Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 9 de 9
Filter
1.
Acta Anaesthesiol Scand ; 68(1): 63-70, 2024 Jan.
Article in English | MEDLINE | ID: mdl-37670491

ABSTRACT

BACKGROUND: There are few studies on the differences in end-of-life decisions making in critically ill patients with and without coronavirus disease 2019 (COVID-19). This study aimed to investigate the independent factors that predicted the decision to withdraw or withhold life-sustaining treatments (LST) in critically ill patients and if these decisions were based on different variables for critically ill patients with COVID-19 compared to those for critically ill patients with other diagnoses in a Swedish intensive care unit. METHODS: This observational pilot study was performed at Sahlgrenska University Hospital, Gothenburg, Sweden. Patients ≥65 years were included from 1 March 2020 to 30 April 2021. The association between a decision to limit LST and a priori selected variables including sex, age, Simplified Acute Physiology Score 3 (SAPS 3), Clinical Frailty Scale ≥4, Charlson Comorbidity Index, Body Mass Index, living at home, invasive and non-invasive mechanical ventilation was assessed using a univariate and multivariable logistic regression model and presented as odds ratio with corresponding 95% confidence intervals. RESULTS: There were 394 patients included in this study, 131 in the non-COVID-19 group and 263 in the COVID-19 group. For the non-COVID-19 cohort, the univariate analysis demonstrated that age and SAPS 3 were significantly associated with the decision to withdraw or withhold life-sustaining treatments, and this association remained in the multivariable analysis, with odds ratios of 1.10 (1.03-1.19) p = .009 and 1.06 (1.03-1.10) p < .001, respectively. For the COVID-19 cohort, the univariate analysis indicated that age, SAPS 3, and Charlson comorbidity index were significantly associated with the decision to withdraw or withhold life-sustaining treatments. However, in multivariable analysis, only the Charlson comorbidity index remained independently associated with the decision to withdraw or withhold life-sustaining treatments, with an odds ratio of 1.26 (1.07-1.49), p = .006. CONCLUSION: Decisions to withdraw or withhold life-sustaining treatments were based on other variables for the critically ill COVID-19 cohort compared to those for the critically ill non-COVID-19 cohort. Further studies are warranted to forge a common path for ethical end-of-life decision-making in critically ill patients.


Subject(s)
COVID-19 , Withholding Treatment , Humans , COVID-19/therapy , Critical Illness/therapy , Death , Intensive Care Units , Pilot Projects
2.
Clin Interv Aging ; 18: 249-261, 2023.
Article in English | MEDLINE | ID: mdl-36843633

ABSTRACT

Background: Frail older adults experience higher rates of adverse health outcomes. Therefore, assessing pre-hospital frailty early in the course of care is essential to identify the most vulnerable patients and determine their risk of deterioration. The Clinical Frailty Scale (CFS) is a frailty assessment tool that evaluates pre-hospital mobility, energy, physical activity, and function to generate a score that ranges from very fit to terminally ill. Purpose: To synthesize the evidence of the association between the CFS degree and all-cause mortality, all-cause readmission, length of hospital stay, adverse discharge destination, and functional decline in patients >65 years in acute clinical settings. Design: Systematic review with narrative synthesis. Methods: Electronic databases (PubMed, EMBASE, CINAHL, Scopus) were searched for prospective or retrospective studies reporting a relationship between pre-hospital frailty according to the CFS and the outcomes of interest from database inception to April 2020. Results: Our search yielded 756 articles, of which 29 studies were included in this review (15 were at moderate risk and 14 at low risk of bias). The included studies represented 26 cohorts from 25 countries (N = 44166) published between 2011 and 2020. All included studies showed that pre-hospital frailty according to the CFS is an independent predictor of all adverse health outcomes included in the review. Conclusion: A primary purpose of the CFS is to grade clinically increased risk (i.e. risk stratification). Our results report the accumulated knowledge on the risk-predictive performance of the CFS and highlight the importance of routinely including frailty assessments, such as the CFS, to estimate biological age, improve risk assessments, and assist clinical decision-making in older adults in acute care. Further research into the potential of the CFS and whether implementing the CFS in routine practice will improve care and patients' quality of life is warranted.


