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Maze Y, Tokui T, Narukawa T, Murakami M, Yamaguchi D, Inoue R, Hirano K, Takamura T, Nakamura K, Seko T, Kasai A. Impact of the Barthel Index Score and Prognosis on Patients Undergoing Transcatheter Aortic Valve Replacement and Surgical Aortic Valve Replacement. Circ J 2024; 88:483-491. [PMID: 37899252 DOI: 10.1253/circj.cj-23-0458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
BACKGROUND Few studies have compared the Barthel Index (BI) score and postoperative outcomes of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). We aimed to examine the relationship between the BI score and postoperative outcomes in patients who underwent TAVR and SAVR. METHODS AND RESULTS The study included patients who underwent SAVR between January 2014 and December 2022 (n=293) and patients who underwent TAVR between January 2016 and December 2022 (n=312). We examined the risk factors for long-term mortality in the 2 groups. The mean (±SD) preoperative BI score was 88.7±18.0 in the TAVR group and 95.8±12.3 in the SAVR group. The home discharge rate was significantly lower in the SAVR than TAVR group. The BI score at discharge was significantly higher in the SAVR than in TAVR group (86.2 vs. 80.2; P<0.001). Significant risk factors for long-term mortality in the TAVR group were sex (P<0.001) and preoperative hemoglobin level (P=0.008), whereas those in the SAVR group were preoperative albumin level (P=0.04) and postoperative BI score (P=0.02). The cut-off point of the postoperative BI score determined by receiver operating characteristic curve analysis was 60.0. CONCLUSIONS The BI score at discharge was a significant risk factor for long-term mortality in the SAVR group, with a cut-off value of 60.0.
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Affiliation(s)
- Yasumi Maze
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Toshiya Tokui
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Takahiro Narukawa
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Masahiko Murakami
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Daisuke Yamaguchi
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Ryosai Inoue
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Koji Hirano
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | | | | | - Tetsuya Seko
- Department of Cardiology, Ise Red Cross Hospital
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Jawad BN, Shaker SM, Altintas I, Eugen-Olsen J, Nehlin JO, Andersen O, Kallemose T. Development and validation of prognostic machine learning models for short- and long-term mortality among acutely admitted patients based on blood tests. Sci Rep 2024; 14:5942. [PMID: 38467752 PMCID: PMC10928126 DOI: 10.1038/s41598-024-56638-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 03/08/2024] [Indexed: 03/13/2024] Open
Abstract
Several scores predicting mortality at the emergency department have been developed. However, all with shortcomings either simple and applicable in a clinical setting, with poor performance, or advanced, with high performance, but clinically difficult to implement. This study aimed to explore if machine learning algorithms could predict all-cause short- and long-term mortality based on the routine blood test collected at admission. METHODS We analyzed data from a retrospective cohort study, including patients > 18 years admitted to the Emergency Department (ED) of Copenhagen University Hospital Hvidovre, Denmark between November 2013 and March 2017. The primary outcomes were 3-, 10-, 30-, and 365-day mortality after admission. PyCaret, an automated machine learning library, was used to evaluate the predictive performance of fifteen machine learning algorithms using the area under the receiver operating characteristic curve (AUC). RESULTS Data from 48,841 admissions were analyzed, of these 34,190 (70%) were randomly divided into training data, and 14,651 (30%) were in test data. Eight machine learning algorithms achieved very good to excellent results of AUC on test data in a of range 0.85-0.93. In prediction of short-term mortality, lactate dehydrogenase (LDH), leukocyte counts and differentials, Blood urea nitrogen (BUN) and mean corpuscular hemoglobin concentration (MCHC) were the best predictors, whereas prediction of long-term mortality was favored by age, LDH, soluble urokinase plasminogen activator receptor (suPAR), albumin, and blood urea nitrogen (BUN). CONCLUSION The findings suggest that measures of biomarkers taken from one blood sample during admission to the ED can identify patients at high risk of short-and long-term mortality following emergency admissions.
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Affiliation(s)
- Baker Nawfal Jawad
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | | | - Izzet Altintas
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Eugen-Olsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Jan O Nehlin
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
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Matsuo T, Morisawa T, Yamamoto S, Nyuba K, Maehata M, Fujii D, Iwaki H, Ueno K, Iwata K, Saitoh M, Takahashi T. Effect of in-patient cardiac rehabilitation at rehabilitation hospital for cardiology patients: two-center trial. Heart Vessels 2024; 39:75-85. [PMID: 37702812 DOI: 10.1007/s00380-023-02310-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/24/2023] [Indexed: 09/14/2023]
Abstract
The effectiveness of cardiac rehabilitation (CR) in patients with cardiovascular disease requiring continuous CR from an acute care hospital to a convalescent rehabilitation hospital is unknown. Therefore, we compared the effect of CR in a rehabilitation hospital for patients with cardiovascular disease with that of those who underwent cardiovascular surgery. Sixty-nine consecutive patients were admitted to two rehabilitation hospitals for CR. Patients were classified by primary disease into two groups: patients with cardiovascular disease (cardiology group, 26 patients) and patients who underwent cardiovascular surgery (surgery group, 43 patients). Clinical information, physical function, cognitive function, activities of daily living (ADL), quality of life (QOL), amount of CR, and length of hospital stay were compared between the two groups. Compared with clinical features, age was significantly higher in the cardiology group (P < 0.001), and the preadmission Barthel index was significantly lower in the cardiology group (P = 0.025). Physical function at the time of transfer was significantly lower in the cardiology group than in the surgery group for the short physical performance battery (P < 0.001), gait speed (P = 0.005), and 6-min walking distance (P = 0.042). No significant difference was found in the amount of CR performed or the length of hospital stay, and no interaction effects were observed in improvements in physical function, exercise tolerance, or QOL. In conclusion, in rehabilitation hospitals, patients with cardiovascular disease were older, had lower preadmission ADL, and had lower a physical function at transfer than those who underwent cardiovascular surgery, but CR improved physical function and QOL to the same extent. The results suggest that the recovery of patients with cardiovascular disease may be similar to those who undergo cardiovascular surgery.
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Affiliation(s)
- Tomohiro Matsuo
- Department of Rehabilitation, Nishi Memorial Port-island Rehabilitation Hospital, 8-5-2, Minatojimanakamachi, Chuo-ku, Kobe, Hyogo, 650-0046, Japan
| | - Tomoyuki Morisawa
- Department of Physical Therapy, Faculty of Health Sciences, Juntendo University, 1-1 Hongo 2-chome, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Satoshi Yamamoto
- Department of Rehabilitation, IMS Itabashi Rehabilitation Hospital, 3-11-1 Azukizawa, Itabashi-ku, Tokyo, 174-0051, Japan
| | - Kyohei Nyuba
- Department of Rehabilitation, Nishi Memorial Port-island Rehabilitation Hospital, 8-5-2, Minatojimanakamachi, Chuo-ku, Kobe, Hyogo, 650-0046, Japan
| | - Miyuki Maehata
- Department of Rehabilitation, Nishi Memorial Port-island Rehabilitation Hospital, 8-5-2, Minatojimanakamachi, Chuo-ku, Kobe, Hyogo, 650-0046, Japan
| | - Daisuke Fujii
- Department of Rehabilitation, IMS Itabashi Rehabilitation Hospital, 3-11-1 Azukizawa, Itabashi-ku, Tokyo, 174-0051, Japan
| | - Hirokazu Iwaki
- Department of Rehabilitation, IMS Itabashi Rehabilitation Hospital, 3-11-1 Azukizawa, Itabashi-ku, Tokyo, 174-0051, Japan
| | - Katsuhiro Ueno
- Department of Rehabilitation, Nishi Memorial Port-island Rehabilitation Hospital, 8-5-2, Minatojimanakamachi, Chuo-ku, Kobe, Hyogo, 650-0046, Japan
| | - Kentaro Iwata
- Department of Rehabilitation, Kobe City Medical Center General Hospital, 1-1-2 Minatojimaminami-Cho, Chuo-ku, Kobe-shi, 650-0047, Japan
| | - Masakazu Saitoh
- Department of Physical Therapy, Faculty of Health Sciences, Juntendo University, 1-1 Hongo 2-chome, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tetsuya Takahashi
- Department of Physical Therapy, Faculty of Health Sciences, Juntendo University, 1-1 Hongo 2-chome, Bunkyo-ku, Tokyo, 113-8421, Japan
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Pan L, Wang H, Cao X, Ning T, Li X, Cao Y. A Higher Postoperative Barthel Index at Discharge is Associated with a Lower One-Year Mortality After Hip Fracture Surgery for Geriatric Patients: A Retrospective Case‒Control Study. Clin Interv Aging 2023; 18:835-843. [PMID: 37251305 PMCID: PMC10224694 DOI: 10.2147/cia.s409282] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/19/2023] [Indexed: 05/31/2023] Open
Abstract
Purpose To evaluate the relationship between the postoperative Barthel index assessing activities of daily living at discharge and the one-year mortality after hip fracture surgery. Methods Patients with hip fracture admitted to Peking University First Hospital from January 2015 to January 2020 were enrolled retrospectively according to the inclusion and exclusion criteria. The Barthel index and other related confounding variables were collected. Logistic regression and Kaplan‒Meier survival curves were constructed to explore the relationship between the postoperative Barthel index at discharge and the one-year mortality of geriatric patients after hip fracture surgery. Results A total of 444 patients with a mean age of 81.61±6.14 years were included. A significant difference was not observed in the preoperative Barthel index at admission between the deceased group and the surviving group (38.90±15.83 vs 36.96±10.74, p=0.446). However, the difference in the postoperative Barthel index at discharge between these two groups was statistically significant (43.08±14.40 vs 53.18±13.43, P<0.001). The multivariable logistic regression analysis revealed that the postoperative Barthel index at discharge was an independent risk factor for one-year mortality after adjustment for confounding variables (adjusted OR 0.73, 95% CI 0.55-0.98, p˂0.05). The Kaplan‒Meier survival curve showed that patients who had a high Barthel index (≥50) at discharge had a significantly lower mortality in the long term than patients with a low Barthel index (<50) at discharge (P< 0.001). Conclusion The postoperative Barthel index at discharge was independently associated with the one-year mortality of geriatric patients after hip fracture surgery. A higher postoperative Barthel index at discharge indicated a lower mortality after hip fracture surgery. The Barthel index at discharge has the potential to provide essential prognostic information for early risk stratification and directing future care.
