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1.
Emergencias (Sant Vicenç dels Horts) ; 31(6): 413-416, dic. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-185140

RESUMO

Objetivo. Estudiar la frecuencia de fragilidad física y si su presencia se asocia con la presencia de resultados adversos en el primer año en los pacientes mayores con insuficiencia cardiaca aguda (ICA) dados de alta desde urgencias. Método. Estudio observacional de cohortes prospectivo que incluyó a los pacientes de 75 o más años con ICA dados de alta desde un servicio de urgencias. Se definió la fragilidad física como la presencia de 7 puntos en el Short Physical Performance Battery. La variable de resultado fue la aparición de un evento compuesto (revisita o reingreso por insuficiencia cardiaca y mortalidad por cualquier causa) en los primeros 365 días tras el alta de urgencias. Resultados. Se incluyeron 86 pacientes [edad media: 84 (DE 6 años); 59,3% mujeres]. La presencia de fragilidad se documentó en 49 (57%) pacientes. La frecuencia de la variable de resultado compuesta a los 365 días tras el alta de urgencias fue de un 46,5%. La fragilidad física fue un factor pronóstico independiente de presentar la variable resultado (OR ajustada = 3,6; IC 95% 1,0-12,9; p = 0,047). Conclusiones. La presencia de fragilidad física en los pacientes mayores con ICA dados de alta desde urgencias podría ser un factor pronóstico de malos resultados durante el primer año


Objective. To study the frequency of physical frailty and explore whether its presence in older patients with acute heart failure (AHF) is associated with adverse outcomes in the year after discharge from a emergency department (ED). Methods. Prospective observational cohort study in patients with AHF aged 75 years or older who were discharged from our ED. Physical frailty was defined by a score of 7 or less on the Short Physical Performance Battery. The outcome was the development of a composite event (ED revisit for AHF, hospital readmission for AHF, or all-cause mortality) within 365 days of discharge from the ED. Results. Eighty-six patients with a mean (SD) age of 84 (6) years were included; 59.3% were women. Frailty was identified in 49 patients (57%). The composite outcome was observed in 46.5% within 365 days. Physical fragility was an independent predictor of the outcome (adjusted odds ratio, 3.6; 95% CI, 1.0–12.9; P=.047). Conclusions. Frailty in older patients with AHF may predict a poor outcome during the year following discharge from an emergency department


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Insuficiência Cardíaca/diagnóstico , Idoso Fragilizado , Prognóstico , Alta do Paciente , Serviços Médicos de Emergência , Estudos de Coortes , Estudos Prospectivos
2.
Emergencias ; 31(6): 413-416, 2019.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-31777214

RESUMO

OBJECTIVES: To study the frequency of physical frailty and explore whether its presence in older patients with acute heart failure (AHF) is associated with adverse outcomes in the year after discharge from a emergency department (ED). MATERIAL AND METHODS: Prospective observational cohort study in patients with AHF aged 75 years or older who were discharged from our ED. Physical frailty was defined by a score of 7 or less on the Short Physical Performance Battery. The outcome was the development of a composite event (ED revisit for AHF, hospital readmission for AHF, or all-cause mortality) within 365 days of discharge from the ED. RESULTS: Eighty-six patients with a mean (SD) age of 84 (6) years were included; 59.3% were women. Frailty was identified in 49 patients (57%). The composite outcome was observed in 46.5% within 365 days. Physical fragility was an independent predictor of the outcome (adjusted odds ratio, 3.6; 95% CI, 1.0-12.9; P=.047). CONCLUSION: Frailty in older patients with AHF may predict a poor outcome during the year following discharge from an emergency department.

