ABSTRACT
Este documento de posicionamiento describe los aspectos más relevantes e imprescindibles sobre la valoración integral y multidimensional del anciano hospitalizado. El cambio del patrón demográfico y del perfil epidemiológico de las enfermedades requiere una adaptación de los Servicios de Medicina Interna, que tengan en cuenta las vulnerabilidades de las personas ancianas en este contexto. Una valoración integral y multidimensional y la elaboración multidisciplinar de un plan de atención durante el ingreso pueden tener un impacto para evitar mortalidad, discapacidad e institucionalización al alta. Es necesario que todos los internistas adquiramos competencias para mejorar la experiencia de la hospitalización en la persona mayor y obtengamos mejores resultados en salud en nuestros pacientes. Este documento lo ha desarrollado el Grupo Focal de Envejecimiento y el Grupo de Trabajo de Pluripatología y Edad Avanzada, y está avalado por la Sociedad Española de Medicina Interna (AU)
This position paper describes the most relevant and essential aspects of a comprehensive, multidimensional assessment of hospitalized elderly people. The change in demographic patterns and the epidemiological profiles of diseases makes it necessary for internal medicine departments to adapt in order to take into account the vulnerabilities of the elderly in this context. A comprehensive, multidimensional assessment and the multidisciplinary development of a care plan during hospitalization can have an impact in terms of preventing mortality, disability, and institutionalization at discharge. It is necessary for all internists to acquire skills to improve the hospitalization experience in the elderly and obtain better health outcomes in our patients. This document has been developed by the Focus Group on Aging and the Polypathological and Advanced Age Working Group and endorsed by the Spanish Society of Internal Medicine (AU)
Subject(s)
Humans , Aged , Health Services for the Aged , Integral Healthcare Practice , Hospitalization , Societies, Medical , SpainABSTRACT
This position paper describes the most relevant and essential aspects of a comprehensive, multidimensional assessment of hospitalized elderly people. The change in demographic patterns and the epidemiological profiles of diseases makes it necessary for internal medicine departments to adapt in order to take into account the vulnerabilities of the elderly in this context. A comprehensive, multidimensional assessment and the multidisciplinary development of a care plan during hospitalization can have an impact in terms of preventing mortality, disability, and institutionalization at discharge. It is necessary for all internists to acquire skills to improve the hospitalization experience in the elderly and obtain better health outcomes in our patients. This document has been developed by the Focus Group on Aging and the Polypathological and Advanced Age Working Group and endorsed by the Spanish Society of Internal Medicine.
Subject(s)
Hospitalization , Internal Medicine , Aged , Humans , Aging , SpainABSTRACT
This position paper describes the most relevant and essential aspects of a comprehensive, multidimensional assessment of hospitalized elderly people. The change in demographic patterns and the epidemiological profiles of diseases makes it necessary for internal medicine departments to adapt in order to take into account the vulnerabilities of the elderly in this context. A comprehensive, multidimensional assessment and the multidisciplinary development of a care plan during hospitalization can have an impact in terms of preventing mortality, disability, and institutionalization at discharge. It is necessary for all internists to acquire skills to improve the hospitalization experience in the elderly and obtain better health outcomes in our patients. This document has been developed by the Focus Group on Aging and the Polypathological and Advanced Age Working Group and endorsed by the Spanish Society of Internal Medicine.
ABSTRACT
BACKGROUND: Patients with atrial fibrillation (AF) admitted to hospital commonly have comorbidities. Few studies have attempted to determine factors prognostic of mortality in hospitalized AF patients with multimorbidity. AIM: To identify factors associated with mortality in hospitalized AF patients. DESIGN: Retrospective cohort study. METHODS: Patients with multimorbidity (≥2 chronic diseases), with or without AF, discharged from Lugo hospital (Spain) between 1 January 2000 and 31 December 2015. Data were extracted from hospital medical records. RESULTS: Of 74 220 patients (170 978 hospitalizations), 52 939 had multimorbidity (14 181 had AF; 38 758 no AF) and were included in our study. Patients with AF were older (mean ± standard deviation 78.6 ± 10.0 vs. 71.9 ± 14.2 years) and had a higher mortality rate (27.1 vs. 20.5%) than those without AF. Gender (female), age, stroke and congestive heart failure (CHF), but not AF, were independently associated with mortality. AF significantly increased the mortality risk in women [relative risk (RR) 1.091; 95% confidence interval (CI) 1.021-1.165; P = 0.010] and in those aged >80 years (RR 1.153; 95% CI, 1.1-1.2; P < 0.001). CHF independently increased the risk of mortality across all age groups (RR 1.496; 95% CI 1.422-1.574; P < 0.001). CONCLUSIONS: Hospitalized patients with AF have a higher mortality rate than those without AF. The prognostic significance of AF changes with age and gender while CHF is associated with the greatest risk of death.