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Affiliation(s)
- Liping Pan
- Department of Orthopedics, Peking University First Hospital, Beijing, 100034, People’s Republic of China
| | - Hao Wang
- Department of Orthopedics, Peking University First Hospital, Beijing, 100034, People’s Republic of China
| | - Xiangyu Cao
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, People’s Republic of China
| | - Taiguo Ning
- Department of Orthopedics, Peking University First Hospital, Beijing, 100034, People’s Republic of China
| | - Xueying Li
- Department of Medical Statistics, Peking University First Hospital, Beijing, 100034, People’s Republic of China
| | - Yongping Cao
- Department of Orthopedics, Peking University First Hospital, Beijing, 100034, People’s Republic of China
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Association between postoperative delirium and heart rate variability in the intensive care unit and readmissions and mortality in elderly patients with cardiovascular surgery. Heart Vessels 2023; 38:438-447. [PMID: 36205773 DOI: 10.1007/s00380-022-02173-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 09/14/2022] [Indexed: 02/07/2023]
Abstract
This study aimed to investigate the relationship between heart rate variability (HRV), a parameter of the autonomic nervous system activity (ANSA), and postoperative delirium and postoperative events. This retrospective cohort study included elderly patients aged 65 years or older who were admitted to the intensive care unit (ICU) after cardiovascular surgery. ANSA was measured using HRV parameters for 1 h at daytime and 1 h at night-time before ICU discharge. The primary endpoint was the effect of HRV parameters and delirium on mortality and readmission rates within 1 year after discharge, and the secondary endpoint was the association between HRV parameters and delirium. Cox proportional hazards models were used to examine the association between HRV parameters and postoperative events by adjusting for delirium and pre and postoperative information. A total of 71 patients, 39 without delirium and 32 with delirium, met the inclusion criteria. The incidence of death and readmission within 1 year was significantly higher in the delirium group and in the group with higher daytime HF (high frequency power) and r-MSSD (square root of the squared mean of the difference of successive NN intervals), parameters of the parasympathetic nervous system activity (PNSA), than that in other groups. Furthermore, the delirium group had significantly higher HF and r-MSSD than the nondelirium group. Even after adjusting for confounding factors in the multivariate analysis, a trend of higher daytime HF and r-MSSD was observed, indicating a significant effect on the occurrence of combined events within 1 year of discharge. ICU delirium has been associated with higher daytime HF and r-MSSD, parameters of PNSA. ICU delirium was a prognostic factor, and increased daytime PNSA may worsen the prognosis of elderly patients after cardiovascular surgery.
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Hou XP, Zhang YY, Zhang HF, Wang S, Xing YL, Li HW, Sun Y. Combination of the Barthel Index at Discharge with GRACE Leads to Improved One-Year Mortality Prediction in Older Patients with Acute Myocardial Infarction. Clin Interv Aging 2023; 18:1-11. [PMID: 36628327 PMCID: PMC9826607 DOI: 10.2147/cia.s383609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/14/2022] [Indexed: 01/05/2023] Open
Abstract
Purpose Many older patients with acute myocardial infarction (AMI) have impaired ability for activities of daily living (ADL). Impaired ADL leads to poor prognosis in elderly patients. The Global Registry of Acute Coronary Events (GRACE) score is widely used for risk stratification in AMI patients but does not consider physical performance, which is an important prognosis predictor for older adults. This study assessed whether the Barthel Index (BI) score combine the GRACE score would achieve improved one-year mortality prediction in older AMI patients. Patients and Methods This single-center retrospective study included 688 AMI patients aged ≥65 years who were divided into an impaired ADL group (BI ≤60, n = 102) and a normal ADL group (BI >60, n = 586) based on BI scores at discharge. The participants were followed up for one year. Cox survival models were constructed for BI score, GRACE score, and BI score combined GRACE score for one-year mortality prediction. Results Patients had a mean age of 76.29 ± 7.42 years, and 399 were men (58%). A lower BI score was associated with more years of hypertension and diabetes, less revascularization, longer hospital stays, and higher one-year mortality after discharge. Multivariable Cox regression analysis identified BI as a significant risk factor for one-year mortality in older AMI patients (HR 0.977, 95% CI, 0.963-0.992, P = 0.002). BI (0.774, 95% CI: 0.731-0.818) and GRACE (0.758, 95% CI: 0.704-0.812) scores had similar predictive power, but their combination outperformed either score alone (0.810, 95% CI: 0.770-0.851). Conclusion BI at discharge is a significant risk factor for one-year mortality in older AMI patients, which can be better predicted by the combination of BI and GRACE scores.
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Affiliation(s)
- Xiao-Pei Hou
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yan-Yang Zhang
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Hong-Feng Zhang
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Shan Wang
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yun-Li Xing
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Hong-Wei Li
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Ying Sun
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China,Correspondence: Ying Sun, Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, No. 95 of Yong’an Road, Xicheng District, Beijing, People’s Republic of China, Tel +86-010-63137740, Email
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Shehu E, Trevisan C, Sambo S, Ceolin C, Pavan S, Piazzani F, Sergi G, March A. Sex Differences in the Burden of Hip Fractures on Functional Status in Older Age. J Womens Health (Larchmt) 2023; 32:57-62. [PMID: 36459629 DOI: 10.1089/jwh.2021.0270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background: Hip fractures can dramatically impact the health and self-sufficiency of older people. We investigated the influence of pre-fracture functional status on functional decline and mortality after hip fracture, and possible sex differences in this regard. Materials and Methods: The sample comprised 288 older patients hospitalized with hip fracture in an Orthogeriatric Unit. Data on perioperative management and multidimensional evaluation were collected. After 15 months, we obtained information on housing arrangements, new falls, walking level, and self-sufficiency (Barthel Index [BI]) through outpatient visits or phone interviews. Data on re-hospitalizations and deaths were obtained from hospital records. Results: The sample median age was 87 years, and 75% were women. The median pre-fracture BI was 75 (interquartile range [IQR]: 50, 100), and at follow-up it decreased by a median of 20 (IQR: 40, -5) points. Sex differences emerged among those with the highest pre-fracture functional status (BI ≥85), with women showing lower BI loss than men (-15 [IQR: -40, 0] vs. -30 [IQR: -80, -15], respectively; p = 0.04). A pre-fracture BI ≥85 (vs. <85) was associated with a 41% lower mortality rate (95% confidence interval [95% CI]: 0.21-0.79), especially in women (hazard ratios = 0.28, 95% CI: 0.11-0.69). Moreover, male sex was an independent risk factor for functional loss after a hip fracture (odds ratio = 2.52, 95% CI: 1.09-5.80). Conclusions: Older men may have a worse functional prognosis than women after a hip fracture. This difference seemed to be exacerbated in cases of high pre-fracture functional performance, suggesting that females have a greater functional reserve, namely better adaptation and recovery strategies to deal with the fracture. Clinical Trial Registration: Registration code: NCT02687698.
