

Objective: To determine the prevalence and profiles of people with advanced chronic diseases in Primary Care and to analyse the elements related to their mortality in order to orient strategies for improvement in this level of care. Design: An observational, analytical and prospective study during 3 years conducted on a cohort of patients with palliative needs. Location: Three Primary Care teams of Osona (Catalonia). Participants: A total of 251 people identified as advanced patients using a systematic population-based strategy that included the NECPAL tool. Main measurements: Basic demographic and clinical profile (age, gender, type of residence, health stratification level and main disease); date, place, and cause of eventual deaths. Results: 1% of the adult Primary Care population suffer from advanced diseases, of which 56.6% are women, and with a median age of 85 years. Dementia or advanced frailty is observed in 49.3%, and only 13.7% have cancer. Just under one-quarter (24.3%) live in nursing homes. The accumulated mortality at 3 years is 62.1%, with a median survival of 23 months. Factors significantly associated with the likelihood of dying are cancer, female gender, and over-aging. Patients died at their home (47.3%), in an intermediate care hospital (37.2%), or in an acute care hospital (15.5%), depending on certain explanatory factors. Conclusions: The prevalence and characteristics of advanced community-based disease coincide with that reported in the literature. Potentially, Primary Care is the reference level of care for these patients, especially if it incorporates nursing homes as a usual field of practice

[Every week counts: Use of health services and related costs of a community-based cohort of people with advanced chronic diseases]. / Cada semana cuenta: uso de dispositivos sanitarios y costes relacionados de una cohorte comunitaria de personas con enfermedades crónicas avanzadas.

OBJECTIVE: To describe the use of health resources of people with advanced chronicity, quantifying and characterizing its cost to suggest improvements in health care models. DESIGN: Observational, analytical and prospective study during 3 years of a cohort of people with advanced chronicity. LOCATION: Three primary care teams (EAP) of Osona, Cataluña. PARTICIPANTS: 224 people identified as advanced patients through a systematic population strategy. MAIN MEASUREMENTS: Age, sex, type of home, end-of-life trajectory; use, type and cost of resources in primary care, emergencies, palliative teams or hospitalization (in acute or intermediate care). RESULTS: Patients made an average of 1.1 admissions per year (average stay=6 days), 74% in intermediate care hospitals. They lived in the community 93.4% of time, carrying out 1 weekly contact with the EAP (45.1% home care). The average daily cost was 19.4euros, the main chapters were intermediate care hospitalizations (36.5%), EAP activity (29.4%) and admissions in acute hospitals (28.6%). Factors determining a potential lower cost are frailty/dementia as trajectory (p<0.001), living in a nursing-home facility (p<0.001) and over-aging (p<0.001). There are certain differences in the behavior of the EAP related to the global cost and to community resources (p<0.05). CONCLUSIONS: Consumption in intermediate hospitalization and primary care is more relevant than stays in acute care centers. Nursing-homes and home-care strategies are important to attend effectively and efficiently, especially when primary care teams get ready for it.

[Find your 1%: prevalence and mortality of a community cohort of people with advanced chronic disease and palliative needs]. / Busca tu 1%: prevalencia y mortalidad de una cohorte comunitaria de personas con enfermedad crónica avanzada y necesidades paliativas.

OBJECTIVE: To determine the prevalence and profiles of people with advanced chronic diseases in Primary Care and to analyse the elements related to their mortality in order to orient strategies for improvement in this level of care. DESIGN: An observational, analytical and prospective study during 3 years conducted on a cohort of patients with palliative needs. LOCATION: Three Primary Care teams of Osona (Catalonia). PARTICIPANTS: A total of 251 people identified as advanced patients using a systematic population-based strategy that included the NECPAL tool. MAIN MEASUREMENTS: Basic demographic and clinical profile (age, gender, type of residence, health stratification level and main disease); date, place, and cause of eventual deaths. RESULTS: 1% of the adult Primary Care population suffer from advanced diseases, of which 56.6% are women, and with a median age of 85 years. Dementia or advanced frailty is observed in 49.3%, and only 13.7% have cancer. Just under one-quarter (24.3%) live in nursing homes. The accumulated mortality at 3 years is 62.1%, with a median survival of 23 months. Factors significantly associated with the likelihood of dying are cancer, female gender, and over-aging. Patients died at their home (47.3%), in an intermediate care hospital (37.2%), or in an acute care hospital (15.5%), depending on certain explanatory factors. CONCLUSIONS: The prevalence and characteristics of advanced community-based disease coincide with that reported in the literature. Potentially, Primary Care is the reference level of care for these patients, especially if it incorporates nursing homes as a usual field of practice.

Frail-VIG index: a concise frailty evaluation tool for rapid geriatric assessment.

