Baseline CHA2 DS2 -VASc score and prognosis in octogenarians with non-ST segment elevation acute coronary syndrome.

BACKGROUND: CHA2 DS2 -VASc Score is widely used to predict thromboembolic risk in patients with Atrial Fibrillation (AF). We sought to study if this score predicts outcomes in elderly patients with Non-ST segment Elevation Acute Coronary Syndromes (NSTEACS). METHODS: The multicenter LONGEVO-SCA prospective registry included 532 unselected patients with NSTEACS aged ≥80 years. Data to calculate CHA2 DS2 -VASc Score were available in 523 patients (98.3%). They were classified according to CHA2 DS2 -VASc Score: group 1 (score ≤ 4), and 2 (5-9). We studied outcomes in terms of mortality or readmission at 6 months follow-up. RESULTS: A total of 266 patients (51%) had a high CHA2 DS2 -VASc Score (group 2). They were more often women, with more cardiovascular risk factors, such as hypertension or diabetes mellitus, and history of previous stroke and cardiovascular disease and heart failure (all, P = .001). Geriatric syndromes (Barthel Index, Lawton Brody, cognitive impairment, and frailty) and Charlson Index were worse in this group (all, P = .001). They had poorer clinical status on admission, with worse Killip class and lower left ventricle ejection fraction (all, P = .001), and developed new-onset AF more often during admission (12.4% vs. 6.6%, P = .024). At six months follow-up, patients in group 2 had higher reinfarction, all-cause mortality, and mortality or readmission rates. A CHA2 DS2 -VASc Score > 4 was associated with mortality or readmission at 6 months (HR 2.07, P < .001). However, after adjusting for potential confounders, this last association was not significant (P = .175). CONCLUSIONS: A CHA2 DS2 -VASc Score > 4 is present in half of octogenarians with NSTEACS and is associated with poorer outcomes. However, it is not an independent predictor of events and should not replace recommended tools for risk prediction in this setting.

Elaboración de una herramienta para la estimación del riesgo de mortalidad a corto y medio plazo tras el alta de una Unidad de Hospitalización de Agudos de Geriatría / Development of a risk-mortality index for elderly patients discharged from a Geriatric Acute Care Unit

Objetivo. Desarrollar un índice capaz de estimar el riesgo individual de muerte a los 6 meses y un año, de los pacientes dados de alta de una Unidad de Agudos de Geriatría. Metodología y análisis. Estudio cohorte, prospectivo. Pacientes mayores de 70 años que ingresaron en una Unidad de Agudos de Geriatría y sobrevivieron al alta hospitalaria. El índice se construirá con el 75% de la muestra obtenida de forma aleatorizada y se validará con el 25% restante. La variable dependiente es la mortalidad a los 6 y 12 meses del alta hospitalaria. Las variables independientes incluyen datos sociodemográficos, estado funcional, comorbilidades, características clínicas y de laboratorio. Se utiliza el modelo de regresión logística multivariante para analizar la relación entre los factores de riesgo y mortalidad. Para construir el índice, la puntuación de cada factor de riesgo se determinará dividiendo cada coeficiente beta por el menor, y la puntuación de riesgo de cada paciente se hará sumando los puntos de cada factor. La precisión de este modelo predictivo se analizará comparando la mortalidad predicha versus la observada en la población de validación y calculando el área bajo las curvas ROC tanto en la población de construcción del índice como en la validación. Conclusiones. El índice predictor de mortalidad desarrollado nos permitirá estimar de forma sencilla el riesgo individual de fallecer a los 6 y 12 meses siguientes al alta de una Unidad de Agudos de Geriatría, con la finalidad de establecer planes de cuidados e individualizar tratamientos, según los objetivos realistas (AU)

Objectives. To identify predictive factors for 6 and 12-months mortality after discharge from a geriatric acute care unit, and from these, derive a mortality-risk index. Methods and analysis. Prospective cohort study will be conducted on patients over 70 years-old admitted to a geriatric acute care unit and survived to hospital discharge. The main outcome measure will be mortality at 6 months and 12 months after discharge. Independent variables include sociodemographics, functional status, comorbidities, and clinical and laboratory characteristics. Risk factors associated with mortality will be constructed using multivariate logistic regression models. To build the mortality index, points will be assigned to each risk factor by dividing each beta coefficient in the logistic model by the lowest beta coefficient. A score will be assigned to each subject by adding up the points for each risk factor present in the model. The predictive accuracy of the model will be determined by comparing the predicted versus observed mortality in the study population and calculating the area under the ROC curves in both populations. Conclusions. The risk-mortality index developed would allow an easy estimate to be made of individual risk of death at 6 months and 12 months after discharge from a geriatric acute care unit, with the purpose of establishing care plans and individualising treatment, according to real objectives (AU)

Revisión sobre el deterioro funcional en el anciano asociado al ingreso por enfermedad aguda / Review of functional impairment associated with acute illness in the elderly

El ingreso hospitalario supone un riesgo para el paciente mayor, con alta probabilidad de sufrir eventos adversos, entre los que destaca el deterioro funcional asociado, por su alta frecuencia y el grave impacto sobre la calidad de vida que produce. Los principales factores de riesgo del deterioro funcional asociado al ingreso hospitalario son la edad avanzada, la inmovilidad, las alteraciones cognitivas y la situación funcional previa al ingreso. Es preciso detectar a tiempo al paciente de riesgo para poner en marcha las medidas necesarias para evitar este deterioro, entre las que destacan el ejercicio físico y la atención geriátrica multidisciplinar (AU)

Hospitalization is a risk for elderly population, with a high probability of having adverse events. The most important one is functional impairment, due to its high prevalence and the serious impact it has on the quality of life. The main risk factors for functional decline associated with hospitalization are, age, immobility, cognitive impairment, and functional status prior to admission. It is necessary to detect patients at risk in order to implement the necessary actions to prevent this deterioration, with physical exercise and multidisciplinary geriatric care being the most important (AU)

[Review of functional impairment associated with acute illness in the elderly]. / Revisión sobre el deterioro funcional en el anciano asociado al ingreso por enfermedad aguda.

