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AIMS: Heart failure (HF) is prevalent in older adults and is associated with impaired physical and cognitive function. However, these factors are rarely included in studies about long-term prognosis of HF. The aim of the study was to determine whether functional status and delirium at admission (prevalent delirium) would predict 1-year mortality in patients with decompensated HF (DHF). METHODS: We performed a prospective observational study in adult patients with DHF attended at two Spanish Emergency Departments (ED) in the context of the Epidemiology Acute HF Emergency project. Functional status was assessed by Barthel Index (BI) and prevalent delirium by the Brief Confusion Assessment Method within the first 24 h of admission. We used Kaplan-Meier survival curves for delirium and multivariable Cox regression models to estimated hazard ratio (HR) and survival probability for death while adjusting for six potential confounders. RESULT: We enrolled 239 patients (age 81.7 ± 9.4 years, women 61.1%). BI < 60 was 23.4 and 14.6% of patients had delirium. Age (HR 1.046 CI 95% 1.014-1.080, p < 0.004) and BI (HR 0.979 CI 95% 0.972-0.979, p < 0.001) were independently associated with 1-year mortality. In patients without severe functional dependence at admission, delirium (HR 3.579 CI 95% 1.730-7.403, p < 0.001) and age (HR 1.051 CI 95% 1.014-1.090, p = 0.007) independently predicted long-term mortality. CONCLUSION: Age and functional dependence are strong predictors of long-term mortality in patients with DHF. In patients without severe functional dependence, delirium-a potentially modifiable risk factor-identified a subgroup of patients with higher mortality. Evaluating functional status and delirium in ED could improve decision-making and future care of patients with DHF.
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.
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.