Impact of Frailty and Disability on 30-Day Mortality in Older Patients With Acute Heart Failure.
Por:
Martín-Sánchez FJ, Rodríguez-Adrada E, Vidan MT, Llopis García G, González Del Castillo J, Rizzi MA, Alquezar A, Piñera P, Lázaro Aragues P, Llorens P, Herrero P, Jacob J, Gil V, Fernández C, Bueno H, Miró Ò and Representing the members of the OAK Register Investigators
Publicada:
1 oct 2017
Ahead of Print:
14 jul 2017
Categoría:
Cardiology and cardiovascular medicine
Resumen:
The objectives were to determine the impact of frailty and disability on 30-day mortality and whether the addition of these variables to HFRSS EFFECT risk score (FBI-EFFECT model) improves the short-term mortality predictive capacity of both HFRSS EFFECT and BI-EFFECT models in older patients with acute decompensated heart failure (ADHF) atended in the emergency department. We performed a retrospective analysis of OAK Registry including all consecutive patients =65 years old with ADHF attended in 3 Spanish emergency departments over 4 months. FBI-EFFECT model was developed by adjusting probabilities of HFRSS EFFECT risk categories according to the 6 groups (G1: non frail, no or mildly dependent; G2: frail, no or mildly dependent; G3: non frail, moderately dependent; G4: frail, moderately dependent; G5: severely dependent; G6: very severely dependent).We included 596 patients (mean age: 83 [SD7]; 61.2% females). The 30-day mortality was 11.6% with statistically significant differences in the 6 groups (p < 0.001). After adjusting for HFRSS EFFECT risk categories, we observed a progressive increase in hazard ratios from groups G2 to G6 compared with G1 (reference). FBI-EFFECT had a better prognostic accuracy than did HFRSS EFFECT (log-rank p < 0.001; Net Reclassification Improvement [NRI] = 0.355; p < 0.001; Integrated Discrimination Improvement [IDI] = 0.052; p ;< 0.001) and BI-EFFECT (log-rank p = 0.067; NRI = 0.210; p = 0.033; IDI = 0.017; p = 0.026). In conclusion, severe disability and frailty in patients with moderate disability are associated with 30-day mortality in ADHF, providing additional value to HFRSS EFFECT model in predicting short-term prognosis and establishing a care plan.
Filiaciones:
Martín-Sánchez FJ:
Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
Rodríguez-Adrada E:
Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
Vidan MT:
Department of Geriatric Medicine, Hospital General Universitario Gregorio Marañón, Instituto de Investigación IiSGM, Universidad Complutense de Madrid, Madrid, Spain
Llopis García G:
Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
González Del Castillo J:
Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
Rizzi MA:
Emergency Department, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
Alquezar A:
Emergency Department, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
Piñera P:
Emergency Department, Hospital Reina Sofia, Murcia, Spain
Lázaro Aragues P:
Emergency Department, Hospital Reina Sofia, Murcia, Spain
:
Emergency Department-UCE-UHD, Hospital General Universitario de Alicante, Alicante, Spain
Herrero P:
Emergency Department, Hospital Central de Asturias, Oviedo, Asturias, Spain
Jacob J:
Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
Gil V:
Emergency Department, Hospital Clínic, Institut de Recerca Biomédica August Pi iSunyer (IDIBAPS), Barcelona, Catalonia, Spain
Fernández C:
Department of Preventive Medicine, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
Bueno H:
Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
Instituto de Investigación i+12 y Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
Universidad Complutense de Madrid, Madrid, Spain
Miró Ò:
Emergency Department, Hospital Clínic, Institut de Recerca Biomédica August Pi iSunyer (IDIBAPS), Barcelona, Catalonia, Spain
Representing the members of the OAK Register Investigators:
Hospital La Fe de Valencia
Pérez-Durá MJ:
Hospital La Fe de Valencia
Gil PB:
Hospital La Fe de Valencia
Miró Ó:
Hospital Clinic de Barcelona
Espinosa VG:
Hospital Clinic de Barcelona
Sánchez C:
Hospital Clinic de Barcelona
Aguiló S:
Hospital Clinic de Barcelona
Vall MÀP:
Hospital del Mar de Barcelona
Aguirre A:
Hospital del Mar de Barcelona
Piñera P:
Hospital Reina Sofia de Murcia
Aragues PL:
Hospital Reina Sofia de Murcia
Bordigoni MAR:
Hospital San Pau de Barcelona
Alquezar A:
Hospital San Pau de Barcelona
Richard F:
Hospital de Burgos
Jacob J:
Hospital Universitari de Bellvitge, Barcelona
Ferrer C:
Hospital Universitari de Bellvitge, Barcelona
Llopis F:
Hospital Universitari de Bellvitge, Barcelona
Sánchez FJM:
Hospital Clínico San Carlos, Madrid
Del Castillo JG:
Hospital Clínico San Carlos, Madrid
Rodríguez-Adrada E:
Hospital Clínico San Carlos, Madrid
García GL:
Hospital Clínico San Carlos, Madrid
Salgado L:
Hospital Clínico San Carlos, Madrid
Mandly EA:
Hospital Clínico San Carlos, Madrid
Ortega JS:
Hospital Clínico San Carlos, Madrid
de Los Ángeles Cuadrado Cenzual M:
Hospital Clínico San Carlos, Madrid
de Heredia MDIO:
Hospital Clínico San Carlos, Madrid
Soriano PL:
Hospital Universitario General de Alicante
Fernández-Cañadas JM:
Hospital Universitario General de Alicante
:
Hospital Universitario General de Alicante
:
Hospital Universitario General de Alicante
Puente PH:
Hospital Universitario Central de Asturias
García IR:
Hospital Universitario Central de Asturias
Coya MF:
Hospital Universitario Central de Asturias
Fernández JAS:
Hospital Universitario Gregorio Marañón
Andueza J:
Hospital Universitario Gregorio Marañón
Pareja RR:
Hospital Universitario de Getafe
Del Arco C:
Hospital Universitario de La Princesa de Madrid
Martín A:
Hospital Universitario Severo Ochoa de Leganés
Torres R:
Hospital Universitario Severo Ochoa de Leganés
Miranda BR:
Hospital Universitario Rey Juan Carlos de Móstoles
Martín VS:
Hospital Universitario Rey Juan Carlos de Móstoles
Guillén CB:
Hospital Universitario Infanta Leonor de Vallecas
Puig RP:
Hospital Universitario Infanta Leonor de Vallecas
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