Hospitalization is a risk for elderly population, with a high probability of having adverse events. The most important one is functional impairment, due to its high prevalence and the serious impact it has on the quality of life. The main risk factors for functional decline associated with hospitalization are, age, immobility, cognitive impairment, and functional status prior to admission. It is necessary to detect patients at risk in order to implement the necessary actions to prevent this deterioration, with physical exercise and multidisciplinary geriatric care being the most important.

[Development of a risk-mortality index for elderly patients discharged from a geriatric acute care unit]. / Elaboración de una herramienta para la estimación del riesgo de mortalidad a corto y medio plazo tras el alta de una Unidad de Hospitalización de Agudos de Geriatría.

OBJECTIVES: To identify predictive factors for 6 and 12-months mortality after discharge from a geriatric acute care unit, and from these, derive a mortality-risk index. METHODS AND ANALYSIS: Prospective cohort study will be conducted on patients over 70 years-old admitted to a geriatric acute care unit and survived to hospital discharge. The main outcome measure will be mortality at 6 months and 12 months after discharge. Independent variables include sociodemographics, functional status, comorbidities, and clinical and laboratory characteristics. Risk factors associated with mortality will be constructed using multivariate logistic regression models. To build the mortality index, points will be assigned to each risk factor by dividing each beta coefficient in the logistic model by the lowest beta coefficient. A score will be assigned to each subject by adding up the points for each risk factor present in the model. The predictive accuracy of the model will be determined by comparing the predicted versus observed mortality in the study population and calculating the area under the ROC curves in both populations. CONCLUSIONS: The risk-mortality index developed would allow an easy estimate to be made of individual risk of death at 6 months and 12 months after discharge from a geriatric acute care unit, with the purpose of establishing care plans and individualising treatment, according to real objectives.

Differences in the therapeutic approach to colorectal cancer in young and elderly patients.

PURPOSE: To analyze differences in the therapeutic approach to and tumor-related mortality of young and elderly colorectal cancer (CRC) patients. PATIENTS AND METHODS: This was a descriptive study of a retrospective cohort, based on administrative databases, of all patients with CRC diagnosed or treated in our institution. We extracted data on sociodemographic characteristics, comorbidity, type of cancer, type of treatment received, survival time, and cause of death. We compared differences between a young group (YG) (age <75 years) and an older group (OG) (age ≥75 years) and assessed the variables associated with receiving different therapeutic options (multivariate analysis) and with survival time (Cox proportional hazards models). RESULTS: The study included 503 patients (YG, 320; OG, 183), with mean ages of 63.1 years in the YG and 81.8 years in the OG. No differences were observed between the groups in degree of differentiation, extension, tumor stage, or comorbidity. After adjustment for gender, comorbidity, and tumor localization and extension, YG patients were more likely than OG patients to receive surgery, radiotherapy, and chemotherapy and less likely to receive palliative care. After a median follow-up of 36.5 months, YG patients had a longer tumor-specific survival time than OG patients (36.41 months vs 26.05 months). After further adjustment, the YG had a lower tumor-specific mortality risk (hazard ratio, 0.66) than the OG. CONCLUSION: In comparison with younger patients, elderly CRC patients are undertreated, mainly because of their age and not because of their tumor type or comorbidity. Elderly patients have a significantly shorter tumor-specific survival time, partially because of this undertreatment.

Efficacy of a comprehensive geriatric intervention in older patients hospitalized for hip fracture: a randomized, controlled trial.

OBJECTIVES: To evaluate whether an early multidisciplinary geriatric intervention in elderly patients with hip fracture reduced length of stay, morbidity, and mortality and improved functional evolution. DESIGN: Randomized, controlled intervention trial. SETTING: Orthopedic ward in a university hospital. PARTICIPANTS: Three hundred nineteen patients aged 65 and older hospitalized for hip fracture surgery. INTERVENTION: Participants were randomly assigned to a daily multidisciplinary geriatric intervention (n=155) or usual care (n=164) during hospitalization in the acute phase of hip fracture. MEASUREMENTS: Primary endpoints were in-hospital length of stay and incidence of death or major medical complications. Secondary endpoints were the rate of recovery of previous activities of daily living and ambulation ability at 3, 6, and 12 months. RESULTS: Median length of stay was 16 days in the geriatric intervention group and 18 days in the usual care group (P=.06). Patients assigned to the geriatric intervention showed a lower in-hospital mortality (0.6% vs 5.8%, P=.03) and major medical complications rate (45.2% vs 61.7%, P=.003). After adjustment for confounding variables, geriatric intervention was associated with a 45% lower probability of death or major complications (95% confidence interval=7-68%). More patients in the geriatric intervention group achieved a partial recovery at 3 months (57% vs 44%, P=.03), but there were no differences between the groups at 6 and 12 months. CONCLUSION: Early multidisciplinary daily geriatric care reduces in-hospital mortality and medical complications in elderly patients with hip fracture, but there is not a significant effect on length of hospital stay or long-term functional recovery.