Subject(s)
Frailty , Humans , Aged , Frailty/diagnosis , Retrospective Studies , Prospective Studies , Quality of Life , Frail Elderly , Outcome Assessment, Health Care
3.
Cardiology ; 147(2): 121-132, 2022.
Article in English | MEDLINE | ID: mdl-35042214

ABSTRACT

AIMS: This study aimed to examine the multimorbidity as well as the 30-day and 1-year readmission rates in a large, unselected cohort of elderly patients with acute coronary syndrome (ACS). METHODS AND RESULTS: All patients ≥70 years hospitalized due to ACS during January 1, 2006, to December 31, 2013, and registered in the SWEDEHEART registry were included. In-hospital multimorbidity and disease burden were determined. Outcomes included 30-day and 1-year all-cause mortality, any readmission, and readmissions due to ACS, heart failure, ischaemic stroke or transient ischaemic attack (TIA), and bleeding events. Out of 80,176 patients, 25.6% had ST-elevation myocardial infarction (STEMI) and 74.4% non-ST-segment elevation ACS (NSTE-ACS). The mean age was 79.8 (±6.4 standard deviation) and 43.4% were women. Multimorbidity, or two chronic diseases, was present in 67.7%, thereof in 53.0% of STEMI patients and 72.7% of NSTE-ACS patients. In-hospital mortality was 7.0%. Of the 74,577 patients who survived to discharge, 24.6% were readmitted within 30 days and 59.5% were readmitted during the following year. Multimorbid patients had a higher risk of readmissions than those without multimorbidity. Multimorbid STEMI patients were admitted the following year in 56.2% of cases compared to 44.5% of STEMI patients without multimorbidity, adjusted odds ratio (OR) 1.35 (95% confidence interval: 1.26-1.45). Multimorbid patients with NSTE-ACS were readmitted in 63.4% of cases the following year compared with 49.1% of those without multimorbidity, adjusted OR 1.42 (1.35-1.50). More than half of the readmissions were due to cardiovascular causes (ACS, stroke, TIA, or heart failure) or bleeding events. CONCLUSIONS: Older people with ACS have a high multimorbidity burden and a high readmission rate both within 30 days and 1 year. Half of the readmissions were due to a cardiovascular event or a bleeding event. The presence of multimorbidity increases the risk of readmissions for patients with ACS. As hospital admissions are costly for the health care system and can include risks, especially for older patients, there may be opportunities in better risk stratifying this group at discharge for subsequent decrease in readmission rates.


Subject(s)
Acute Coronary Syndrome , Brain Ischemia , Stroke , Acute Coronary Syndrome/epidemiology , Acute Coronary Syndrome/therapy , Aged , Female , Humans , Multimorbidity , Patient Readmission , Stroke/epidemiology
4.
Eur Heart J Acute Cardiovasc Care ; 11(2): 89-98, 2022 Feb 08.
Article in English | MEDLINE | ID: mdl-34905049

ABSTRACT

AIMS: Data on the prognostic value of frailty to guide clinical decision-making for patients with myocardial infarction (MI) are scarce. To analyse the association between frailty classification, treatment patterns, in-hospital outcomes, and 6-month mortality in a large population of patients with MI. METHODS AND RESULTS: An observational, multicentre study with a retrospective analysis of prospectively collected data using the SWEDEHEART registry. In total, 3381 MI patients with a level of frailty assessed using the Clinical Frailty Scale (CFS-9) were included. Of these patients, 2509 (74.2%) were classified as non-vulnerable non-frail (CFS 1-3), 446 (13.2%) were vulnerable non-frail (CFS 4), and 426 (12.6%) were frail (CFS 5-9). Frailty and non-frail vulnerability were associated with worse in-hospital outcomes compared with non-frailty, i.e. higher rates of mortality (13.4% vs. 4.0% vs. 1.8%), cardiogenic shock (4.7% vs. 2.5% vs. 1.9%), and major bleeding (4.5% vs. 2.7% vs. 1.1%) (all P < 0.001), and less frequent use of evidence-based therapies. In Cox regression analyses, frailty was strongly and independently associated with 6-month mortality compared with non-frailty, after adjustment for age, sex, the GRACE risk score components, and other potential risk factors [hazard ratio (HR) 3.32, 95% confidence interval (CI) 2.30-4.79]. A similar pattern was seen for vulnerable non-frail patients (fully adjusted HR 2.07, 95% CI 1.41-3.02). CONCLUSION: Frailty assessed with the CFS was independently and strongly associated with all-cause 6-month mortality, also after comprehensive adjustment for baseline differences in other risk factors. Similarly, non-frail vulnerability was independently associated with higher mortality compared with those with preserved functional ability.