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Affiliation(s)
- Enron Shehu
- Geriatric Unit, Department of Medicine (DIMED), University of Padua, Padova, Italy.,Department of Geriatrics, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy
| | - Caterina Trevisan
- Geriatric Unit, Department of Medicine (DIMED), University of Padua, Padova, Italy
| | - Sara Sambo
- Geriatric Unit, Department of Medicine (DIMED), University of Padua, Padova, Italy
| | - Chiara Ceolin
- Geriatric Unit, Department of Medicine (DIMED), University of Padua, Padova, Italy
| | - Silvia Pavan
- Department of Geriatrics, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy
| | - Fabrizio Piazzani
- Department of Geriatrics, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy
| | - Giuseppe Sergi
- Geriatric Unit, Department of Medicine (DIMED), University of Padua, Padova, Italy
| | - Albert March
- Department of Geriatrics, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy
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Li D, Chen X, Li F, Jia Y, Li Z, Liu Y, Ye L, Gao Y, Zhang W, Li H, Zeng R, Wan Z, Zeng Z, Cao Y. Evaluation of risk stratification program based on trajectories of functional capacity in patients with acute coronary syndrome: The REACP study. Front Cardiovasc Med 2022; 9:1020488. [PMID: 36606276 PMCID: PMC9808036 DOI: 10.3389/fcvm.2022.1020488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Background As a validated assessment tool for functional disability (activities of daily living), the Barthel index (BI) assessed initially at admission has the potential to stratify patients with high-risk acute coronary syndrome (ACS). Dynamic trajectory evaluation of functional capacity in hospitals may provide more prognostic information. We aimed to establish a novel dynamic BI-based risk stratification program (DBRP) during hospitalization to predict outcomes among ACS patients. Methods A total of 2,837 ACS patients were included from the Retrospective Multicenter Study for Early Evaluation of Acute Chest Pain. The DBRP rating (low, medium, and high-risk categories) was calculated from dynamic BI at admission and discharge. The primary outcome was all-cause mortality, and the secondary outcome was cardiac mortality. Results Of all the included patients, 312 (11%) died during a median follow-up period of 18.0 months. Kaplan-Meier analysis revealed that the cumulative mortality was significantly higher in patients in the higher risk category according to the DBRP. Multivariable Cox regression analysis indicated that, compared to the low-risk category, the higher risk category in the DBRP was an independent strong predictor of all-cause mortality after adjusting for confounding factors (medium-risk category: hazard ratio [HR]: 1.756, 95% confidence interval [95% CI]: 1.214-2.540; P = 0.003; high-risk category: HR: 5.052, 95% CI: 3.744-6.817; P < 0.001), and the same result was found for cardiac mortality. Conclusion The DBRP was a useful risk stratification tool for the early dynamic assessment of patients with ACS. Clinical trial registration [http://www.chictr.org.cn], identifier [ChiCTR1900024657].
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Affiliation(s)
- Dongze Li
- Department of Emergency Medicine and West China School of Nursing, Laboratory of Emergency Medicine, Disaster Medical Center, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
| | - Xiaoli Chen
- Department of Emergency Medicine and West China School of Nursing, Laboratory of Emergency Medicine, Disaster Medical Center, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
| | - Fanghui Li
- Department of Cardiology, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
| | - Yu Jia
- Department of Emergency Medicine and West China School of Nursing, Laboratory of Emergency Medicine, Disaster Medical Center, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
| | - Zhilin Li
- Department of Emergency Medicine and West China School of Nursing, Laboratory of Emergency Medicine, Disaster Medical Center, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
| | - Yi Liu
- Department of Emergency Medicine and West China School of Nursing, Laboratory of Emergency Medicine, Disaster Medical Center, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
| | - Lei Ye
- Department of Emergency Medicine and West China School of Nursing, Laboratory of Emergency Medicine, Disaster Medical Center, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
| | - Yongli Gao
- Department of Emergency Medicine and West China School of Nursing, Laboratory of Emergency Medicine, Disaster Medical Center, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
| | - Wei Zhang
- Department of Emergency Medicine and West China School of Nursing, Laboratory of Emergency Medicine, Disaster Medical Center, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
| | - Hong Li
- Department of Emergency Medicine and West China School of Nursing, Laboratory of Emergency Medicine, Disaster Medical Center, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
| | - Rui Zeng
- Department of Cardiology, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
| | - Zhi Wan
- Department of Emergency Medicine and West China School of Nursing, Laboratory of Emergency Medicine, Disaster Medical Center, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
| | - Zhi Zeng
- Department of Emergency Medicine and West China School of Nursing, Laboratory of Emergency Medicine, Disaster Medical Center, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China,Zhi Zeng,
| | - Yu Cao
- Department of Emergency Medicine and West China School of Nursing, Laboratory of Emergency Medicine, Disaster Medical Center, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China,*Correspondence: Yu Cao,
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Kojima I, Tanaka S, Otobe Y, Suzuki M, Koyama S, Kimura Y, Ishiyama D, Maetani Y, Kusumi H, Terao Y, Abe R, Nishizawa K, Yamada M. What is the optimal nutritional assessment tool for predicting decline in the activity of daily living among older patients with heart failure? Heart Vessels 2022; 37:1356-1362. [PMID: 35122493 DOI: 10.1007/s00380-022-02033-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/21/2022] [Indexed: 11/04/2022]
Abstract
The clinical importance of nutritional management in activities of daily living (ADL) among older inpatients with heart failure (HF) is greatly increasing. We determined the optimal nutritional assessment tool that can predict ADL decline among older inpatients with HF. We prospectively investigated 91 inpatients aged ≥ 65 years with HF in an acute hospital. We measured their nutritional status at admission using nutrition indices: the controlling nutritional status (CONUT), the geriatric nutritional risk index, the prognostic nutritional index, and the mini nutritional assessment. Logistic regression analysis was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of the relationships between the malnutrition status assessed by each nutritional index category and the ADL decline measured by the Barthel index (BI) in the univariate and multivariate analyses. Among the participants, 28.6% (n = 26; median age 81.5 years; 69.2% men) of the participants were included in the Reduced BI group and 71.4% (n = 65; median age 79.0 years; 67.7% men) in the Maintained BI group. The Reduced BI group showed a significantly higher CONUT value than the Maintained BI group, but there were no significant differences in other nutritional indices. In the multivariate logistic regression analysis, a higher CONUT score was associated with a significantly elevated risk of Reduced BI (adjusted OR 0.24; 95%CI 0.08-0.75; p = 0.014). We found that CONUT is an appropriate nutritional assessment tool for predicting ADL decline among older inpatients with HF in the early phase of hospitalization.
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Affiliation(s)
- Iwao Kojima
- Department of Rehabilitation Medicine, Kawasaki Municipal Kawasaki Hospital, Kanagawa, Japan. .,Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan.
| | - Shu Tanaka
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Yuhei Otobe
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Mizue Suzuki
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Shingo Koyama
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Yosuke Kimura
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan.,Department of Electrical Engineering, Health and Sports Technology Course, Kanto Gakuin University, Kanagawa, Japan
| | - Daisuke Ishiyama
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Yusuke Maetani
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Haruhiko Kusumi
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Yusuke Terao
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Reon Abe
- Department of Rehabilitation Medicine, Kawasaki Municipal Kawasaki Hospital, Kanagawa, Japan
| | - Kenya Nishizawa
- Division of Cardiology, Department of Internal Medicine, Kawasaki Municipal Kawasaki Hospital, Kanagawa, Japan
| | - Minoru Yamada
- Faculty of Human Sciences, University of Tsukuba, Tokyo, Japan
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10
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Tedesco S, Andrulli M, Larsson MÅ, Kelly D, Alamäki A, Timmons S, Barton J, Condell J, O’Flynn B, Nordström A. Comparison of Machine Learning Techniques for Mortality Prediction in a Prospective Cohort of Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12806. [PMID: 34886532 PMCID: PMC8657506 DOI: 10.3390/ijerph182312806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 12/16/2022]
Abstract
As global demographics change, ageing is a global phenomenon which is increasingly of interest in our modern and rapidly changing society. Thus, the application of proper prognostic indices in clinical decisions regarding mortality prediction has assumed a significant importance for personalized risk management (i.e., identifying patients who are at high or low risk of death) and to help ensure effective healthcare services to patients. Consequently, prognostic modelling expressed as all-cause mortality prediction is an important step for effective patient management. Machine learning has the potential to transform prognostic modelling. In this paper, results on the development of machine learning models for all-cause mortality prediction in a cohort of healthy older adults are reported. The models are based on features covering anthropometric variables, physical and lab examinations, questionnaires, and lifestyles, as well as wearable data collected in free-living settings, obtained for the "Healthy Ageing Initiative" study conducted on 2291 recruited participants. Several machine learning techniques including feature engineering, feature selection, data augmentation and resampling were investigated for this purpose. A detailed empirical comparison of the impact of the different techniques is presented and discussed. The achieved performances were also compared with a standard epidemiological model. This investigation showed that, for the dataset under consideration, the best results were achieved with Random UnderSampling in conjunction with Random Forest (either with or without probability calibration). However, while including probability calibration slightly reduced the average performance, it increased the model robustness, as indicated by the lower 95% confidence intervals. The analysis showed that machine learning models could provide comparable results to standard epidemiological models while being completely data-driven and disease-agnostic, thus demonstrating the opportunity for building machine learning models on health records data for research and clinical practice. However, further testing is required to significantly improve the model performance and its robustness.
