Centenarians and their hearts: A prospective registry with comprehensive geriatric assessment, electrocardiogram, echocardiography, and follow-up.

BACKGROUND: Data on the cardiac characteristics of centenarians are scarce. Our aim was to describe electrocardiogram (ECG) and echocardiography in a cohort of centenarians and to correlate them with clinical data. METHODS: We used prospective multicenter registry of 118 centenarians (28 men) with a mean age of 101.5±1.7 years. Electrocardiogram was performed in 103 subjects (87.3%) and echocardiography in 100 (84.7%). All subjects underwent a follow-up for at least 6 months. RESULTS: Centenarians with abnormal ECG were less frequently females (72% vs 93%), had higher rates of previous consumption of tobacco (14% vs 0) and alcohol (24% vs 12%), and scored lower in the perception of health status (6.8±2.0 vs 8.3±6.8). Centenarians with significant abnormalities in echocardiography were less frequently able to walk 6 m (33% vs 54%). Atrial fibrillation/flutter was found in 27 subjects (26%). Mean left ventricular (LV) ejection fraction was 60.0±10.5%. Moderate or severe aortic valve stenosis was found in 16%, mitral valve regurgitation in 15%, and aortic valve regurgitation in 13%. Diastolic dysfunction was assessed in 79 subjects and was present in 55 (69.6%). Katz index and LV dilation were independently associated with the ability to walk 6 m. Age, Charlson and Katz indexes, and the presence of significant abnormalities in echocardiography were associated with mortality. CONCLUSIONS: Centenarians have frequent ECG alterations and abnormalities in echocardiography. More than one fifth has atrial fibrillation, and most have diastolic dysfunction. Left ventricular dilation was associated with the ability to walk 6 m. Significant abnormalities in echocardiography were associated with mortality.

Análisis de mortalidad tras el ingreso en una unidad de agudos de geriatría: influencia de la dependencia funcional / Analysis of mortality after admission to an acute geriatric unit: influence of functional dependency

Objetivo: analizar la influencia de diversos factores clínicos y funcionales en la tasa de mortalidad anual tras ingreso en unidad de agudos de geriatría (UGA). Material y métodos: pacientes ingresados durante 6 meses en la UGA. Se excluyeron los ingresos inadecuados o trasladados a otro servicio en el primer día. Para la valoración clínica, funcional y psíquica basal se utilizaron los índices de Katz y de Barthel, la escala de la Cruz Roja física y la presencia de demencia. Los datos al ingreso: mortalidad, complicaciones, impacto funcional del ingreso. En el seguimiento al año se analizaron los datos de mortalidad cruda y comorbilidad (índice de Charlson [ICh]). Se analizó la influencia de los datos basales y del ingreso en la supervivencia. El análisis estadístico se realizó mediante la comparación de medias y proporciones mediante las pruebas de la χ2, de la t de Student y ANOVA de un factor. El estudio de supervivencia se realizó mediante curvas de Kaplan-Meier y regresión de Cox, con un intervalo de confianza del 95%. Se utilizó el programa SPSS 11.0 para el procesamiento estadístico de los datos. Resultados: se analizó a 336 pacientes, con una edad media ± desviación estándar de 85,6 ± 6,9 años; el 59,2% eran mujeres. El grupo relacionado de diagnóstico principal fue de 541. Datos basales: demencia moderada o grave, 39,3%; dependencia en más de 3 actividades básicas, 45,4%; movilidad restringida, 48,2%, e incontinencia funcional, 29,9%. Datos del ingreso: impacto funcional, 19,5%, e infección nosocomial, 47,6%. La mortalidad intrahospitalaria fue del 22,9%. Durante el seguimiento hubo un 5,1% de pérdidas. Al año fallecieron 107 pacientes más (total 184; 54,8%). La mitad de los fallecimientos se produjo en los primeros 59 días contados desde el día del ingreso. Mediana de supervivencia, 275 días. Comorbilidad ICh > 2 (47,6%). Las causas de defunción fueron: en el 37,5% de los casos, respiratoria, y en el 31,0% de los pacientes, circulatoria. Los factores relacionados con la mortalidad fueron: sexo varón (p = 0,029), demencia (p = 0,002), pérdida funcional (p < 0,001), infección respiratoria nosocomial (p = 0,026), cuadro confusional (p < 0,001) y comorbilidad (p = 0,015); no se encontró asociación con la edad u otros factores clínicos. En el modelo de regresión de Cox, únicamente ser varón (p = 0,021) y la pérdida funcional asociada al ingreso (p < 0,001) se asociaron a mortalidad en el seguimiento. Conclusiones: se observó una elevada mortalidad durante los primeros dos meses desde el ingreso hospitalario, sobre todo por afección respiratoria y circulatoria. Aunque el sexo se asocia con la mortalidad en el seguimiento, ésta depende en mayor medida de la situación funcional. Se hace necesario establecer estrategias preventivas o de intervención en determinados grupos de ancianos de riesgo en los que es previsible una elevada mortalidad

Objective: to analyze the influence of several clinical and functional factors on the annual mortality rate following admission to an acute geriatric unit (AGU). Material and methods: patients admitted to the AGU over a 6-month period were included. Inappropriate admissions and those transferred to another service within 24 hours were excluded. Clinical, functional and psychic evaluations (Katz index, Barthel index, Physical Red Cross scale, presence of dementia) were performed. Admission data: mortality, complications, functional impact of admission. Follow-up at 1 year: data on crude mortality and comorbidity (Charlson index). The influence of baseline data and of admission on survival was analyzed. The statistical analysis consisted of comparison of means and proportions through the chi-squared test, Student's t-test and one-way ANOVA. Survival was studied through Kaplan-Meier curves and Cox regression. A 95% confidence interval was used. Data were analyzed with the SPSS 11.0 statistical package. Results: there were 336 patients (mean age 85.6 years; SD 6.9); 59.2% were women. Main diagnosis-related group: 541. Baseline data: moderate or severe dementia was found in 39.3%, dependency for more than three basic activities of daily living in 45.4%, restricted mobility in 48.2%, and functional incontinence in 29.9%. Admission data: functional impact was found in 19.5% and nosocomial infection in 47.6%. In-hospital mortality: 22.9%. Follow-up: 5.1% were lost to follow-up. At 1 year a further 107 patients had died (total 184; 54.8%). Half of the deaths occurred in the first 59 days after admission. The median survival was 275 days. The Charlson comorbidity index score was >2: 47.6%. Causes of death were respiratory in 37.5% and circulatory in 31.0%. The factors related to mortality were male sex (P=.029), dementia (P =.002), functional loss (P<.001), nosocomial respiratory infection (P =.026), confusional syndrome (P<.001), and comorbidity (P =.015). No association was found with age or other clinical factors. In the Cox regression model, only male sex (P=.021) and functional loss associated with admission (P<.001) were related to mortality during follow-up. Conclusions: mortality was high during the first 2 months after hospital admission, especially that due to respiratory and circulatory disease. Although sex was associated with mortality during follow-up, mortality was to a greater extent due to functional status. Preventive strategies and/or interventions are required in specific groups of elderly patients with an elevated risk of mortality