Effect of Barthel Index on the Risk of Thirty-Day Mortality in Patients With Acute Heart Failure Attending the Emergency Department: A Cohort Study of Nine Thousand Ninety-Eight Patients From the Epidemiology of Acute Heart Failure in Emergency Departments Registry
Por:
Rossello, X, Miro, O, Llorens, P, Jacob, J, Herrero-Puente, P, Gil, V, Rizzi, MA, Perez-Dura, MJ, Espiga, FR, Romero, R, Sevillano, JA, Vidan, MT, Bueno, H, Pocock, SJ, Martin-Sanchez, FJ, Fuentes, M, Gil, C, Alonso, H, Garmila, P, Adrada, ER, Garcia, GL, Yanez-Palma, MC, Lopez, SI, Escoda, R, Xipell, C, Sanchez, C, Gaytan, JM, Salvo, E, Pavon, J, Noval, A, Torres, JM, Lopez-Grima, ML, Valero, A, Juan, MA, Aguirre, A, Morales, JE, Mas, SM, Alonso, MI, Ruiz, F, Franco, JM, Diaz, E, Mecina, AB, Tost, J, Sanchez, S, Carbajosa, V, Pinera, P, Nicolas, JAS, Garate, RT, Alquezar, A, Herrera, S, Roset, A, Cabello, I, Richard, F, Perez, JMA, Diez, MPL, Alvarez, JV, Morilla, AA, Irimia, A, Javaloyes, P, Marquina, V, Jimenez, I, Hernandez, N, Brouzet, B, Ramos, S, Lopez, A, Andueza, JA, Calvache, R, Lorca, MT, Calderon, L, Arriaga, BA, Sierra, B, Mojarro, EM, Becquer, LT, Burillo, G, Garcia, LL, LaSalle, GC, Urbano, CA, Garcia, AB, Padial, SED, Ferrer, ES, Garrido, M, Lucas, FJ, Gaya, R
Publicada:
1 jun 2019
Resumen:
Study objective: We assess the value of the Barthel Index (BI) in predicting 30-day mortality risk among patients with acute heart failure who are attending the emergency department (ED).
Methods: We selected 9,098 acute heart failure patients from the Acute Heart Failure in Emergency Departments registry who had BI score available both at baseline and the ED visit. Patients' data were collected from 41 Spanish hospitals during four 1- to 2-month periods between 2009 and 2016. Unadjusted and adjusted logistic regression models were used to assess the association between 30-day mortality and BI score. c Statistics were used to estimate their prognostic value.
Results: The mean baseline BI score was 79.4 (SD 24.6) and the mean ED BI score was 65.3 (SD 29.1). Acute functional decline (>= 5-point decrease between baseline BI and ED BI score) was observed in 5,771 patients (53.4%). Within 30 days of the ED visit, 905 patients (9.9%) died. There was a steep inverse gradient in 30-day mortality risk for baseline BI and ED BI score. For instance, compared with BI score=100, a BI score of 50 to 55 doubled the mortality risk both at baseline and the ED visit. At the ED visit, a BI score of 0 to 5 carried a 5-fold increase in risk after adjustment for other risk predictors. In comparison with baseline BI score, ED BI score consistently provided greater discrimination. Neither baseline BI score nor the change in BI score from baseline to the ED visit added further prognostic value to the ED BI score.
Conclusion: Functional status assessed by the BI score at the ED visit is a strong predictor of 30-day mortality in acute heart failure patients, with higher predictive value than baseline BI score and acute functional decline. Routine recording of BI score at the ED visit may help in decisionmaking and health care planning.