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Affiliation(s)
- Salvatore Tedesco
- Tyndall National Institute, University College Cork, Lee Maltings Complex, Dyke Parade, T12R5CP Cork, Ireland; (M.A.); (J.B.); (B.O.)
| | - Martina Andrulli
- Tyndall National Institute, University College Cork, Lee Maltings Complex, Dyke Parade, T12R5CP Cork, Ireland; (M.A.); (J.B.); (B.O.)
| | - Markus Åkerlund Larsson
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, SE-901 87 Umeå, Sweden; (M.Å.L.); (A.N.)
| | - Daniel Kelly
- School of Computing, Engineering and Intelligent Systems, Ulster University, Londonderry BT48 7JL, UK; (D.K.); (J.C.)
| | - Antti Alamäki
- Department of Physiotherapy, Karelia University of Applied Sciences, Tikkarinne 9, FI-80200 Joensuu, Finland;
| | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, University College Cork, T12XH60 Cork, Ireland;
| | - John Barton
- Tyndall National Institute, University College Cork, Lee Maltings Complex, Dyke Parade, T12R5CP Cork, Ireland; (M.A.); (J.B.); (B.O.)
| | - Joan Condell
- School of Computing, Engineering and Intelligent Systems, Ulster University, Londonderry BT48 7JL, UK; (D.K.); (J.C.)
| | - Brendan O’Flynn
- Tyndall National Institute, University College Cork, Lee Maltings Complex, Dyke Parade, T12R5CP Cork, Ireland; (M.A.); (J.B.); (B.O.)
| | - Anna Nordström
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, SE-901 87 Umeå, Sweden; (M.Å.L.); (A.N.)
- School of Sport Sciences, UiT the Arctic University of Norway, 9037 Tromsø, Norway
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11
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Maki N, Sakamoto H, Takata Y, Taniguchi K, Wijesinghe A, Okamura J, Kawamura T, Yanagihara T, Saeki Y, Kitazawa S, Kobayashi N, Kikuchi S, Goto Y, Ichimura H, Sato Y, Yanagi H. Effect of pulmonary training for community‐dwelling frail older adults with chronic stroke: A randomized controlled pilot trial. J Gen Fam Med 2021; 23:140-148. [PMID: 35509345 PMCID: PMC9062559 DOI: 10.1002/jgf2.511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 10/16/2021] [Accepted: 11/08/2021] [Indexed: 11/30/2022] Open
Abstract
Background Decreased pulmonary function and poor deglutition are a major risk factor for poststroke aspiration pneumonia. We analyzed the benefits of pulmonary training on pulmonary function, deglutition, and quality of life (QOL) in community‐dwelling, frail elderly people with chronic stroke. Method This study was designed as an open, randomized, controlled pilot trial. The participants, who were frail older adults with a history of stroke, were randomized to 2 rehabilitation groups: intervention group (n = 15) and control (n = 15). All participants (65–94 years) attended twelve 20‐min sessions twice a week for 6 weeks of either standard rehabilitation (control group) or standard rehabilitation with pulmonary training including home pulmonary exercise (intervention group). The main outcome measures were pulmonary function (%MIP), deglutition (DRACE), and QOL (SF8・PCS), while secondary outcomes were muscle strength (grip and abdominal), thorax flexibility, 6‐min walk distance, and activities in daily living. All outcomes were measured both prior to training and after the 12 sessions. Results The intervention group showed significant improvement in %MIP (95% CI, 2.9–31.6; p < 0.01), DRACE (95% CI, −4.1–0.1; p < 0.01), and SF8・PCS (95% CI, 2.5–7.2; p < 0.01) compared with controls. There were no cognitive function decline and higher brain dysfunction. Conclusions These results suggest that the addition of pulmonary training including home pulmonary exercise to a standard rehabilitation program could improve pulmonary function, deglutition, and QOL in frail elderly people with chronic stroke.
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Affiliation(s)
- Naoki Maki
- Department of Thoracic Surgery Faculty of Medicine University of Tsukuba Tsukuba Japan
| | | | - Yu Takata
- AHR Medical and Welfare College School Tsuchiura Japan
| | | | - Ashoka Wijesinghe
- Department of Thoracic Surgery Faculty of Medicine University of Tsukuba Tsukuba Japan
| | - Junko Okamura
- Department of Thoracic Surgery Faculty of Medicine University of Tsukuba Tsukuba Japan
| | - Tomoyuki Kawamura
- Department of Thoracic Surgery Faculty of Medicine University of Tsukuba Tsukuba Japan
| | - Takahiro Yanagihara
- Department of Thoracic Surgery Faculty of Medicine University of Tsukuba Tsukuba Japan
| | - Yusuke Saeki
- Department of Thoracic Surgery Faculty of Medicine University of Tsukuba Tsukuba Japan
| | - Shinsuke Kitazawa
- Department of Thoracic Surgery Faculty of Medicine University of Tsukuba Tsukuba Japan
| | - Naohiro Kobayashi
- Department of Thoracic Surgery Faculty of Medicine University of Tsukuba Tsukuba Japan
| | - Shinji Kikuchi
- Department of Thoracic Surgery Faculty of Medicine University of Tsukuba Tsukuba Japan
| | - Yukinobu Goto
- Department of Thoracic Surgery Faculty of Medicine University of Tsukuba Tsukuba Japan
| | - Hideo Ichimura
- Department of Thoracic Surgery Faculty of Medicine University of Tsukuba Tsukuba Japan
| | - Yukio Sato
- Department of Thoracic Surgery Faculty of Medicine University of Tsukuba Tsukuba Japan
| | - Hisako Yanagi
- Department of Medical Science and Welfare Faculty of Medicine University of Tsukuba Tsukuba Japan
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12
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Higuchi S, Kohno T, Kohsaka S, Shiraishi Y, Takei M, Goda A, Shoji S, Nagatomo Y, Yoshikawa T. Different Impact of Beta-Blockers on Long-Term Mortality in Heart Failure Patients with and without Chronic Obstructive Pulmonary Disease. J Clin Med 2021; 10:jcm10194378. [PMID: 34640396 PMCID: PMC8509631 DOI: 10.3390/jcm10194378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 12/04/2022] Open
Abstract
The administration of beta-blockers is challenging and their efficacy is unclear in heart failure (HF) patients with chronic obstructive pulmonary disease (COPD). This study aimed to investigate the association of beta-blockers with mortality in such patients. This multicenter observational cohort study included hospitalized HF patients with a left ventricular ejection fraction <50% and evaluated them retrospectively. COPD was diagnosed based on medical records and/or the clinical judgment of each investigator. The study endpoints were two-year all-cause, cardiac, and non-cardiac mortality. This study included 83 patients with COPD and 1760 patients without. Two-year all-cause, cardiac, and non-cardiac mortality were observed in 315 (17%), 149 (8%), and 166 (9%) patients, respectively. Beta-blockers were associated with lower all-cause mortality regardless of COPD (COPD: hazard ratio [HR] 0.39, 95% CI 0.16–0.98, p = 0.044; non-COPD: HR 0.62, 95% CI 0.46–0.83, p = 0.001). This association in HF patients with COPD persisted after multivariate analysis and inverse probability weighting and was due to lower non-cardiac mortality (HR 0.40, 95% CI 0.14–1.18. p = 0.098), not cardiac mortality (HR 0.37, 95% CI 0.07–2.01, p = 0.248). Beta-blockers were associated with lower all-cause mortality in HF patients with COPD due to lower non-cardiac mortality. This may reflect selection biases in beta-blocker prescription.
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Affiliation(s)
- Satoshi Higuchi
- Department of Emergency and General Medicine, Kyorin University School of Medicine, Tokyo 181-8611, Japan
- Correspondence: (S.H.); (T.K.)
| | - Takashi Kohno
- Department of Cardiovascular Medicine, Kyorin University School of Medicine, Tokyo 181-8611, Japan;
- Correspondence: (S.H.); (T.K.)
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan; (S.K.); (Y.S.); (S.S.)
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan; (S.K.); (Y.S.); (S.S.)
| | - Makoto Takei
- Department of Cardiology, Saiseikai Central Hospital, Tokyo 108-0073, Japan;
| | - Ayumi Goda
- Department of Cardiovascular Medicine, Kyorin University School of Medicine, Tokyo 181-8611, Japan;
| | - Satoshi Shoji
- Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan; (S.K.); (Y.S.); (S.S.)
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan;
| | - Tsutomu Yoshikawa
- Department of Cardiology, Sakakibara Heart Institute, Tokyo 183-0003, Japan;
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13
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Corrao S, Nobili A, Natoli G, Mannucci PM, Perticone F, Pietrangelo A, Argano C. Hyperglycemia at admission, comorbidities, and in-hospital mortality in elderly patients hospitalized in internal medicine wards: data from the RePoSI Registry. Acta Diabetol 2021; 58:1225-1236. [PMID: 33890176 PMCID: PMC8316168 DOI: 10.1007/s00592-021-01716-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/31/2021] [Indexed: 12/22/2022]
Abstract
AIMS The association between hyperglycemia at hospital admission and relevant short- and long-term outcomes in elderly population is known. We assessed the effects on mortality of hyperglycemia, disability, and multimorbidity at admission in internal medicine ward in patients aged ≥ 65 years. METHODS Data were collected from an active register of 102 internal medicine and geriatric wards in Italy (RePoSi project). Patients were recruited during four index weeks of a year. Socio-demographic data, reason for hospitalization, diagnoses, treatment, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), renal function, functional (Barthel Index), and cognitive status (Short Blessed Test) and mood disorders (Geriatric Depression Scale) were recorded. Mortality rates were assessed in hospital 3 and 12 months after discharge. RESULTS Of the 4714 elderly patients hospitalized, 361 had a glycemia level ≥ 250 mg/dL at admission. Compared to subjects with lower glycemia level, patients with glycemia ≥ 250 mg/dL showed higher rates of male sex, smoke and class III obesity. These patients had a significantly lower Barthel Index (p = 0.0249), higher CIRS-SI and CIRS-CI scores (p = 0.0025 and p = 0.0013, respectively), and took more drugs. In-hospital mortality rate was 9.2% and 5.1% in subjects with glycemia ≥ 250 and < 250 mg/dL, respectively (p = 0.0010). Regression analysis showed a strong association between in-hospital death and glycemia ≥ 250 mg/dL (OR 2.07; [95% CI 1.34-3.19]), Barthel Index ≤ 40 (3.28[2.44-4.42]), CIRS-SI (1.87[1.27-2.77]), and male sex (1.54[1.16-2.03]). CONCLUSIONS The stronger predictors of in-hospital mortality for older patients admitted in general wards were glycemia level ≥ 250 mg/dL, Barthel Index ≤ 40, CIRS-SI, and male sex.
