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Objective:To investigate the frailty status in elderly patients with atrial fibrillation(AF)and the underlying factors.Methods:In this prospective study, a total of 400 elderly hospitalized patients with AF from May 2017 to October 2021 were consecutively enrolled, 65.8% of whom were men(263), with an average age of 83(75, 90)years.According to age, 90 patients were between 65 and 74 years old, 137 were between 75 and 84 years old, and 173 were ≥85 years old.AF patients' frailty was assessed by the FRAIL scale, and logistic regression was employed to analyze related factors.Results:The overall prevalence of frailty was 41.25%(165)in the elderly AF patients, with 10.00%(9)in the 65-74 year-old group, 33.58%(46)in the 75-84 year-old group, and 63.58%(110)in the ≥85 year-old group.Clinical features of frail elderly patients with AF included a lower body mass index, longer hospitalization days, a faster heart rate on admission, a higher age-adjusted Charlson comorbidity index(ACCI), a higher non-valvular atrial fibrillation stroke risk score(CHA 2DS 2-VASc), a higher bleeding risk score(HAS-BLED), use of fewer anticoagulant drugs, and higher proportions with old myocardial infarction, congestive heart failure and anemia.Comprehensive geriatric assessment revealed that this population usually had a lower score for activities of daily living(ADL), a lower mini nutritional assessment-short form(MNA-SF)score, a lower Mini-Cog test score, and a higher fall risk score.These patients also exhibited higher high-sensitivity C-reactive protein, lower hemoglobin, lower albumin, a lower glomerular filtration rate(eGFR), lower total cholesterol, and lower apolipoprotein B, all with statistical significance( P<0.05). Logistic regression analysis showed that age( OR=1.068, 95% CI: 1.027-1.111, P<0.01), high-sensitivity C-reactive protein( OR=1.049, 95% CI: 1.024-1.075, P<0.01), and CHA 2DS 2-VASc score( OR=1.328, 95% CI: 1.083-1.628, P<0.01)increased, and albumin( OR=0.854, 95% CI: 0.786-0.929, P<0.01), MNA-SF score( OR=0.830, 95% CI: 0.747-0.923, P<0.01), and Mini-Cog score( OR=0.845, 95% CI: 0.717-0.997, P<0.05)decreased, and these were factors associated with the prevalence of frailty in elderly AF patients. Conclusions:The prevalence of frailty in elderly patients with AF is high.Elderly patients with AF are more likely to develop frailty with advanced age, poor nutrition and cognitive status, a high risk of stroke and high levels of inflammatory factors.
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OBJECTIVE： To evaluate the medication of elderly inpatients receiving multiple medication， to evaluate the effects of pharmaceutical care provided by clinical pharmacists， and to provide reference for clinical drug use of elderly patients. METHODS： The elderly inpatients receiving multiple medication were selected from Beijing Friendship Hospital Affiliated to Capital Medical University during Oct. 2018 to Feb. 2019. The process of pharmaceutical care for elderly inpatients was established and developed through the CGA team of the elderly. PCNE classification system was used to analyze drug-related problems； Bayliff tool was used to evaluate the harmfulness of drug-related problems； Morisky questionnaire was used to analyze medication compliance. Drug use was followed up 3 months after discharge to evaluate the effect of clinical pharmacist’s intervention. RESULTS： A total of 71 elderly inpatients with multiple medication were included， 73.24％ of them （52 patients） suffered from 54 drug-related problems， 32 of which were related to therapeutic effects （59.26％）， 13 （24.07％） drug adverse events （possible）， 9 unnecessary drug therapy problems （16.67％）. There were 69 causes of pharmaceutical related problems， of which 58 （84.06％） were doctor’s orders. The main causes were drug selection （36.23％）， drug dosage （24.64％） and drug dosage form （20.29％）. Totally 143 interventions were conducted by clinical pharmacists， including 102 successful interventions， with success rate of 71.33％. The highest acceptance of intervention was adverse drug events reporting（100％）， followed by patient level （97.56％）， doctor level （65.12％） and drug level （52.83％）. Among 54 pharmaceutical-related problems， the most potential hazards were grade 1 hazards， involving 35 problems （64.81％）. The score of medication compliance in patients who received medication education from clinical pharmacists was （6.19±0.58）， which was significantly higher than （4.13±1.62） at the initial stage of admission （P＜0.05）. Follow-up results showed that 6 patients discontinued drugs by themselves， and 13 patients took drugs additionally by themselves. CONCLUSIONS： Drug related problems were common in elderly inpatients receiving multiple medication. Clinical pharmacists can establish a feasible pharmaceutical care process suitable for clinical needs according to the actual clinical situation. With the help of relevant evaluation tools such as relevant drug criteria， drug instructions and drug software， and at the same time， according to the physiological and pathological conditions of patients， they can cooperate with clinicians to select suitable therapeutic drugs for elderly patients to reduce the phenomenon of unreasonable medication and multiple medication， so as to improve the effectiveness and safety of drug use in the elderly.