Filiaciones:
Rossello, X:
London Sch Hyg & Trop Med, London, England
Ctr Nacl Invest Cardiovasc Carlos III CNIC, Madrid, Spain
CIBER Enfermedades Cardiovasc CIBERCV, Madrid, Spain
Miro, O:
Hosp Clin Barcelona, Emergency Dept, Barcelona, Catalonia, Spain
Llorens, P:
Hosp Gen Alicante, Short Stay Unit & Home Hospitalizat, Emergency Dept, Alicante, Comunidad Valen, Spain
Jacob, J:
Hosp Univ Bellvitge, Emergency Dept, Lhospitalet De Llobregat, Catalonia, Spain
Herrero-Puente, P:
Hosp Univ Cent Asturias, Emergency Dept, Oviedo, Asturias, Spain
Gil, V:
Hosp Clin Barcelona, Emergency Dept, Barcelona, Catalonia, Spain
Rizzi, MA:
Hosp Santa Creu & St Pau Barcelona, Barcelona, Spain
Perez-Dura, MJ:
Hosp Fe Valencia, Short Stay Unit, Emergency Dept, Valencia, Comunidad Valen, Spain
Espiga, FR:
Hosp Univ Burgos, Short Stay Unit, Emergency Dept, Burgos, Castilla & Leon, Spain
Romero, R:
Univ Europea, Sch Biomed & Hlth Sci, Hosp Univ Getafe, Emergency Dept, Madrid, Spain
Hosp Getafe Madrid, Madrid, Spain
Sevillano, JA:
Hosp Gen Univ Gregorio Maranon, Emergency Dept, Madrid, Spain
Vidan, MT:
Hosp Gen Univ Gregorio Maranon, Dept Geriatr Med, Madrid, Spain
Univ Complutense Madrid, CIBER Fragilidad & Envejecimiento, Inst Invest IiSGM, Madrid, Spain
Bueno, H:
Ctr Nacl Invest Cardiovasc Carlos III CNIC, Madrid, Spain
Univ Complutense, Hosp Univ 12 Octubre Imasl2, Cardiol Dept, Madrid, Spain
Univ Complutense, Hosp Univ 12 Octubre Imasl2, Inst Invest, Madrid, Spain
Univ Complutense, Fac Med, Madrid, Spain
Pocock, SJ:
London Sch Hyg & Trop Med, London, England
Ctr Nacl Invest Cardiovasc Carlos III CNIC, Madrid, Spain
Martin-Sanchez, FJ:
Univ Complutense Madrid, Inst Invest Sanitaria Hosp Clin San Carlos IdISSC, Hosp Clin San Carlos, Emergency Dept, Madrid, Spain
Fuentes, M:
Hosp Univ Salamanca, Salamanca, Spain
Gil, C:
Hosp Univ Salamanca, Salamanca, Spain
Alonso, H:
Hosp Marques Valdecilla, Santander, Spain
Garmila, P:
Hosp Marques Valdecilla, Santander, Spain
Adrada, ER:
Hosp Clin San Carlos, Madrid, Spain
Garcia, GL:
Hosp Clin San Carlos, Madrid, Spain
Yanez-Palma, MC:
Hosp Clin San Carlos, Madrid, Spain
Lopez, SI:
Hosp Clin San Carlos, Madrid, Spain
Escoda, R:
Hosp Clin Barcelona, Barcelona, Spain
Xipell, C:
Hosp Clin Barcelona, Barcelona, Spain
Sanchez, C:
Hosp Clin Barcelona, Barcelona, Spain
Gaytan, JM:
Hosp Clin Barcelona, Barcelona, Spain
Salvo, E:
Hosp La Fe Valencia, Valencia, Spain
Pavon, J:
Hosp Dr Negrin Las Palmas de Gran Canaria, Las Palmas Gran Canaria, Spain
Noval, A:
Hosp Insular Las Palmas de Gran Canaria, Las Palmas Gran Canaria, Spain
Torres, JM:
Hosp Reina Sofia Cordoba, Cordoba, Spain
Lopez-Grima, ML:
Hosp Dr Peset Valencia, Valencia, Spain
Valero, A:
Hosp Dr Peset Valencia, Valencia, Spain