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Affiliation(s)
- Salvatore Corrao
- Department of Internal Medicine, UOC Medicina Interna 2 iGR, National Relevance Hospital Trust, ARNAS Civico, Di Cristina e Benfratelli, Piazza Nicola Leotta, 4 - 90127, Palermo, Italy.
- Biomedical Department of Internal Medicine and Medical Specialties (DiBiMIS), University of Palermo, Palermo, Italy.
| | - Alessandro Nobili
- Department of Neuroscience, IRCCS Istituto Di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Giuseppe Natoli
- Department of Internal Medicine, UOC Medicina Interna 2 iGR, National Relevance Hospital Trust, ARNAS Civico, Di Cristina e Benfratelli, Piazza Nicola Leotta, 4 - 90127, Palermo, Italy
| | | | - Francesco Perticone
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Antonello Pietrangelo
- Department of Internal Medicine II, CenterforHemochromatosis, University of Modena and Reggio Emilia Policlinico, Modena, Italy
| | - Christiano Argano
- Department of Internal Medicine, UOC Medicina Interna 2 iGR, National Relevance Hospital Trust, ARNAS Civico, Di Cristina e Benfratelli, Piazza Nicola Leotta, 4 - 90127, Palermo, Italy
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14
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Sato M, Mutai H, Yamamoto S, Tsukakoshi D, Takeda S, Oguchi N, Ichimura H, Ikegami S, Wada Y, Seto T, Horiuchi H. Decreased activities of daily living at discharge predict mortality and readmission in elderly patients after cardiac and aortic surgery: A retrospective cohort study. Medicine (Baltimore) 2021; 100:e26819. [PMID: 34397842 PMCID: PMC8341368 DOI: 10.1097/md.0000000000026819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/15/2021] [Indexed: 01/04/2023] Open
Abstract
Recently, activities of daily living (ADL) were identified as a prognostic factor among elderly patients with heart disease; however, a specific association between ADL and prognosis after cardiac and aortic surgery is not well established. We aimed to clarify the impact of ADL capacity at discharge on prognosis in elderly patients after cardiac and aortic surgery.This retrospective cohort study included 171 elderly patients who underwent open operation for cardiovascular disease in a single center (median age: 74 years; men: 70%). We used the Barthel Index (BI) as an indicator for ADL. Patients were classified into 2 groups according to the BI at discharge, indicating a high (BI ≥ 85) or low (BI < 85) ADL status. All-cause mortality and unplanned readmission events were observed after discharge.Thirteen all-cause mortality and 44 all-cause unplanned readmission events occurred during the median follow-up of 365 days. Using Kaplan-Meier analysis, a low ADL status was determined to be significantly associated with all-cause mortality and unplanned readmission. In the multivariable Cox proportional hazard models, a low ADL status was an independent predictor of all-cause mortality and unplanned readmission after adjusting for age, sex, length of hospital stay, and other variables (including preoperative status, surgical parameter, and postoperative course).A low ADL status at discharge predicted all-cause mortality and unplanned readmission in elderly patients after cardiac and aortic surgery. A comprehensive approach from the time of admission to postdischarge to improve ADL capacity in elderly patients undergoing cardiac and aortic surgery may improve patient outcomes.
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Affiliation(s)
- Masaaki Sato
- Division of Occupational Therapy, Shinshu University School of Health Sciences, Matsumoto, Japan
- Department of Rehabilitation, Shinshu University Hospital, Matsumoto, Japan
| | - Hitoshi Mutai
- Division of Occupational Therapy, Shinshu University School of Health Sciences, Matsumoto, Japan
| | - Shuhei Yamamoto
- Department of Rehabilitation, Shinshu University Hospital, Matsumoto, Japan
| | - Daichi Tsukakoshi
- Department of Rehabilitation, Shinshu University Hospital, Matsumoto, Japan
| | - Shuhei Takeda
- Department of Rehabilitation, Shinshu University Hospital, Matsumoto, Japan
| | - Natsuko Oguchi
- Department of Rehabilitation, Shinshu University Hospital, Matsumoto, Japan
| | - Hajime Ichimura
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shota Ikegami
- Department of Rehabilitation, Shinshu University Hospital, Matsumoto, Japan
| | - Yuko Wada
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tatsuichiro Seto
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiroshi Horiuchi
- Department of Rehabilitation, Shinshu University Hospital, Matsumoto, Japan
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15
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Gauthier V, Cottel D, Amouyel P, Dallongeville J, Meirhaeghe A. Large disparities in 28-day case fatality by stroke subtype: data from a French stroke registry between 2008 and 2017. Eur J Neurol 2021; 28:2208-2217. [PMID: 33942445 PMCID: PMC8252764 DOI: 10.1111/ene.14876] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The objectives of the present analysis were to assess 28-day stroke case fatality according to the stroke aetiology and to identify associated factors. METHODS All stroke events in adults aged ≥35 years between 2008 and 2017 were collected in a population-based stroke registry in northern France. RESULTS Out of a total of 2933 strokes, there were 479 (16%) haemorrhagic strokes and 2454 (84%) ischaemic strokes; the 28-day case fatality rates were 48% and 15%, respectively. Three-quarters of the 28-day case fatalities occurred within 6 days of the event for haemorrhagic strokes and within 16.5 days for ischaemic strokes. After an ischaemic stroke, the case fatality rate was higher for women (18%) than for men (12%, p < 0.0001); however, this difference disappeared after adjustment for age. Cardioembolic strokes (34%) and strokes of undetermined cause (33%) were the most common ischaemic subtypes, with case fatality rates of 16% and 18%, respectively. Large artery atherosclerosis (11%) and lacunar strokes (10%) were less common, and both types had a case fatality rate of 3%. Age at the time of the event and stroke severity were both significantly associated with case fatality. For some types of stroke, a history of cardiovascular events and residence in a nursing home were associated with a poor prognosis. Medical care in a neurology ward was inversely associated with case fatality, for all stroke subtypes. CONCLUSIONS In northern France, post-stroke case fatality remains high, especially for haemorrhagic stroke. Being treated in a neurology ward improved survival by around 80%.
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Affiliation(s)
- Victoria Gauthier
- Facteurs de Risque et Déterminants Moléculaires des Maladies Liées au Vieillissement, INSERM, CHU Lille, Institut Pasteur de Lille, Univ. Lille, Lille, France
| | - Dominique Cottel
- Facteurs de Risque et Déterminants Moléculaires des Maladies Liées au Vieillissement, INSERM, CHU Lille, Institut Pasteur de Lille, Univ. Lille, Lille, France
| | - Philippe Amouyel
- Facteurs de Risque et Déterminants Moléculaires des Maladies Liées au Vieillissement, INSERM, CHU Lille, Institut Pasteur de Lille, Univ. Lille, Lille, France
| | - Jean Dallongeville
- Facteurs de Risque et Déterminants Moléculaires des Maladies Liées au Vieillissement, INSERM, CHU Lille, Institut Pasteur de Lille, Univ. Lille, Lille, France
| | - Aline Meirhaeghe
- Facteurs de Risque et Déterminants Moléculaires des Maladies Liées au Vieillissement, INSERM, CHU Lille, Institut Pasteur de Lille, Univ. Lille, Lille, France
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16
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Li F, Li D, Yu J, Jia Y, Jiang Y, Chen T, Gao Y, Wan Z, Cao Y, Zeng Z, Zeng R. Barthel Index as a Predictor of Mortality in Patients with Acute Coronary Syndrome: Better Activities of Daily Living, Better Prognosis. Clin Interv Aging 2020; 15:1951-1961. [PMID: 33116449 PMCID: PMC7568594 DOI: 10.2147/cia.s270101] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/27/2020] [Indexed: 02/05/2023] Open
Abstract
Background The Barthel index (BI) is a widely used assessment tool for evaluating physical performance in activities of daily living (ADL). The association between BI scores and mortality in hospital and during follow-up of acute coronary syndrome (ACS) patients remains unclear. The present study investigated whether the BI score could be used as a predictor for mortality of ACS. Methods We investigated ACS patients from the multi-center Retrospective Evaluation of Acute Chest Pain (REACP) study. The association between BI scores and all-cause mortality of patients with ACS was analyzed by Cox proportional hazards models. The primary endpoint was all-cause death and the secondary endpoint was cardiac death during follow-up. Results Among 2908 patients with ACS enrolled, 277 (9.5%) patients died within a median follow-up time of 10.6 months. Patients with lower BI had higher risks of mortality, compared with those with higher BI in ACS patients. Kaplan–Meier analysis revealed that patients with lower BI had worse survival rates than patients with higher BI (P < 0.001). After adjustment for potential influencing factors, multivariate Cox regression analysis showed that the BI was independently associated with all-cause mortality and cardiac mortality, respectively. Conclusion The BI at admission has the powerful potential to provide useful prognostic information of early risk stratification, and routine recording of the BI at the ED visit may help in decision-making and health care planning for patients with ACS.