3.
Eur J Heart Fail ; 21(11): 1353-1365, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31127677

RESUMO

OBJECTIVE: To compare the clinical characteristics and outcomes of patients with acute heart failure (AHF) according to clinical profiles based on congestion and perfusion determined in the emergency department (ED). METHODS AND RESULTS: Overall, 11 261 unselected AHF patients from 41 Spanish EDs were classified according to perfusion (normoperfusion = warm; hypoperfusion = cold) and congestion (not = dry; yes = wet). Baseline and decompensation characteristics were recorded as were the main wards to which patients were admitted. The primary outcome was 1-year all-cause mortality; secondary outcomes were need for hospitalisation during the index AHF event, in-hospital all-cause mortality, prolonged hospitalisation, 7-day post-discharge ED revisit for AHF and 30-day post-discharge rehospitalisation for AHF. A total of 8558 patients (76.0%) were warm + wet, 1929 (17.1%) cold + wet, 675 (6.0%) warm + dry, and 99 (0.9%) cold + dry; hypoperfused (cold) patients were more frequently admitted to intensive care units and geriatrics departments, and warm + wet patients were discharged home without admission. The four phenotypes differed in most of the baseline and decompensation characteristics. The 1-year mortality was 30.8%, and compared to warm + dry, the adjusted hazard ratios were significantly increased for cold + wet (1.660; 95% confidence interval 1.400-1.968) and cold + dry (1.672; 95% confidence interval 1.189-2.351). Hypoperfused (cold) phenotypes also showed higher rates of index episode hospitalisation and in-hospital mortality, while congestive (wet) phenotypes had a higher risk of prolonged hospitalisation but decreased risk of rehospitalisation. No differences were observed among phenotypes in ED revisit risk. CONCLUSIONS: Bedside clinical evaluation of congestion and perfusion of AHF patients upon ED arrival and classification according to phenotypic profiles proposed by the latest European Society of Cardiology guidelines provide useful complementary information and help to rapidly predict patient outcomes shortly after ED patient arrival.

4.
Eur J Intern Med ; 65: 69-77, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31076345

RESUMO

BACKGROUND: Little is known about the prevalence and impact of risk of malnutrition on short-term mortality among seniors presenting with acute heart failure (AHF) in emergency setting. The objective was to determine the impact of risk of malnutrition on 30-day mortality risk among older patients who attended in Emergency Departments (EDs) for AHF. MATERIAL AND METHODS: We performed a secondary analysis of the OAK-3 Registry including all consecutive patients ≥65 years attending in 16 Spanish EDs for AHF. Risk of malnutrition was defined by the Mini Nutritional Assessment Short Form (MNA-SF) < 12 points. Unadjusted and adjusted logistic regression models were used to assess the association between risk of malnutrition and 30-day mortality. RESULTS: We included 749 patients (mean age: 85 (SD 6); 55.8% females). Risk of malnutrition was observed in 594 (79.3%) patients. The rate of 30-day mortality was 8.8%. After adjusting for MEESSI-AHF risk score clinical categories (model 1) and after adding all variables showing a significantly different distribution among groups (model 2), the risk of malnutrition was an independent factor associated with 30-day mortality (adjusted OR by model 1 = 3.4; 95%CI 1.2-9.7; p = .020 and adjusted OR by model 2 = 3.1; 95%CI 1.1-9.0; p = .033) compared to normal nutritional status. CONCLUSIONS: The risk of malnutrition assessed by the MNA-SF is associated with 30-day mortality in older patients with AHF who were attended in EDs. Routine screening of risk of malnutrition may help emergency physicians in decision-making and establishing a care plan.

5.
Emergencias (Sant Vicenç dels Horts) ; 31(1): 27-35, feb. 2019. ilus, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182433

RESUMO

Objetivos: Demostrar la eficacia de una intervención integral en la transición de cuidados (Plan de Alta Guiado Multinivel, PAGM) para disminuir eventos adversos a 30 días en ancianos frágiles con insuficiencia cardiaca aguda (ICA) dados de alta desde servicios de urgencias (SU) y validar los resultados de dicha intervención en condiciones reales. Método: Se seleccionarán pacientes mayores de 70 años frágiles con diagnóstico principal de ICA dados del alta a su domicilio desde SU. La intervención consistirá en aplicar un PAGM: 1) lista de verificación sobre recomendaciones clínicas y activación de recursos; 2) programación de visita precoz; 3) transmisión de información a atención primaria; 4) hoja de instrucciones al paciente por escrito. Fase 1: ensayo clínico con asignación al azar por conglomerados emparejado. Se asignará de forma aleatoria 10 SU (N = 480) al grupo de intervención y 10 SU (N = 480) al grupo de control. Se compararán los resultados entre grupo de intervención y control. Fase 2: estudio cuasi-experimental. Se realizará la intervención en los 20 SU (N = 300). Se comparará los resultados entre la fase 1 y 2 del grupo de intervención y entre la fase 1 y 2 del grupo de control. La variable principal de resultado es compuesta (revisita a urgencias u hospitalización por ICA o mortalidad de origen cardiovascular) a los 30 días del alta. Conclusiones: El estudio valorará la eficacia y factibilidad de una intervención integral en la transición de cuidados para reducir resultados adversos a 30 días en ancianos frágiles con ICA dados de alta desde los SU


