ABSTRACT
BACKGROUND AND OBJECTIVE: Spain has been one of the countries most affected by the SARS-CoV-2 pandemic. The objective of this study is to describe the characteristics of the patients treated for COVID-19 at Guadarrama Hospital and to identify the associated mortality factors in those admitted in an acute situation. MATERIAL AND METHODS: Retrospective observational study of COVID-19 patients admitted from 3/15 to 5/15/2020. Sociodemographic, mental, functional, analytical, clinical, radiological and therapeutic variables were collected. Factors associated with mortality were analysed using a bivariate and multivariate study. RESULTS: Two hundred eleven patients were included: 102 (48.3%) in an acute situation and 109 (51.7%) in the convalescent phase, the median (interquartile range) age was 82 (72, 85) years. The most frequent symptoms were fever, cough and respiratory failure. The 89.9% had pneumonia. An acute mortality rate of 26.5% (27/102) was detected and the associated factors were: respiratory failure (P 0.002), Charlson index (ChI)≥3 (P<0.001), CURB≥2 (P 0.011), low SatO2/FiO2 ratio (<0.001), elevated urea (P<0.001) and creatinine (P 0.036), hypoproteinemia (P 0.037) and age (P<0.018). The deceased had a worse functional situation than the survivors (P 0.025). In the multivariate analysis, SatO2/FiO2 ratio (OR: 2.23; 95% CI: 1.07-4.63; P 0.031) and ChI≥3 (OR: 4.25; 95% CI: 1.06-17.04; P 0.041) were independent factors of mortality. CONCLUSIONS: The COVID-19 patients treated were mostly severe cases. The variables associated with mortality were age, respiratory failure, comorbidity, kidney failure, and malnutrition. Respiratory failure and comorbidity outweigh age as independent risk factors for mortality.
Subject(s)
COVID-19 , Pandemics , Comorbidity , Hospitals , Humans , SARS-CoV-2ABSTRACT
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Subject(s)
Humans , Aged , Natriuretic Peptide, Brain/blood , Peptide Fragments/blood , Heart Failure/bloodABSTRACT
OBJECTIVE: To describe factors related to prescription on discharge of treatment for Chronic Heart Failure(CHF)-Stage C and to analyse whether this is related to 12month-mortality. MATERIAL AND METHODS: Observational follow-up study of patients over 85 hospitalized during 2006/7 with Stage C-Chronic Heart Failure in an outskirt support hospital. Drug-prescription adherence was assessed according to the American Heart Society 2005-Guidelines and recommendations of the American Geriatrics Society-2007. A multivariate analysis of logistic regression was performed to obtain odds for 12-month mortality for each recommended therapy, adjusting by mortality risk factors. RESULTS: 104 patients aged 90+/-3yr were followed on discharge, 85% of which were women. NYHA-classes were distributed NYHA I-28,2%, II-37,9%, III-30,1%, IV-3,9%. Most frequently prescribed drugs were loop diuretics (83,3%) and IACEs/ARB (62%), and the less frequent beta-blockers (19,1%). IACEs/ARB were prescribed to those with lower functional impairment (p=0.04), and beta-blockers to those with worse NYHA class (p=0.02). All recommended prescriptions had a tendency to 12 month mortality risk reduction, even adjusted by age, functional status, co-morbidity, NYHA class and co-morbid atrial fibrillation, except for spironolactone (OR-1,8; IC95% 0,48-17,19). CONCLUSIONS: Treatment with CHF disease-modifying therapies except for spironolactone can reduce 12 month risk mortality, also in the oldest old. There exists room for improvement in frequency of drug prescription in this group of age.
Subject(s)
Guideline Adherence/statistics & numerical data , Heart Failure/drug therapy , Heart Failure/mortality , Aged, 80 and over , Chronic Disease , Disease Progression , Female , Follow-Up Studies , Humans , Male , Prospective Studies , Time FactorsABSTRACT
Objetivo: Describir factores relacionados con la prescripción farmacológica al alta hospitalaria de tratamiento para Insuficiencia Cardiaca (IC)-estadio C y analizar la relación entre dicho tratamiento y la incidencia de muerte al año. Material y Métodos: Estudio observacional prospectivo de pacientes mayores de 85 años ingresados en 2006 y 2007 con IC descompensada en un hospital de apoyo periurbano. La adecuación de la prescripción farmacológica se evaluó según las recomendaciones de la Sociedad Americana de Geriatría-2007 y American Heart Association-2005. Se realizó un análisis multivariante de regresión logística para objetivar el riesgo de mortalidad con los fármacos recomendados para tratar la IC estadío C ajustado por factores basales predictores de mortalidad. Resultados: Se siguieron 104 pacientes de 90±3 años, 85% mujeres con clase funcional basal NYHA I-28,2%, II-37,9%, III-30,1%, IV-3,9%. La fármacos más frecuentemente prescritos fueron diuréticos de asa (83,3%) e IECAs/ARA II (62%) y el menos frecuente beta-bloqueantes (19,1%). Se prescribieron más IECAs/ARAII a menor deterioro funcional (p=0.04), más Betabloqueantes a peor clase NYHA (p=0.02). Todos los fármacos estudiados presentaron una tendencia a reducir el riesgo de mortalidad al año ajustado por edad, situación funcional, comorbilidad, clase NYHA y presencia de fibrilación auricular, salvo la espironolactona (OR-1,8; IC95% 0,4817,19). Conclusiones: El tratamiento con fármacos moduladores de IC salvo la espironolactona puede reducir el riesgo de mortalidad al año en pacientes también mayores de 85 años, existiendo un margen de mejoría en la frecuencia de prescripción en este grupo de edad (AU)
Objective: To describe factors related to prescription on discharge of treatment for Chronic Heart Failure(CHF)-Stage C and to analyse whether this is related to 12month-mortality. Material and methods: Observational follow-up study of patients over 85 hospitalized during 2006/7 with Stage C-Chronic Heart Failure in an outskirt support hospital. Drug-prescription adherence was assessed according to the American Heart Society 2005-Guidelines and recommendations of the American Geriatrics Society-2007. A multivariate analysis of logistic regression was performed to obtain odds for 12-month mortality for each recommended therapy, adjusting by mortality risk factors. Results: 104 patients aged 90±3yr were followed on discharge, 85% of which were women. NYHA-classes were distributed NYHA I-28,2%, II-37,9%, III-30,1%, IV-3,9%. Most frequently prescribed drugs were loop diuretics (83,3%) and IACEs/ARB (62%), and the less frequent beta-blockers (19,1%). IACEs/ARB were prescribed to those with lower functional impairment (p=0.04), and beta-blockers to those with worse NYHA class (p=0.02). All recommended prescriptions had a tendency to 12 month mortality risk reduction, even adjusted by age, functional status, co-morbidity, NYHA class and co-morbid atrial fibrillation, except for spironolactone (OR-1,8; IC95% 0,4817,19). Conclusions: Treatment with CHF disease-modifying therapies except for spironolactone can reduce 12 month risk mortality, also in the oldest old. There exists room for improvement in frequency of drug prescription in this group of age (AU)
