Impact of Frailty and Disability on 30-Day Mortality in Older Patients With Acute Heart Failure
Por:
Martin-Sanchez, FJ, Rodriguez-Adrada, E, Vidan, MT, Garcia, GL, del Castillo, JG, Rizzi, MA, Alquezar, A, Pinera, P, Aragues, PL, Llorens, P, Herrero, P, Jacob, J, Gil, V, Fernandez, C, Bueno, H, Miro, O
Publicada:
1 oct 2017
Resumen:
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 (Gl: 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. (C) 2017 Elsevier Inc. All rights reserved.
Filiaciones:
Martin-Sanchez, FJ:
Univ Complutense Madrid, Inst Invest Sanitaria Hosp Clin San Carlos IdISSC, Hosp Clin San Carlos, Emergency Dept, Madrid, Spain
Rodriguez-Adrada, E:
Univ Complutense Madrid, Inst Invest Sanitaria Hosp Clin San Carlos IdISSC, Hosp Clin San Carlos, Emergency Dept, Madrid, Spain
Vidan, MT:
Univ Complutense Madrid, Inst Invest IiSGM, Hosp Gen Univ Gregorio Maranon, Dept Geriatr Med, Madrid, Spain
Garcia, GL:
Univ Complutense Madrid, Inst Invest Sanitaria Hosp Clin San Carlos IdISSC, Hosp Clin San Carlos, Emergency Dept, Madrid, Spain
del Castillo, JG:
Univ Complutense Madrid, Inst Invest Sanitaria Hosp Clin San Carlos IdISSC, Hosp Clin San Carlos, Emergency Dept, Madrid, Spain
Rizzi, MA:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Emergency Dept, Barcelona, Spain
Alquezar, A:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Emergency Dept, Barcelona, Spain
Pinera, P:
Hosp Reina Sofia, Emergency Dept, Murcia, Spain
Aragues, PL:
Hosp Reina Sofia, Emergency Dept, Murcia, Spain
Llorens, P:
Hosp Gen Univ Alicante, UCE UHD, Emergency Dept, Alicante, Spain
Herrero, P:
Hosp Cent Asturias, Emergency Dept, Oviedo, Asturias, Spain
Jacob, J:
Hosp Univ Bellvitge, Emergency Dept, Barcelona, Spain
Gil, V:
Hosp Clin Barcelona, Inst Recerca Biomed August Pi i Sunyer IDIBAPS, Emergency Dept, Barcelona, Catalonia, Spain
Fernandez, C:
Univ Complutense Madrid, Inst Invest Sanitaria Hosp Clin San Carlos IdISSC, Hosp Clin San Carlos, Dept Prevent Med, Madrid, Spain
Bueno, H:
CNIC, Madrid, Spain
Hosp Univ 12 Octubre, Inst Invest I 12, Madrid, Spain
Hosp Univ 12 Octubre, Serv Cardiol, Madrid, Spain
Univ Complutense Madrid, Madrid, Spain
Miro, O:
Hosp Clin Barcelona, Inst Recerca Biomed August Pi i Sunyer IDIBAPS, Emergency Dept, Barcelona, Catalonia, Spain
Green Accepted
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