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Objective The clinical features,bacteriological changes,the characteristics of auxiliary examination and the timing of treatment in patients with infective endocarditis (IE) were discussed in the study retrospectively.The characteristics of the patients with infective endocarditis in our hospital in the last 8 years were summarized in order to improve the level of diagnosis and treatment.Methods From Jan.2010 to Dec.2017,39 cases of IE were admitted from the department of infectious medicine,cardiology and heart surgery in our hospital.The basic causes,clinical symptoms,signs,auxiliary examination and treatment outcome were summarized through retrospective case analysis.The results were recorded by Excel 2010 and analysed by SPSS 20.0 software.Results The total mortality rate was 7.69％ (3/39),all of which were ill treated in internal medicine.After surgery,there was no death in patients,the positive rate of blood culture was 41.03 ％ (16/39),and the rate of valvular neoplasm was 82.05 ％ (32/39) by echocardiography.Conclusions At present,the main cause of infective endocarditis is congenital heart disease,and the endocarditis caused by rheumatic heart disease is becoming less.Early diagnosis and rational selection of antibiotics and the time of operation are very critical.The significance of clinical echocardiography is greater than that of blood culture.Since the positive rate of blood culture is not satisfactory,and the strain of the bacteria has changed slightly compared with the previous reports in most foreign countries.And there is a mutual influence between the primary disease and the renal function,so it is necessary to monitor the renal function.
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Objective To examine the impact of chronic diseases and blood biomarkers on daily living activities of hospitalized nonagenarians.Methods We used data from 161 nonagenarians who had been admitted to the Department of Internal Medicine from January to December 2014.Patients were divided into three groups:the mild dependence group,the moderate dependence group and the severe dependence group,based on the Barthel Index.Data were collected from patients' medical records.Differences in chronic disease characteristics and biomarkers between the three groups were compared and multiple regression and correlation analysis was also carried out.Results Compared with the mild independence group,patients in the severe dependence group were older(92.6 ± 2.6 vs.91.2 ±1.7 years,P＜ 0.05)and had lower levels of sodium(138.0 ± 5.0 vs.140.9 ± 3.7 mmol/L),albumin(35.4 ± 4.2 vs.39.2 ± 4.3 g/L),prealbumin,total cholesterol,low density lipoprotein cholesterol,and total iron binding (34.8 ± 7.9 vs.43.2 ± 7.4 mmol/L) respectively,P＜ 0.01 or 0.05),and higher levels of high-sensitivity C-reactive protein [22.0 (31.6) vs.2.6 (6.6) g/L,P＜ 0.01].Multivariate linear regression showed that albumin (β=0.23,P =0.011),sodium (β=0.21,P=0.003),total iron biding capacity(β=0.26,P=0.003),and age (β=-0.15,P =0.036) were significantly associated with daily living activities.Conclusions Higher proportions of hospitalized nonagenarians suffer multiple diseases.Activities of daily living are significantly associated with albumin,total iron biding capacity,and sodium.While the number of diseases has no influence on activities of daily living,good nutritional status and electrolyte balance are very important to nonagenarians.
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A 77-year-old man was admitted to our hospital at July 5th,2010 with an unexplained massive pericardial effusion for 10 years.With dyspnea for one month and normal vital signs without pulsus paradoxus,other physical examination included a small amount of moist rale,normal heart sounds,jugular vein engorgement,positive hepatojugular reflux,hepatosplenomegaly and pitting edema of the extremities.The patient had a complex past history with lymph node tuberculosis,primary artertial hypertension,polycythernia vera,chronic renal insufficiency and hypothyroidism (Hashimoto's thyroiditis),and moreover,received a high dose radiation of 31p in 1967. Family history is negative.The patient had no cardiac tamponade or pericardial constriction during 10 years,he received pericardiocentesis twice,and pericardial effusion was exudative with a high proportion of monocyte.There was no evidences of tuberculosis infection,hypothyroidism,malignant tumor,severe heart failure,uremia,trauma,severe bacterial or fungus infection,chronic myeloid leukemia or bone marrow fibrosis during the admission. The patient refused anti tuberculosis,indwelling catheter drainage or surgical therapy.In this rare case,the aetiology of chronic massive pericardial effusion is most probably chronic idiopathic recurrent pericarditis.