BACKGROUND: Demographic changes have led to an increase in the number of elderly frail persons and, consequently, systematic geriatric assessment is more important than ever. Frailty Indexes (FI) may be particularly useful to discriminate between various degrees of frailty but are not routinely assessed due, at least in part, to the large number of deficits assessed (from 30 to 70). Therefore, we have developed a new, more concise FI for rapid geriatric assessment (RGA)-the Frail-VIG index ("VIG" is the Spanish/Catalan abbreviation for Comprehensive Geriatric Assessment), which contains 22 simple questions that assess 25 different deficits. Here we describe this FI and report its ability to predict mortality at 24 months. METHODS: Prospective, observational, longitudinal study of geriatric patients followed for 24 months or until death. The study participants were patients (n = 590) admitted to the Acute Geriatric Unit at the at the University Hospital of Vic (Barcelona) during the year 2014. Participants were classified into one of seven groups based on their Frail-VIG score (0-0.15; 0.16-0.25; 0.26-0.35; 0.36-0.45; 0.46-0.55; 0.56-0.65; and 0.66-1). Survival curves for these groups were compared using the log-rank test. ROC curves were used to assess the index's capacity to predict mortality at 24 months. RESULTS: Mean (standard deviation) patient age was 86.4 (5.6) years. The 24-month mortality rate was 57.3% for the whole sample. Significant between-group (deceased vs. living) differences (p < 0.05) were observed for most index variables. Survival curves for the seven Frail-VIG groups differed significantly (X2 = 433.4, p < 0.001), with an area under the ROC curve (confidence interval) of 0.90 (0.88-0.92) at 12 months and 0.85 (0.82-0.88) at 24 months. Administration time for the Frail-VIG index ranged from 5 to 10 min. CONCLUSIONS: The Frail-VIG index, which requires less time to administer than previously validated FIs, presents a good discriminative capacity for the degree of frailty and a high predictive capacity for mortality in the present cohort. Although more research is needed to confirm the validity of this instrument in other populations and settings, the Frail-VIG may provide clinicians with a RGA method and also a reliable tool to assess frailty in routine practice.

Kernel-Based Measure of Variable Importance for Genetic Association Studies.

The identification of genetic variants that are associated with disease risk is an important goal of genetic association studies. Standard approaches perform univariate analysis where each genetic variant, usually Single Nucleotide Polymorphisms (SNPs), is tested for association with disease status. Though many genetic variants have been identified and validated so far using this univariate approach, for most complex diseases a large part of their genetic component is still unknown, the so called missing heritability. We propose a Kernel-based measure of variable importance (KVI) that provides the contribution of a SNP, or a group of SNPs, to the joint genetic effect of a set of genetic variants. KVI can be used for ranking genetic markers individually, sets of markers that form blocks of linkage disequilibrium or sets of genetic variants that lie in a gene or a genetic pathway. We prove that, unlike the univariate analysis, KVI captures the relationship with other genetic variants in the analysis, even when measured at the individual level for each genetic variable separately. This is specially relevant and powerful for detecting genetic interactions. We illustrate the results with data from an Alzheimer's disease study and show through simulations that the rankings based on KVI improve those rankings based on two measures of importance provided by the Random Forest. We also prove with a simulation study that KVI is very powerful for detecting genetic interactions.

Índice frágil-VIG: diseño y evaluación de un índice de fragilidad basado en la Valoración Integral Geriátrica / Frail-VIG index: design and evaluation of a new frailty index based on the Comprehensive Geriatric Assessment

Introducción. La fragilidad es una condición crónica íntimamente relacionada con resultados de salud. Los índices de fragilidad (IF) -que comparten con la valoración integral geriátrica (VIG) su naturaleza multidimensional- son herramientas diseñadas para medir cuantitativamente el grado de fragilidad. Aunque los IF han demostrado excelente correlación con mortalidad, su uso en la práctica clínica es aún limitado. Ante la necesidad de nuevos IF más sintéticos y pragmáticos, se ha diseñado y evaluado un nuevo IF, basado en la VIG (IF-VIG). Material y métodos. Estudio observacional longitudinal prospectivo de una cohorte de pacientes que ingresaron en la Unidad Geriátrica de Agudos del Hospital Universitari de Vic a lo largo del año 2014. Se ha efectuado seguimiento hasta 12 meses o constar defunción, realizando contraste de hipótesis log-rank para las curvas de supervivencia según IF-VIG y análisis de curvas ROC para determinar la capacidad pronóstica. Resultados. Se incluyeron 590 pacientes (edad media 86,39 años), con una mortalidad al año del 46,4%. En el análisis comparativo se constatan diferencias estadísticamente significativas (p<0,05) para casi la totalidad de variables incluidas en el IF-VIG. Para las distintas puntuaciones del IF-VIG, las curvas de supervivencia también muestran diferencias significativas (X2=445, p<0,001). El área bajo la curva ROC a 12 meses es de 0,9 (0,88-0,92). Se estima un tiempo de administración inferior a 10min. Conclusiones. Los resultados avalan el IF-VIG como una herramienta sencilla (respecto al contenido), rápida (en el tiempo de administración), con capacidad discriminativa (en el diagnóstico situacional) y predictiva (con elevada correlación con mortalidad) (AU)