Objectives: To demonstrate the efficacy of a system for comprehensive care transfer (Multilevel Guided Discharge Plan [MGDP]) for frail older patients diagnosed with acute heart failure (AHF) and to validate the results of MGDP implementation under real clinical conditions. The MGDP seeks to reduce the number of adverse outcomes within 30 days of emergency department (ED) discharge. Method: We will enroll frail patients over the age of 70 years discharged home from the ED with a main diagnosis of AHF. The MGDP includes the following components: 1) a checklist of clinical recommendations and resource activations, 2) scheduling of an early follow-up visit, 3) transfer of information to the primary care doctor, and 4) written instructions for the patient. Phase 1 of the study will be a matched-pair cluster-randomized controlled trial. Ten EDs will be randomly assigned to the intervention group and 10 to the control group. Each group will enroll 480 patients, and the outcomes will be compared between groups. Phase 2 will be a quasi-experimental study of the intervention in 300 new patients enrolled by the same 20 EDs. The outcomes will be compared to those for each Phase-1 group. The main endpoint at 30 days will be a composite of 2 outcomes: revisits to an ED and/for hospitalization for AHF or cardiovascular death. Conclusions: The study will assess the efficacy and feasibility of comprehensive MGDP transfer of care for frail older AHF patients discharged home


Assuntos
Humanos , Assistência ao Convalescente/métodos , Idoso Fragilizado , Insuficiência Cardíaca/terapia , Planejamento de Assistência ao Paciente , Transferência de Pacientes , Alta do Paciente , Doença Aguda , Lista de Checagem , Protocolos Clínicos , Serviço Hospitalar de Emergência , Seguimentos , Insuficiência Cardíaca/mortalidade , Hospitalização , Análise por Pareamento , Estudos Prospectivos , Projetos de Pesquisa
6.
Emergencias ; 31(1): 27-35, 2019 02.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30656870

RESUMO

OBJECTIVES: To demonstrate the efficacy of a system for comprehensive care transfer (Multilevel Guided Discharge Plan [MGDP]) for frail older patients diagnosed with acute heart failure (AHF) and to validate the results of MGDP implementation under real clinical conditions. The MGDP seeks to reduce the number of adverse outcomes within 30 days of emergency department (ED) discharge. MATERIAL AND METHODS: We will enroll frail patients over the age of 70 years discharged home from the ED with a main diagnosis of AHF. The MGDP includes the following components: 1) a checklist of clinical recommendations and resource activations, 2) scheduling of an early follow-up visit, 3) transfer of information to the primary care doctor, and 4) written instructions for the patient. Phase 1 of the study will be a matched-pair cluster-randomized controlled trial. Ten EDs will be randomly assigned to the intervention group and 10 to the control group. Each group will enroll 480 patients, and the outcomes will be compared between groups. Phase 2 will be a quasi-experimental study of the intervention in 300 new patients enrolled by the same 20 EDs. The outcomes will be compared to those for each Phase-1 group. The main endpoint at 30 days will be a composite of 2 outcomes: revisits to an ED and/for hospitalization for AHF or cardiovascular death. CONCLUSION: The study will assess the efficacy and feasibility of comprehensive MGDP transfer of care for frail older AHF patients discharged home.