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Affiliation(s)
- Fanghui Li
- Department of Emergency Medicine and Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, People's Republic of China
| | - Dongze Li
- Department of Emergency Medicine and Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, People's Republic of China
| | - Jing Yu
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yu Jia
- Department of Emergency Medicine and Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, People's Republic of China
| | - Ying Jiang
- Department of Emergency Medicine and Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, People's Republic of China
| | - Tengda Chen
- Department of Emergency Medicine and Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, People's Republic of China
| | - Yongli Gao
- Department of Emergency Medicine and Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, People's Republic of China
| | - Zhi Wan
- Department of Emergency Medicine and Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, People's Republic of China
| | - Yu Cao
- Department of Emergency Medicine and Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, People's Republic of China
| | - Zhi Zeng
- Department of Emergency Medicine and Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, People's Republic of China
| | - Rui Zeng
- Department of Emergency Medicine and Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, People's Republic of China.,Department of Cardiology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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17
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Huang W, Sun Y, Xing Y, Wang C. Functional impairment and serum albumin predict in-hospital mortality in nonagenarians with acute infection: a retrospective cohort study. BMC Geriatr 2019; 19:269. [PMID: 31615427 PMCID: PMC6794842 DOI: 10.1186/s12877-019-1301-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 09/30/2019] [Indexed: 11/17/2022] Open
Abstract
Background Acute infection leads to substantial mortality in the nonagenarian population. However, the predictive efficacies of functional status and biochemical indexes for in-hospital mortality in these patients remain to be determined. Methods A single-center, retrospective cohort study was performed. Consecutive nonagenarian patients who were admitted to our department from January 1, 2014 to December 31, 2016 for acute infectious diseases were included. Baseline data for medical history, functional status, and biochemical indexes were obtained on admission. The outcomes of these patients during hospitalization were recorded. Predictors of in-hospital mortality were identified via logistic regression analyses. Results A total of 162 patients were included, and 46 patients died (17.2%) during hospitalization. Univariate analysis showed that the prevalence rates of atrial fibrillation (32.1%) and malignant disease (26.5%) were higher in nonagenarian patients who died during hospitalization than in those who discharged. Multivariate logistic regression analyses identified malignant disease (odds ratio [OR] 2.73, 95% confidence interval [CI]: 1.10–6.78), ADL category (OR 0.82, 95% CI: 0.75–0.89) and serum albumin (OR 0.86, 95%CI 0.78–0.95) as independent predictors of in-hospital mortality in nonagenarian patients hospitalized for acute infection. Conclusions Functional impairment as well as serum albumin may be independent predictors of in-hospital mortality in nonagenarian patients hospitalized for acute infectious diseases. Stratification of patients according to Barthel Index score and serum albumin is very necessary.
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Affiliation(s)
- Wei Huang
- Department of Geriatrics and Gerontology. Beijing Friendship Hospital, Capital Medical University, No.95 Yong'an Road Xicheng District, Beijing, People's Republic of China
| | - Ying Sun
- Department of Geriatrics and Gerontology. Beijing Friendship Hospital, Capital Medical University, No.95 Yong'an Road Xicheng District, Beijing, People's Republic of China.
| | - Yunli Xing
- Department of Geriatrics and Gerontology. Beijing Friendship Hospital, Capital Medical University, No.95 Yong'an Road Xicheng District, Beijing, People's Republic of China
| | - Cuiying Wang
- Department of Geriatrics and Gerontology. Beijing Friendship Hospital, Capital Medical University, No.95 Yong'an Road Xicheng District, Beijing, People's Republic of China
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The Charlson Comorbidity and Barthel Index predict length of hospital stay, mortality, cardiovascular mortality and rehospitalization in unselected older patients admitted to the emergency department. Aging Clin Exp Res 2019; 31:1233-1242. [PMID: 30406920 DOI: 10.1007/s40520-018-1067-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 11/01/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS The Charlson Comorbidity Index (CCI) is the most widely used assessment tool to report the presence of comorbid conditions. The Barthel index (BI) is used to measure performance in activities of daily living. We prospectively investigated the performance of CCI or BI to predict length of hospital stay (LOS), mortality, cardiovascular (CV) mortality and rehospitalization in unselected older patients on admission to the emergency department (ED). We also studied the association of CCI or BI with costs. METHODS We consecutively enrolled 307 non-surgical patients ≥ 68 years presenting to the ED with a wide range of comorbid conditions. Baseline characteristic, clinical presentation, laboratory data, echocardiographic parameters and hospital costs were compared among patients. All patients were followed up for mortality, CV mortality and rehospitalization within the following 12 months. A multivariate analysis was performed. RESULTS Mortality was increased for patients having a higher CCI or BI with a hazard ratio around 1.17-1.26 or 0.75-0.81 (obtained for different models) for one or ten point increase in CCI or BI, respectively. The prognostic impact of a high CCI or BI on CV mortality and rehospitalization was also significant. In a multiple linear regression using the same independent variables, CCI and BI were identified as a predictor of LOS in days. Multiple linear regression analysis did not confirm an association between CCI and costs, but for BI after adjusting for multiple factors. CONCLUSION CCI and BI independently predict LOS, mortality, CV mortality, and rehospitalization in unselected older patients admitted to ED.
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Fukui S, Kawakami M, Otaka Y, Ishikawa A, Yashima F, Hayashida K, Muraoka K, Liu M. Activities of daily living among elderly persons with severe aortic stenosis. Disabil Rehabil 2019; 43:338-344. [PMID: 31204521 DOI: 10.1080/09638288.2019.1624838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To determine the level of limitations in activities of daily living (ADL) and instrumental ADL, and identify related factors to instrumental ADL among elderly persons with severe aortic stenosis (AS). MATERIALS AND METHODS We prospectively enrolled 112 consecutive elderly persons (mean age, 84.6 ± 4.4 y) with severe AS. We assessed ADL and instrumental ADL using the Barthel index (BI) and the Frenchay activities index (FAI), respectively. Cardiac, physical, cognitive and kidney functions, nutritional status, medical histories, and comorbidities were assessed. A multiple logistic analysis was developed to explore related factors to the FAI. RESULTS The medians (ranges) of BI and FAI were 100 (15-100) and 21 (0-38), respectively. The multiple logistic analysis revealed that a history of heart failure (sβ = -0.189), a history of cerebrovascular disease (sβ = -0.233), the short physical performance battery score ≤ 8 (sβ = -0.272), the mini-mental state examination score ≤ 23 (sβ = -0.168) were significantly related to the FAI (p < 0.05). CONCLUSIONS Physical frailty, a history of heart failure, cerebrovascular disease, and cognitive decline were independently related to declined instrumental ADL. IMPLICATIONS FOR REHABILIATION Activities of daily living was well-preserved among elderly persons with severe aortic stenosis. Instrumental activities of daily living varied among patients with aortic stenosis and was sometimes impaired. Physical frailty, a history of heart failure, and a history of cerebrovascular disease were independently associated with instrumental activities of daily living in elderly persons with severe aortic stenosis.