Subject(s)
Frailty , Myocardial Infarction , Aged , Frail Elderly , Humans , Prognosis , Prospective Studies , Retrospective Studies
5.
Am Heart J ; 211: 11-21, 2019 05.
Article in English | MEDLINE | ID: mdl-30831330

ABSTRACT

BACKGROUND: The aim of this study was to assess one-year outcomes of invasive and non-invasive strategies in ST-elevation myocardial infarction (STEMI) among multimorbid older people with complex health needs. METHODS: We included patients, registered between 2006 and 2013 in the SWEDEHEART registry, who were 70 years old or older with STEMI, had multimorbidity and complex health needs and were discharged alive. The one-year outcomes of patients who underwent invasive strategy (examined with coronary angiography ≤14 days) were compared to those who did not. The primary event was a composite of all-cause death, admission due to new acute coronary syndrome, stroke or transient ischemic attack. RESULTS: We identified patients, and 1089 were managed invasively and 570 non-invasively. The mean age was 79 years and 83 years in the 2 groups, respectively. After multivariable adjustment for baseline differences between the groups, including propensity scores, the primary event occurred in 31% of patients in the invasive group and 55% in the non-invasive group, adjusted hazard ratio (95% confidence intervals): 0.67 (0.54-0.83). One-year mortality was 18% in the invasive group and 45% in the non-invasive group, adjusted hazard ratio 0.51 (0.39-0.65). CONCLUSIONS: Multimorbid older people with complex health needs and STEMI had high rates of new ischemic events and death. In this cohort of older, high risk STEMI patients, an invasive strategy was associated with lower event rates. Randomized studies are needed to clarify whether these high risk patients who might benefit from invasive care are being managed too conservatively.


Subject(s)
Multimorbidity , ST Elevation Myocardial Infarction/mortality , ST Elevation Myocardial Infarction/therapy , Acute Coronary Syndrome/complications , Acute Coronary Syndrome/diagnosis , Aged , Aged, 80 and over , Coronary Angiography , Female , Humans , Ischemic Attack, Transient/complications , Ischemic Attack, Transient/diagnosis , Male , Patient Readmission , Prognosis , Propensity Score , Proportional Hazards Models , ST Elevation Myocardial Infarction/complications , ST Elevation Myocardial Infarction/diagnostic imaging , Stroke/complications , Stroke/diagnosis
6.
Am Heart J ; 191: 65-74, 2017 Sep.
Article in English | MEDLINE | ID: mdl-28888272

ABSTRACT

BACKGROUND: The objective was to investigate whether gender disparities are found in referrals of patients with acute coronary syndromes to percutaneous coronary interventions (PCIs) or coronary artery bypass grafting (CABG) and, furthermore, to study gender differences in complications and mortality. METHODS: All consecutive coronary angiographies (CAs) and PCIs performed in Sweden and Iceland are prospectively registered in the Swedish Coronary Angiography and Angioplasty Registry. For the present analysis, data of patients with acute coronary syndromes, enrolled in 2007-2011, were used to analyze gender differences in revascularization, in-hospital complications, and 30-day mortality. RESULTS: A total of 106,881 CAs were performed during the study period. In patients with significant coronary artery disease, the adjusted odds ratio (OR) for women to undergo PCI compared with men was 0.95 (95% CI 0.92-0.99) and 0.81 (0.76-0.87) for referrals to CABG. In patients with 1-vessel disease, women were less likely to undergo PCI than men, but women with 2- or 3-vessel or left main stem disease were more likely to undergo PCI. All in-hospital complications after CA followed by PCI were more frequent among women (adjusted OR 1.58 [1.47-1.70]). There was no gender difference in adjusted 30-day mortality after PCI (1.02 [0.92-1.12]) and after CABG (0.97 [0.72-1.31]). CONCLUSIONS: After CA showing 1-vessel disease, women as compared with men were less likely to undergo PCI. In the group with 2- or 3-vessel disease or left main stem stenosis, women were more likely to undergo PCI but less likely to undergo CABG. However, there was no gender difference in 30-day mortality.