Assuntos
Assistência ao Convalescente/métodos , Idoso Fragilizado , Insuficiência Cardíaca/terapia , Planejamento de Assistência ao Paciente , Alta do Paciente , Transferência de Pacientes , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Lista de Checagem , Protocolos Clínicos , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Insuficiência Cardíaca/mortalidade , Hospitalização , Humanos , Masculino , Análise por Pareamento , Estudos Prospectivos , Projetos de Pesquisa
8.
Emergencias (Sant Vicenç dels Horts) ; 30(3): 149-155, jun. 2018. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-172955

RESUMO

Objetivos. Estudiar el impacto de las variables geriátricas en la mortalidad a 30 días entre los ancianos con insuficiencia cardiaca aguda (ICA). Método. Análisis retrospectivo del registro Older Acute heart failure Key data (OAK) que incluye prospectivamente a pacientes consecutivos 65 años con ICA en 3 servicios de urgencias españoles durante 4 meses (noviembre-diciembre 2011 y enero-febrero 2014). Se realizó una valoración geriátrica adaptada a urgencias durante los días laborales de 8 am a 10 pm. Se recogieron variables demográficas, clínicas, analíticas y geriátricas (comorbilidad, polifarmacia, fragilidad, situación basal funcional, cognitiva y social, despistaje de síndrome confusional, deterioro cognitivo y depresión, y situación nutricional). La variable de resultado fue la mortalidad por cualquier causa a los 30 días. Resultados. Se incluyeron 565 pacientes con edad media 83 años (DE 7,1), 346 mujeres (61,6%). Sesenta y cinco sujetos (11,5%) fallecieron a los 30 días. La presencia de síndrome confusional agudo (OR ajustada = 2,2; IC95% 1,0-4,8; p = 0,04), de enfermedad aguda (OR ajustada = 1,8; IC95% 0,9-3,4; p = 0,05) o pérdida de apetito (OR ajustada = 1,8; IC95% 1-3,4; p = 0,04) en los últimos 3 meses, y de fragilidad (OR ajustada = 2,0; IC95% 1,0-4,1; p = 0,05) o dependencia funcional grave (OR ajustada = 4,4; IC95% 1,9-11,4; p = 0,01) fueron factores independientes asociados con mortalidad a los 30 días. Conclusiones. Existen ciertas variables geriátricas que debieran contemplarse en la estratificación de riesgo a corto plazo de los pacientes ancianos con ICA


Objective. To study the impact of geriatric assessment variables on 30-day mortality among older patients with acute heart failure (AHF). Methods. Retrospective analysis of cases in the OAK Registry (Older Acute Heart Failure Key Data), a prospectively compiled database of consecutive patients aged 65 years or older treated for AHF in 3 Spanish emergency departments over a 4-month period (November-December 2011 and January-February 2014). The patients underwent a geriatric assessment adapted for emergency department use on weekdays between 8 AM and 10 PM. Demographic, clinical, laboratory, and geriatric assessment variables were recorded. The geriatric variables were concurrent diseases; polypharmacy; frailty; functional, social, and cognitive status at baseline; results of screening for confusional state, cognitive impairment, and depression; and nutritional status. The primary outcome was all-cause mortality at 30 days. Results. We included 565 patients with a mean (SD) age of 83 (7.1) years; 346 (61.6%) were women. Sixty-five (11.5%) died within 30 days. Independent factors associated with 30-day mortality were acute confusional state (adjusted odds ratio [aOR], 2.2; 95% CI, 1.0–4.8; P=.04), acute illness (aOR, 1.8; 95% CI, 0.9–3.4; P=.05), loss of appetite in the past 3 months (aOR, 1.8; 95% CI, 1.0–3.4; P=.04), frailty (aOR, 2.0, 95% CI, 1.0–4.1; P=.05), and severe disability (aOR, 4.4; 95% CI, 1.9–11.4; P=.01). Conclusions. Certain geriatric variables should be considered when assessing short-term risk in older patients with AHF


Assuntos
Humanos , Idoso , Avaliação Geriátrica/estatística & dados numéricos , Insuficiência Cardíaca/mortalidade , Transtornos Cognitivos/epidemiologia , Doença Aguda/epidemiologia , Indicadores de Morbimortalidade , Hospitalização/estatística & dados numéricos , Estudos Retrospectivos , Delírio/epidemiologia , Fatores de Risco , Idoso Fragilizado/estatística & dados numéricos , Múltiplas Afecções Crônicas/epidemiologia , Polimedicação
10.
Emergencias ; 30(3): 149-155, 2018 06.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29687668