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Affiliation(s)
- Shogo Fukui
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Aiko Ishikawa
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Fumiaki Yashima
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Kaori Muraoka
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Meigen Liu
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
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Uemura S, Okamoto H, Nakai M, Nishimura K, Miyamoto Y, Yasuda S, Tanaka N, Kohsaka S, Kadota K, Saito Y, Tsutsui H, Komuro I, Ikari Y, Ogawa H, Nakamura M. Primary Percutaneous Coronary Intervention in Elderly Patients With Acute Myocardial Infarction ― An Analysis From a Japanese Nationwide Claim-Based Database ―. Circ J 2019; 83:1229-1238. [DOI: 10.1253/circj.cj-19-0004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shiro Uemura
- Cardiovascular Medicine, Kawasaki Medical School
| | | | | | | | | | | | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | | | | | | | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo
| | - Yuji Ikari
- Department of Cardiovascular Medicine, Tokai University School of Medicine
| | | | - Masato Nakamura
- Division of Cardiovascular Medicine, Ohashi Medical Center, Toho University School of Medicine
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21
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Abdo R, Abboud H, Salameh P, El Hajj T, Hosseini H. Mortality and Predictors of Death Poststroke: Data from a Multicenter Prospective Cohort of Lebanese Stroke Patients. J Stroke Cerebrovasc Dis 2019; 28:859-868. [PMID: 30638943 DOI: 10.1016/j.jstrokecerebrovasdis.2018.11.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/13/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Despite efforts to reduce stroke mortality rates, the disease remains a leading cause of death in Lebanon highlighting the importance of understanding risk factors and subsequent mortality. We examined mortality rates during the first year after acute stroke and the major short-term (1-month) and long-term (1-year) mortality predictors. METHODS Data were collected prospectively on hospitalized stroke patients from 8 hospitals in Beirut during a 1-year period. Patients were followed up for 1-year or until death. Mortality rates were assessed at 1-month and at 1-year poststroke and predictors of death were evaluated using Cox proportional hazard model. RESULTS A total of 191 stroke patients were included. Survival data were completed for over 97% of patients. Cumulative mortality rates were 14.1% at 1-month and 22% at 1-year. Predictors of short-term and long-term mortality in univariate analysis were low socioeconomic status, intensive care unit admission, decreased level of consciousness, stroke severity, and presence of complications. Marital status also predicted short-term mortality, while age greater than 64 years, atrial fibrillation, coronary heart disease, hypertension, Bamford and TOAST classifications and surgery need were also long-term mortality predictors. In multivariate analysis, stroke severity and presence of complications were predictors of death at 1-month and at 1-year. Low socioeconomic status, dependency in daily living activities, and the presence of comorbidities were additional predictors of 1-year mortality. CONCLUSIONS Approximately 1 over 5 of patients did not survive 1-year after stroke. There is a need for public awareness campaigns to improve stroke knowledge, warning, and prevention which may reduce this high stroke mortality rate in Lebanon.
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Affiliation(s)
- Rachel Abdo
- Laboratory of Clinical and Epidemiology Research, Faculties of Pharmacy and of Public Health, Lebanese University, Beirut, Lebanon; Doctoral School of Life and Health Sciences, Paris-Est University, Creteil, France; INSPECT-LB (Institut National de Santé Publique, d'Epidémiologie Clinique et Toxicologie-Liban), Faculty of Public Health, Fanar, Lebanon.
| | - Halim Abboud
- Department of Neurology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Pascale Salameh
- INSPECT-LB (Institut National de Santé Publique, d'Epidémiologie Clinique et Toxicologie-Liban), Faculty of Public Health, Fanar, Lebanon; Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Taghrid El Hajj
- Faculty of Medicine, Lebanese University, Beirut, Lebanon; Department of Neurology, Rafic Hariri University Hospital, Beirut, Lebanon
| | - Hassan Hosseini
- Department of Neurology, Henri Mondor Hospital AP-HP, Creteil, France
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22
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Leistner DM, Münch C, Steiner J, Jakob P, Reinthaler M, Sinning D, Fröhlich GM, Mochmann HC, Rauch-Kröhnert U, Skurk C, Lauten A, Landmesser U, Stähli BE. Effect of Physical Disability on Mortality in Elderly Patients of ≥80 Years of Age Undergoing Percutaneous Coronary Intervention. Am J Cardiol 2018; 122:537-541. [PMID: 30205884 DOI: 10.1016/j.amjcard.2018.04.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 04/22/2018] [Accepted: 04/30/2018] [Indexed: 10/28/2022]
Abstract
Functional decrease has been linked with adverse events in different clinical contexts. The predictive role of activity of daily living status as assessed by the Barthel index (BI) in elderly patients who underwent percutaneous coronary intervention (PCI) has not been investigated, yet. In this study, a total of 616 patients (≥80 years) who underwent PCI between January 2009 and December 2014 and with available activity of daily living data on admission were stratified according to BI (low BI <85, intermediate BI 85 to 95, high BI 100). The primary end point was all-cause mortality at a total follow-up of 442 days (interquartile range 47 to 1243). Of the 616 patients, 178 (29%), 128 (21%), and 310 (50%) were in the low, the intermediate, and the high BI groups, respectively. All-cause mortality was 10%, 13%, and 5% in the low, the intermediate, and the high BI groups, respectively (log-rank p <0.001). Belonging to the high BI group was associated with a reduced risk of all-cause mortality (hazard ratio 0.35, 95% confidence interval 0.18 to 0.69, p = 0.002), and associations remained significant after multivariable adjustments (adjusted hazard ratio 0.34, 95% confidence interval 0.13 to 0.93, p = 0.04). Functional capacity was identified as independent predictor of survival in a large cohort of patients who underwent PCI. In conclusion, activities of daily living should be incorporated into the risk stratification of elderly patients with coronary artery disease.
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Corrao S, Argano C, Natoli G, Nobili A, Corazza GR, Mannucci PM, Perticone F. Disability, and not diabetes, is a strong predictor of mortality in oldest old patients hospitalized with pneumonia. Eur J Intern Med 2018; 54:53-59. [PMID: 29728312 DOI: 10.1016/j.ejim.2018.04.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/09/2018] [Accepted: 04/10/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pneumonia causes more deaths than any other infectious disease, especially in older patients with multiple chronic diseases. Recent studies identified a low functional status as prognostic factor for mortality in elderly patients with pneumonia while contrasting data are available about the role of diabetes. The aim of this study was to evaluate the in-hospital, 3-month and 1-year mortality in elderly subjects affected by pneumonia enrolled in the RePoSi register. METHODS We retrospectively analyzed the data collected on hospitalized elderly patients in the frame of the REPOSI project. We analyzed the socio-demographic, laboratory and clinical characteristics of subjects with pneumonia. Multivariate logistic analysis was used to explore the relationship between variables and mortality. RESULTS Among 4714 patients 284 had pneumonia. 52.8% were males and the mean age was 80 years old. 19.8% of these patients had a Barthel Index ≤40 (p ˂ 0.0001), as well as 43.2% had a short blessed test ≥10 (p ˂ 0.0117). In these subjects a significant CIRS for the evaluation of severity and comorbidity indexes (p ˂ 0.0001) were present. Although a higher fasting glucose level was identified in people with pneumonia, in the multivariate logistic analysis diabetes was not independently associated with in-hospital, 3-month and 1-year mortality, whereas patients with lower Barthel Index had a higher mortality risk (odds ratio being 9.45, 6.84, 19.55 in hospital, at 3 and 12 months). CONCLUSION Elderly hospitalized patients affected by pneumonia with a clinically significant disability had a higher mortality risk while diabetes does not represent an important determinant of short and long-term outcome.
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Affiliation(s)
- S Corrao
- Dipartimento Biomedico di Medicina Interna e Specialistica (DiBiMIS), University of Palermo, Italy; Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo, Italy.
| | - C Argano
- Ospedali Riuniti Villa Sofia-Cervello, PO Villa Sofia, Internal Medicine Department, Palermo, Italy
| | - G Natoli
- Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo, Italy
| | - A Nobili
- Department of Neuroscience, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - G R Corazza
- Department of Internal Medicine, University of Pavia and San Matteo Hospital, Pavia, Italy
| | - P M Mannucci
- Scientific Direction, IRCCS Foundation Maggiore Policlinico Hospital, Milan, Italy
| | - F Perticone
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
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Chivite D, Formiga F, Corbella X, Conde-Martel A, Aramburu Ó, Carrera M, Dávila MF, Pérez-Silvestre J, Manzano L, Montero-Pérez-Barquero M. Basal functional status predicts one-year mortality after a heart failure hospitalization in elderly patients - The RICA prospective study. Int J Cardiol 2018; 254:182-188. [PMID: 29407089 DOI: 10.1016/j.ijcard.2017.10.104] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 10/10/2017] [Accepted: 10/26/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Dependence for basic activities of the daily living (ADL) relates to adverse outcomes in elderly acute heart failure (AHF) patients. METHODS We evaluated patients ≥75years admitted because of AHF, divided according to preadmission Barthel Index (BI) category: severe (BI 0-60), moderate (BI 61-90) and slight dependence or independence for basic ADL (BI 91-100). We compared their baseline characteristics and used logistic regression models to determine whether a BI≤60 confers higher one-year mortality risk. RESULTS We included 2195 patients, mean age 83years; 57% women, Charlson Index 3, 65% with preserved left ventricular ejection fraction. Their median preadmission BI was 90 (65-100); 21.7% had BI≤60. Patients with BI≤60 were older, more often females, with higher comorbid and cognitive burden and more likely to be institutionalized. 560 patients (26%) died within the follow-up period. A preadmission BI≤60 was significantly associated with higher risk of 12-month mortality (HR 1.42, 95% CI 1.14-1.77) together with male sex (1.27, 1.04-1.54), valve disease (1.49, 1.20-1.83), worse preadmission NYHA class (1.44, 1.20-1.73), stage IV chronic kidney disease (1.70, 1.35-2.15), pulmonary edema (1.33, 1.01-1.76), no family support (1.47, 1.06-2.06), and higher Charlson Comorbidity Index (1.09, CI 1.05-1.13) and Pfeiffer cognitive screening questionnaire scores (1.10, 1.05-1.14). CONCLUSION Among elderly AHF patients, the presence of severe (BI≤60) preadmission dependence for basic ADL confers a significant and independent risk of one-year post-discharge mortality.