Introduction. Frailty is closely linked to health results. Frailty indexes (FI) and the Comprehensive Geriatric Assessment (CGA) are multidimensional tools. FI serve to quantitatively measure frailty levels. They have shown to have an excellent correlation with mortality. However, they are infrequently used in clinical practice. Given the need for new, more concise, and pragmatic FI, a new FI is proposed based on a CGA (Frail-VIG Index). Material and methods. A prospective, observational, longitudinal study was conducted, with cohort follow up at 12 months or death. Participants were patients admitted in the Geriatric Unit of the University Hospital of Vic (Barcelona, Spain) during 2014. Contrast of hypothesis log-rank for survival curves according to Frail-VIG index, and analysis of ROC curves were performed to assess prognostic capacity. Results. A total of 590 patients were included (mean age=86.39). Mortality rate at 12 months was 46.4%. The comparative analysis showed statistically significant differences (P<.05) for almost all variables included in the Frail-VIG index. Survival curves also show significant differences (X2=445, P<.001) for the different Frail-VIG index scores. The area under the ROC curve at 12 months was 0.9 (0.88-0.92). An administration time of the Index is estimated at less than 10minutes. Conclusions. Results endorse the Frail-VIG index as a simple (as for contents), rapid (for administration time) tool, with discriminative (for situational diagnosis) and predictive capacity (high correlation with mortality) (AU)

[Frail-VIG index: Design and evaluation of a new frailty index based on the Comprehensive Geriatric Assessment]. / Índice frágil-VIG: diseño y evaluación de un índice de fragilidad basado en la Valoración Integral Geriátrica.

INTRODUCTION: Frailty is closely linked to health results. Frailty indexes (FI) and the Comprehensive Geriatric Assessment (CGA) are multidimensional tools. FI serve to quantitatively measure frailty levels. They have shown to have an excellent correlation with mortality. However, they are infrequently used in clinical practice. Given the need for new, more concise, and pragmatic FI, a new FI is proposed based on a CGA (Frail-VIG Index). MATERIAL AND METHODS: A prospective, observational, longitudinal study was conducted, with cohort follow up at 12 months or death. Participants were patients admitted in the Geriatric Unit of the University Hospital of Vic (Barcelona, Spain) during 2014. Contrast of hypothesis log-rank for survival curves according to Frail-VIG index, and analysis of ROC curves were performed to assess prognostic capacity. RESULTS: A total of 590 patients were included (mean age=86.39). Mortality rate at 12 months was 46.4%. The comparative analysis showed statistically significant differences (P<.05) for almost all variables included in the Frail-VIG index. Survival curves also show significant differences (X2=445, P<.001) for the different Frail-VIG index scores. The area under the ROC curve at 12 months was 0.9 (0.88-0.92). An administration time of the Index is estimated at less than 10minutes. CONCLUSIONS: Results endorse the Frail-VIG index as a simple (as for contents), rapid (for administration time) tool, with discriminative (for situational diagnosis) and predictive capacity (high correlation with mortality).

Utility of the NECPAL CCOMS-ICO© tool and the Surprise Question as screening tools for early palliative care and to predict mortality in patients with advanced chronic conditions: A cohort study.

BACKGROUND: The Surprise Question (SQ) identifies patients with palliative care needs. The NECPAL CCOMS-ICO© (NECPAL) tool combines the Surprise Question with additional clinical parameters for a more comprehensive assessment. The capacity of these screening tools to predict mortality is still unknown. AIM: To explore the predictive validity of the NECPAL and SQ to determine 12- to 24-month mortality. DESIGN: Longitudinal, prospective and observational cohort study. SETTING/PARTICIPANTS: Three primary care centres, one general hospital, one intermediate care centre, and four nursing homes. Population cohort with advanced chronic conditions and limited life prognosis. Patients were classified according to SQ and NECPAL criteria and followed for 24 months. RESULTS: Data available to assess 1059 of 1064 recruited patients (99.6%) at 12 and 24 months: 837 patients were SQ+ and 780 were NECPAL+. Mortality rates at 24 months were as follows: 44.6% (SQ+) versus 15.8% (SQ-) and 45.8% (NECPAL+) versus 18.3% (NECPAL-) ( p = 0.000). SQ+ and NECPAL+ identification was significantly correlated with 24-month mortality risk (hazard ratios: 2.719 and 2.398, respectively). Both tools were highly sensitive (91.4, CI: 88.7-94.1 and 87.5, CI: 84.3-90.7) with high negative predictive values (84.2, CI: 79.4-89.0 and 81.7, CI: 77.2-86.2), with low specificity and positive predictive value. The prognostic accuracy of SQ and NECPAL was 52.9% and 55.2%, respectively. The predictive validity was slightly better for NECPAL. CONCLUSION: SQ and NECPAL are valuable screening instruments to identify patients with limited life prognosis who may require palliative care. More research is needed to increase its prognostic utility in combination with other parameters.