RESUMO

OBJETIVE: To study the impact of geriatric assessment variables on 30-day mortality among older patients with acute heart failure (AHF). METHODS: Retrospective analysis of cases in the OAK Registry (Older Acute Heart Failure Key Data), a prospectively compiled database of consecutive patients aged 65 years or older treated for AHF in 3 Spanish emergency departments over a 4-month period (November-December 2011 and January-February 2014). The patients underwent a geriatric assessment adapted for emergency department use on weekdays between 8 AM and 10 PM. Demographic, clinical, laboratory, and geriatric assessment variables were recorded. The geriatric variables were concurrent diseases; polypharmacy; frailty; functional, social, and cognitive status at baseline; results of screening for confusional state, cognitive impairment, and depression; and nutritional status. The primary outcome was all-cause mortality at 30 days. RESULTS: We included 565 patients with a mean (SD) age of 83 (7.1) years; 346 (61.6%) were women. Sixty-five (11.5%) died within 30 days. Independent factors associated with 30-day mortality were acute confusional state (adjusted odds ratio [aOR], 2.2; 95% CI, 1.0­4.8; P=.04), acute illness (aOR, 1.8; 95% CI, 0.9­3.4; P=.05), loss of appetite in the past 3 months (aOR, 1.8; 95% CI, 1.0­3.4; P=.04), frailty (aOR, 2.0, 95% CI, 1.0­4.1; P=.05), and severe disability (aOR, 4.4; 95% CI, 1.9­11.4; P=.01). CONCLUSIONS: Certain geriatric variables should be considered when assessing short-term risk in older patients with AHF.


Assuntos
Avaliação Geriátrica , Insuficiência Cardíaca/mortalidade , Atividades Cotidianas , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência , Feminino , Idoso Fragilizado , Insuficiência Cardíaca/diagnóstico , Humanos , Masculino , Estado Nutricional , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco
11.
Am J Cardiol ; 120(7): 1151-1157, 2017 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-28826899

RESUMO

The objectives were to determine the impact of frailty and disability on 30-day mortality and whether the addition of these variables to HFRSS EFFECT risk score (FBI-EFFECT model) improves the short-term mortality predictive capacity of both HFRSS EFFECT and BI-EFFECT models in older patients with acute decompensated heart failure (ADHF) atended in the emergency department. We performed a retrospective analysis of OAK Registry including all consecutive patients ≥65 years old with ADHF attended in 3 Spanish emergency departments over 4 months. FBI-EFFECT model was developed by adjusting probabilities of HFRSS EFFECT risk categories according to the 6 groups (G1: non frail, no or mildly dependent; G2: frail, no or mildly dependent; G3: non frail, moderately dependent; G4: frail, moderately dependent; G5: severely dependent; G6: very severely dependent).We included 596 patients (mean age: 83 [SD7]; 61.2% females). The 30-day mortality was 11.6% with statistically significant differences in the 6 groups (p < 0.001). After adjusting for HFRSS EFFECT risk categories, we observed a progressive increase in hazard ratios from groups G2 to G6 compared with G1 (reference). FBI-EFFECT had a better prognostic accuracy than did HFRSS EFFECT (log-rank p < 0.001; Net Reclassification Improvement [NRI] = 0.355; p < 0.001; Integrated Discrimination Improvement [IDI] = 0.052; p ;< 0.001) and BI-EFFECT (log-rank p = 0.067; NRI = 0.210; p = 0.033; IDI = 0.017; p = 0.026). In conclusion, severe disability and frailty in patients with moderate disability are associated with 30-day mortality in ADHF, providing additional value to HFRSS EFFECT model in predicting short-term prognosis and establishing a care plan.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Idoso Fragilizado/estatística & dados numéricos , Insuficiência Cardíaca/mortalidade , Sistema de Registros , Medição de Risco , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Avaliação da Deficiência , Feminino , Seguimentos , Insuficiência Cardíaca/reabilitação , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologia , Fatores de Tempo
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