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Affiliation(s)
- David Chivite
- Geriatric Unit, Internal Medicine Service, IDIBELL, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Francesc Formiga
- Geriatric Unit, Internal Medicine Service, IDIBELL, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Corbella
- Geriatric Unit, Internal Medicine Service, IDIBELL, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Alicia Conde-Martel
- Internal Medicine Department, Hospital Universitario Dr. Negrín. Las Palmas de Gran Canaria, Spain
| | - Óscar Aramburu
- Internal Medicine Department, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
| | - Margarita Carrera
- Internal Medicine Department, Complejo Hospitalario de Soria, Soria, Spain
| | - Melitón Francisco Dávila
- Internal Medicine Department, Hospital Universitario Ntra. Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - José Pérez-Silvestre
- Internal Medicine Department, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Luis Manzano
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá (IRYCIS), Madrid, Spain
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Kodama A, Koyama A, Sugimoto M, Niimi K, Banno H, Komori K. Association Between Preoperative Frailty and Mortality in Patients With Critical Limb Ischemia Following Infrainguinal Bypass Surgery ― Usefulness of the Barthel Index ―. Circ J 2018; 82:267-274. [DOI: 10.1253/circj.cj-17-0369] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akio Kodama
- Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Akio Koyama
- Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Masayuki Sugimoto
- Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Kiyoaki Niimi
- Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hiroshi Banno
- Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Kimihiro Komori
- Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
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26
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Moskowitz EE, Overbey DM, Jones TS, Jones EL, Arcomano TR, Moore JT, Robinson TN. Post-operative delirium is associated with increased 5-year mortality. Am J Surg 2017; 214:1036-1038. [DOI: 10.1016/j.amjsurg.2017.08.034] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 07/30/2017] [Accepted: 08/17/2017] [Indexed: 01/08/2023]
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Yu WC, Chou MY, Peng LN, Lin YT, Liang CK, Chen LK. Synergistic effects of cognitive impairment on physical disability in all-cause mortality among men aged 80 years and over: Results from longitudinal older veterans study. PLoS One 2017; 12:e0181741. [PMID: 28746360 PMCID: PMC5528830 DOI: 10.1371/journal.pone.0181741] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 07/06/2017] [Indexed: 12/30/2022] Open
Abstract
Objective We evaluated effects of the interrelationship between physical disability and cognitive impairment on long-term mortality of men aged 80 years and older living in a retirement community in Taiwan. Methods This prospective cohort study enrolled older men aged 80 and older living in a Veterans Care Home. Those with confirmed diagnosis of dementia were excluded. All participants received comprehensive geriatric assessment, including sociodemographic data, Charlson’s Comorbidity Index (CCI), geriatric syndromes, activities of daily living (ADL) using the Barthel index and cognitive function using the Mini-Mental State Examination (MMSE). Subjects were categorized into normal cognitive function, mild cognitive deterioration, and moderate-to-severe cognitive impairment and were further stratified by physical disability status. Kaplan-Meier log-rank test was used for survival analysis. After adjusting for sociodemographic characteristics and geriatric syndromes, Cox proportional hazards model was constructed to examine associations between cognitive function, disability and increased mortality risk. Results Among 305 male subjects aged 85.1 ± 4.1 years, 89 subjects died during follow-up (mean follow-up: 1.87 ± 0.90 years). Kaplan-Meier unadjusted analysis showed reduced survival probability associated with moderate-to-severe cognitive status and physical disability. Mortality risk increased significantly only for physically disabled subjects with simultaneous mild cognitive deterioration (adjusted HR 1.951, 95% CI 1.036–3.673, p = 0.038) or moderate-to-severe cognitive impairment (aHR 2.722, 95% CI 1.430–5.181, p = 0.002) after adjusting for age, BMI, education levels, smoking status, polypharmacy, visual and hearing impairment, urinary incontinence, fall history, depressive symptoms and CCI. Mortality risk was not increased among physically independent subjects with or without cognitive impairment, and physically disabled subjects with intact cognition. Conclusions Physical disability is a major risk factor for all-cause mortality among men aged 80 years and older, and risk increased synergistically when cognitive impairment was present. Cognitive impairment alone without physical disability did not increase mortality risk in this population.
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Affiliation(s)
- Wan-Chen Yu
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ming-Yueh Chou
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
| | - Li-Ning Peng
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Te Lin
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Division of Neurology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chih-Kuang Liang
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
- Division of Neurology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- * E-mail: (CKL); (LKC)
| | - Liang-Kung Chen
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
- * E-mail: (CKL); (LKC)
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Patti G, Lucerna M, Pecen L, Siller-Matula JM, Cavallari I, Kirchhof P, De Caterina R. Thromboembolic Risk, Bleeding Outcomes and Effect of Different Antithrombotic Strategies in Very Elderly Patients With Atrial Fibrillation: A Sub-Analysis From the PREFER in AF ( PREvention o F Thromboembolic Events- European Registry in Atrial Fibrillation). J Am Heart Assoc 2017; 6:e005657. [PMID: 28736385 PMCID: PMC5586290 DOI: 10.1161/jaha.117.005657] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 05/15/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND Increasing age predisposes to both thromboembolic and bleeding events in patients with atrial fibrillation; therefore, balancing risks and benefits of antithrombotic strategies in older populations is crucial. We investigated 1-year outcome with different antithrombotic approaches in very elderly atrial fibrillation patients (age ≥85 years) compared with younger patients. METHODS AND RESULTS We accessed individual patients' data from the prospective PREFER in AF (PREvention oF thromboembolic events-European Registry in Atrial Fibrillation), compared outcomes with and without oral anticoagulation (OAC), and estimated weighed net clinical benefit in different age groups. A total of 6412 patients, 505 of whom were aged ≥85 years, were analyzed. In patients aged <85 years, the incidence of thromboembolic events was 2.8%/year without OAC versus 2.3%/year with OAC (0.5% absolute reduction); in patients aged ≥85 years, it was 6.3%/year versus 4.3%/year (2% absolute reduction). In very elderly patients, the risk of major bleeding was higher than in younger patients, but similar in patients on OAC and in those on antiplatelet therapy or without antithrombotic treatment (4.0%/year versus 4.2%/year; P=0.77). OAC was overall associated with weighted net clinical benefit, assigning weights to nonfatal events according to their prognostic implication for subsequent death (-2.19%; CI, -4.23%, -0.15%; P=0.036). We found a significant gradient of this benefit as a function of age, with the oldest patients deriving the highest benefit. CONCLUSIONS Because the risk of stroke increases with age more than the risk of bleeding, the absolute benefit of OAC is highest in very elderly patients, where it, by far, outweighs the risk of bleeding, with the greatest net clinical benefit in such patients.
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Affiliation(s)
- Giuseppe Patti
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Italy
| | | | - Ladislav Pecen
- Institute of Informatics, Academy of Sciences of Czech Republic, Prague, Czech Republic
| | | | - Ilaria Cavallari
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Italy
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom
- SWBH and UHB NHS Trust, Birmingham, United Kingdom
| | - Raffaele De Caterina
- G. d'Annunzio University of Chieti and Center of Excellence on Aging CeSI-Met, Chieti, Italy
- Fondazione G. Monasterio, Pisa, Italy
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Sabaté M. "No Country for Old Men" With ST-segment Elevation Myocardial Infarction. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2017; 70:70-71. [PMID: 27939275 DOI: 10.1016/j.rec.2016.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 08/05/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Manel Sabaté
- Servicio de Cardiología, Instituto Cardiovascular, Universidad de Barcelona, Hospital Clínic, Barcelona, Spain.
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31
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Clinical impact of non-culprit lesions on 1-year mortality in very elderly patients with acute coronary syndrome. Heart Vessels 2016; 32:8-15. [PMID: 27090419 DOI: 10.1007/s00380-016-0833-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 04/08/2016] [Indexed: 10/21/2022]
Abstract
Preventive percutaneous coronary intervention (PCI) for non-culprit lesions after primary PCI remains controversial in patients with acute coronary syndrome (ACS). We analyzed whether PCI for non-culprit lesions would be associated with a better long-term prognosis in very elderly (≥85 years) patients. This study included 91 consecutive patients with ACS (mean age, 88.2 ± 3.0, 52 % male). We investigated the association of residual lesions with 1-year mortality. Culprit lesions affected the left anterior descending artery (LAD) in 50 patients, the left circumflex artery (LCx) in 29, and the right coronary artery (RCA) in 31. Residual lesions affected LAD in 20 cases, LCx in 22, and RCA in 21 patients. Residual lesions in LAD were associated with a higher 1-year mortality (p = 0.013), whereas residual lesions in LCx or RCA were not (p = 0.547 and 0.473, respectively). A Cox regression model demonstrated that patients with residual lesions in LAD had an increased risk of 1-year mortality compared with those without residual lesions (hazard ratio, 2.39; 95 % confidence interval, 1.16-4.96; p = 0.019). Therefore, the option to not treat residual lesions in LAD of patients with PCI may be associated with a higher 1-year mortality. Further studies are needed to confirm these findings.
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