Subject(s)
Acute Coronary Syndrome/diagnosis , Coronary Angiography/methods , Coronary Artery Bypass/methods , Percutaneous Coronary Intervention/methods , Postoperative Complications/epidemiology , Registries , Risk Assessment/methods , Acute Coronary Syndrome/mortality , Acute Coronary Syndrome/surgery , Aged , Female , Follow-Up Studies , Humans , Iceland/epidemiology , Incidence , Male , Odds Ratio , Propensity Score , Prospective Studies , Risk Factors , Sex Distribution , Sex Factors , Survival Rate/trends , Sweden/epidemiology
7.
Lakartidningen ; 1142017 05 30.
Article in Swedish | MEDLINE | ID: mdl-28556885

ABSTRACT

Venous thromboembolism prophylaxis in medical patients at Sahlgrenska University Hospital A hospitalized medical patient with risk factors has a 5-15 % risk of venous thromboembolism (VTE). Nonetheless thromboprophylaxis is largely underused. Our aim was to establish the proportion of high risk patients at Sahlgrenska University Hospital receiving thromboprophylaxis and to examine the 3-month incidence of VTE and bleeding. 198 patients were included and risk-stratified according to American College of Chest Physician guidelines. 12 % of high risk patients without and 26 % with increased bleeding risk received pharmacological thromboprophylaxis, as did 8 % of the patients without increased risk of VTE. VTE events occurred in 4.5 % of high risk patients, none received prophylaxis. Bleeding occurred in 5.8 % of those with increased bleeding risk. There is a need to improve thromboprophylaxis use to enhance patient safety and quality of care, for instance by issuing local guidelines.


Subject(s)
Anticoagulants/therapeutic use , Venous Thromboembolism/prevention & control , Adult , Age Factors , Aged , Aged, 80 and over , Cardiovascular Diseases/complications , Female , Hospitals, University , Humans , Immobilization/adverse effects , Male , Middle Aged , Neoplasms/complications , Practice Guidelines as Topic , Risk Assessment , Risk Factors , Sweden , Venous Thromboembolism/epidemiology , Young Adult
8.
Laeknabladid ; 98(6): 341-6, 2012 06.
Article in Icelandic | MEDLINE | ID: mdl-22647441

ABSTRACT

OBJECTIVE: Venous thromboembolic disease is a serious and often fatal complication following hospital admission. Studies show that thromboprophylactic therapy for this condition is often underutilized. The aim of this study was to evaluate the performance of thromboprophylactic therapy at Landspítali - The University Hospital of Iceland in adult patients admitted to acute wards. METHODS AND MATERIALS: On 2 December 2009 hospital charts of admitted patients on acute wards were reviewed and assessed for appropriate thromboprophylactic treatment according to the 2008 guidelines from The American College of Chest Physicians. The results were compared to those of other countries from the multinational Endorse study from 2008. RESULTS: 251 patient were included of whom 47% were considered at risk for venous thromboembolic disease. Of those 57% received appropriate thromboprophylactic treatment or 78% of surgical and 26% of medical patients. CONCLUSIONS: Adherence to clinical guidelines for thromboprophylactic treatment at surgical wards of Landspítali - The National University Hospital of Iceland was good and well above the average compared to the results of the Endorse study. Performance on the medical wards was on the other hand below average. Our results show that application of thromoboprophylactic treatment at Landspítali could be improved and thereby enhance patient safety.


Subject(s)
Fibrinolytic Agents/administration & dosage , Hospitals, University , Practice Patterns, Physicians' , Venous Thromboembolism/prevention & control , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Guideline Adherence , Hospital Units , Hospitals, University/standards , Humans , Iceland , Male , Middle Aged , Patient Safety , Practice Guidelines as Topic , Practice Patterns, Physicians'/standards , Treatment Outcome
9.
Laeknabladid ; 94(11): 747-52, 2008 Nov.
Article in Icelandic | MEDLINE | ID: mdl-18974436

ABSTRACT

Apical ballooning syndrome is a cardiac syndrome typically characterized by transient focal dyskinesia or akinesia of the mid and apical regions of the left ventricle and hyperkinesia of the basal region. The symptoms and signs of the patient mimic myocardial infarction, with chest pain, electrocardiographic changes and elevation of cardiac enzymes but without significant coronary artery disease. The syndrome is frequently preceded by physical or emotional stress. We describe three cases of apical ballooning syndrome diagnosed during 10 days in December 2007 at Landspítali University Hospital Reykjavík.


Subject(s)
Myocardial Infarction/diagnosis , Takotsubo Cardiomyopathy/pathology , Aged , Angina Pectoris/etiology , Diagnosis, Differential , Echocardiography , Electrocardiography , Female , Humans , Middle Aged , Takotsubo Cardiomyopathy/complications , Takotsubo Cardiomyopathy/physiopathology
SELECTION OF CITATIONS
SEARCH DETAIL
...