Juan, MA:
Hosp Dr Peset Valencia, Valencia, Spain
Aguirre, A:
Hosp Mar Barcelona, Barcelona, Spain
Morales, JE:
Hosp Mar Barcelona, Barcelona, Spain
Mas, SM:
Hosp Mar Barcelona, Barcelona, Spain
Alonso, MI:
Hosp Valme Sevilla, Seville, Spain
Ruiz, F:
Hosp Valme Sevilla, Seville, Spain
Franco, JM:
Hosp Miguel Servet Zaragoza, Zaragoza, Spain
Diaz, E:
Hosp San Juan Alicante, Alicante, Spain
Mecina, AB:
Hosp Alcorcon, Alcorcon, Spain
Tost, J:
Consorci Sanitari Terrassa, Barcelona, Spain
Sanchez, S:
Hosp Rio Ortega Valladolid, Valladolid, Spain
Carbajosa, V:
Hosp Rio Ortega Valladolid, Valladolid, Spain
Pinera, P:
Hosp Reina Sofia Murcia, Murcia, Spain
Nicolas, JAS:
Hosp Reina Sofia Murcia, Murcia, Spain
Garate, RT:
Hosp Severo Ochoa, Madrid, Spain
Alquezar, A:
Hosp Santa Creu & St Pau Barcelona, Barcelona, Spain
Herrera, S:
Hosp Santa Creu & St Pau Barcelona, Barcelona, Spain
Roset, A:
Hosp Univ Bellvitge, Barcelona, Spain
Cabello, I:
Hosp Univ Bellvitge, Barcelona, Spain
Richard, F:
Hosp Univ Burgos, Burgos, Spain
Perez, JMA:
Hosp Univ Burgos, Burgos, Spain
Diez, MPL:
Hosp Univ Burgos, Burgos, Spain
Alvarez, JV:
Hosp Univ Cent Asturias, Oviedo, Spain
Morilla, AA:
Hosp Univ Cent Asturias, Oviedo, Spain
Irimia, A:
Hosp Univ Cent Asturias, Oviedo, Spain
Javaloyes, P:
Hosp Gen Alicante, Alicante, Spain
Marquina, V:
Hosp Gen Alicante, Alicante, Spain
Jimenez, I:
Hosp Gen Alicante, Alicante, Spain
Hernandez, N:
Hosp Gen Alicante, Alicante, Spain
Brouzet, B:
Hosp Gen Alicante, Alicante, Spain
Ramos, S:
Hosp Gen Alicante, Alicante, Spain
Lopez, A:
Hosp Gen Alicante, Alicante, Spain
Andueza, JA:
Hosp Gen Univ Gregorio Maranon Madrid, Madrid, Spain
Calvache, R:
Hosp Henares Madrid, Madrid, Spain
Lorca, MT:
Hosp Tajo Madrid, Madrid, Spain
Calderon, L:
Hosp Tajo Madrid, Madrid, Spain
Arriaga, BA:
Hosp Clin Lozano Blesa Zaragoza, Zaragoza, Spain
Sierra, B:
Hosp Clin Lozano Blesa Zaragoza, Zaragoza, Spain
Mojarro, EM:
Hosp St Pau & Santa Tecla Tarragona, Tarragona, Spain
Becquer, LT:
Hosp Univ Canarias Tenerife, Tenerife, Spain
Burillo, G:
Hosp Univ Canarias Tenerife, Tenerife, Spain
Garcia, LL:
Hosp Univ Vic Barcelona, Barcelona, Spain
LaSalle, GC:
Hosp Univ Vic Barcelona, Barcelona, Spain
Urbano, CA:
Hosp Costa Sol Marbella, Malaga, Spain
Garcia, AB:
Hosp Costa Sol Marbella, Malaga, Spain
Padial, SED:
Hosp Costa Sol Marbella, Malaga, Spain
Ferrer, ES:
Hosp Josep Trueta Girona, Girona, Spain
Garrido, M:
Hosp Virgen Macarena Sevilla, Seville, Spain
Lucas, FJ:
Hosp Gen Albacete, Albacete, Spain
Gaya, R:
Hosp Juan XXIII Tarragona, Tarragona, Spain
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Emergency Dept, Barcelona, Catalonia, Spain
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