Subject(s)
Atrial Fibrillation/mortality , Heart Failure/mortality , Hospital Mortality/trends , Multimorbidity/trends , Aged , Aged, 80 and over , Female , Hospitalization , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors , Spain/epidemiologyABSTRACT
Objetivo. Conocer las características de los pacientes con fibrilación auricular (FA) en el ámbito hospitalario y sus sucesivos ingresos. Método. Estudio retrospectivo de cohortes con la totalidad de los ingresos hospitalarios en el área médica del hospital de Lugo entre el 1 de enero de 2000 y el 31 de diciembre de 2013. La fuente de información fue el conjunto mínimo básico de datos del centro. Resultados. Se registraron 149.271 ingresos hospitalarios correspondientes a 66.286 pacientes. Con respecto al total, el porcentaje de ingresos y pacientes con FA fue del 17,3% (25.870) y 18,9% (12.512), respectivamente. Los pacientes con FA se caracterizaron por una mayor proporción de mujeres (49,7 frente a 44,3%; p<0,0001), mayor edad (78,3 [DE 10,2] frente a 67,1 años [DE 17,9]; p<0,0001), más enfermedades crónicas (4,2 [DE 2,1] frente a 2,9 [DE 1,9]; p<0,001), estancia hospitalaria más prolongada (12,5 [DE 12,5] frente a 10,6 días [DE 19,9]; p<0,0001) y una elevada tasa de reingresos (3,0 [DE 2,75] frente a 2,1 [DE 2,28]; p<0,001), con un acortamiento progresivo del tiempo entre ingresos. El servicio de Medicina Interna asumió la atención de más de la mitad de los enfermos con FA. Los diagnósticos secundarios asociados más frecuentes fueron: enfermedad pulmonar obstructiva crónica, ictus, insuficiencia cardiaca, cardiopatía isquémica, otras enfermedades del aparato respiratorio e hipertensión arterial. Conclusiones. La FA se presenta en pacientes de alta complejidad, ingresados mayoritariamente en servicios de Medicina Interna, y se asocia a una elevada tasa de reingresos. Es preciso considerar las enfermedades asociadas a la FA que permitan un enfoque global de estos pacientes (AU)
Objective. To determine the characteristics of patients with auricular fibrillation (AF) in the hospital setting and their successive hospitalisations. Method. A retrospective cohort study was conducted on all hospital admissions in the medical area of hospital of Lugo between January 1, 2000 and December 31, 2013. The data source was the centre's minimum basic data set. Results. A total of 149,271 hospital admissions corresponding to 66,286 patients were recorded. Of the total, the percentage of admissions and patients with AF was 17.3% (25,870) and 18.9% (12,512), respectively. The patients with AF were characterized by a larger proportion of women (49.7 vs. 44.3%; P<.0001), advanced age (78.3 [DE 10.2] vs. 67.1 years [DE 17.9]; P<.0001), more chronic diseases (4.2 [DE 2.1] vs. 2.9 [DE 1.9]; P<.001), longer hospital stays (12.5 [DE 12.5] vs. 10.6 [DE 19.9] days; P<.0001) and a high rate of readmissions (3.0 [DE 2.75] vs. 2.1 [DE 2.28]; P<.001), with a progressive shortening of the time between hospitalisations. The department of internal medicine was responsible for the care of more than half of the patients with AF. The most common associated secondary diagnoses were chronic obstructive pulmonary disease, stroke, heart failure, ischemic heart disease, other respiratory system diseases and arterial hypertension. Conclusions. AF occurs in highly complex patients, who are mostly hospitalized in internal medicine departments, and is associated with a high rate of readmissions. We need to consider the diseases associated with AF for an overall approach to these patients (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Patient Readmission/statistics & numerical data , Atrial Fibrillation/complications , Atrial Fibrillation/mortality , Chronic Disease/epidemiology , Retrospective Studies , Cohort Studies , Length of Stay/statistics & numerical dataABSTRACT
OBJECTIVE: To determine the characteristics of patients with auricular fibrillation (AF) in the hospital setting and their successive hospitalisations. METHOD: A retrospective cohort study was conducted on all hospital admissions in the medical area of hospital of Lugo between January 1, 2000 and December 31, 2013. The data source was the centre's minimum basic data set. RESULTS: A total of 149,271 hospital admissions corresponding to 66,286 patients were recorded. Of the total, the percentage of admissions and patients with AF was 17.3% (25,870) and 18.9% (12,512), respectively. The patients with AF were characterized by a larger proportion of women (49.7 vs. 44.3%; P<.0001), advanced age (78.3 [DE 10.2] vs. 67.1 years [DE 17.9]; P<.0001), more chronic diseases (4.2 [DE 2.1] vs. 2.9 [DE 1.9]; P<.001), longer hospital stays (12.5 [DE 12.5] vs. 10.6 [DE 19.9] days; P<.0001) and a high rate of readmissions (3.0 [DE 2.75] vs. 2.1 [DE 2.28]; P<.001), with a progressive shortening of the time between hospitalisations. The department of internal medicine was responsible for the care of more than half of the patients with AF. The most common associated secondary diagnoses were chronic obstructive pulmonary disease, stroke, heart failure, ischemic heart disease, other respiratory system diseases and arterial hypertension. CONCLUSIONS: AF occurs in highly complex patients, who are mostly hospitalized in internal medicine departments, and is associated with a high rate of readmissions. We need to consider the diseases associated with AF for an overall approach to these patients.
ABSTRACT
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