Objective
The objective was to determine the effect of frailty on risk of 30‐day mortality in nonseverely disabled older patients with acute heart failure (AHF) attended in emergency departments ...(EDs).
Methodology
The Frailty‐AHF Study is a retrospective analysis of a multicenter, observational, prospective, cohort study (Older‐AHF Register). This study included consecutive patients ≥ 65 years of age without severe functional dependence or dementia attended for AHF in three Spanish EDs for 4 months. Frailty was defined by frailty phenotype as the presence of three or more domains. Baseline and episode characteristics and 30‐day mortality were collected in all the patients.
Results
A total of 465 patients with a mean (±SD) age of 82 (±7) years were included, 283 (61.0%) being female and 225 (51.3%) with severe comorbidity (Charlson index ≥ 3). Frailty was present in 169 (36.3%). The rate of 30‐day mortality was 7.3%. Frailty adjusted for potential confounding factors was an independent factor associated with 30‐day mortality (adjusted hazard ratio = 2.5; 95% confidence interval = 1.0 to 6.0; p = 0.047).
Conclusion
The presence of frailty is an independent risk factor of 30‐day mortality in nonsevere dependent older patients attended with AHF in EDs.
To assess the value of frailty screening tool (Identification of Senior at Risk ISAR) in predicting 30-day mortality risk in older patients attended in emergency department (ED) for acute heart ...failure (AHF).
Observational multicenter cohort study.
OAK-3 register.
Patients aged ≥65 years attended with ADHF in 16 Spanish EDs from January to February 2016.
No.
Variable of study was ISAR scale. The outcome was all-cause 30-day mortality.
We included 1059 patients (mean age 85±5,9 years old). One hundred and sixty (15.1%) cases had 0-1 points, 278 (26.3%) 2 points, 260 (24.6%) 3 points, 209 (19.7%) 4 points, and 152 (14.3%) 5-6 points of ISAR scale. Ninety five (9.0%) patients died within 30 days. The percentage of mortality increased in relation to ISAR category (lineal trend P value <.001). The area under curve of ISAR scale was 0.703 (95%CI 0.655-0.751; P<.001). After adjusting for EFFECT risk categories, we observed a progressive increase in odds ratios of ISAR scale groups compared to reference (0-1 points).
scale is a brief and easy tool that should be considered for frailty screening during initial assessment of older patients attended with AHF for predicting 30-day mortality.
To assess the value of frailty screening tool (Identification of Senior at Risk ISAR) in predicting 30-day mortality risk in older patients attended in emergency department (ED) for acute heart ...failure (AHF).
Observational multicenter cohort study.
OAK-3 register.
Patients aged ≥65 years attended with ADHF in 16 Spanish EDs from January to February 2016.
No.
Variable of study was ISAR scale. The outcome was all-cause 30-day mortality.
We included 1059 patients (mean age 85±5.9 years old). One hundred and sixty (15.1%) cases had 0–1 points, 278 (26.3%) 2 points, 260 (24.6%) 3 points, 209 (19.7%) 4 points, and 152 (14.3%) 5–6 points of ISAR scale. Ninety five (9.0%) patients died within 30 days. The percentage of mortality increased in relation to ISAR category (lineal trend P value<.001). The area under curve of ISAR scale was 0.703 (95%CI 0.655–0.751; P<.001). After adjusting for EFFECT risk categories, we observed a progressive increase in odds ratios of ISAR scale groups compared to reference (0–1 points).
scale is a brief and easy tool that should be considered for frailty screening during initial assessment of older patients attended with AHF for predicting 30-day mortality.
Evaluar la utilidad de la escala de cribado de la fragilidad (Identification of Senior at Risk ISAR) para predecir la mortalidad a los 30 días en los pacientes mayores atendidos por insuficiencia cardiaca aguda (ICA) en los servicios de urgencias hospitalarios (SUH).
Estudio multicéntrico observacional de cohorte multipropósito.
Registro OAK-3.
Pacientes ≥ 65 años atendidos por ICA en 16 SUH españoles de enero a febrero del 2016.
Ninguna.
La variable de estudio fue la escala ISAR. La variable de resultado fue la mortalidad por cualquier causa a los 30 días.
Se incluyó a 1.059 pacientes (edad media 85±5,9 años). Ciento sesenta (15,1%) casos tuvieron 0-1 puntos, 278 (26,3%) 2 puntos, 260 (24,6%) 3 puntos, 209 (19,7%) 4 puntos y 152 (14,3%) 5-6 puntos de la escala ISAR. Noventa y cinco (9,0%) pacientes fallecieron a los 30 días. La frecuencia de mortalidad se incrementó en relación a la categoría del ISAR (p tendencia lineal <0,001). El área bajo la curva de la escala ISAR fue de 0,703 (intervalo de confianza del 95%, 0,655-0,751; p <0,001). Tras el ajuste por las categorías del modelo de riesgo EFFECT, hubo un incremento progresivo de la razón de ventajas de los grupos de la escala ISAR en comparación con el grupo de referencia (0-1 puntos).
La escala ISAR es una herramienta breve y sencilla que debería ser considerada para el despistaje de la fragilidad en la valoración inicial de los pacientes mayores con insuficiencia cardiaca aguda de cara a predecir la mortalidad a 30 días.
To analyze the prognostic accuracy of the scores NEWS, qSOFA, GYM used in hospital emergency department (ED) in the assessment of elderly patients who consult for an infectious disease.
Data from the ...EDEN (Emergency Department and Elderly Need) cohort were used. This retrospective cohort included all patients aged ≥65 years seen in 52 Spanish EDs during two weeks (from 1-4-2019 to 7-4-2019 and 30/3/2020 to 5/4/2020) with an infectious disease diagnosis in the emergency department. Demographic variables, demographic variables, comorbidities, Charlson and Barthel index and needed scores parameters were recorded. The predictive capacity for 30-day mortality of each scale was estimated by calculating the area under the receiver operating characteristic (ROC) curve, and sensitivity and specificity were calculated for different cut-off points. The primary outcome variable was 30-day mortality.
6054 patients were analyzed. Median age was 80 years (IQR 73-87) and 45.3% women. 993 (16,4%) patients died. NEWS score had better AUC than qSOFA (0.765, 95CI: 0.725-0.806, versus 0.700, 95%CI: 0.653-0.746; P < .001) and GYM (0.716, 95%CI: 0.675-0.758; P = .024), and there was no difference between qSOFA and GYM (P = .345). The highest sensitivity scores for 30-day mortality were GYM ≥ 1 point (85.4%) while the qSOFA score ≥2 points showed high specificity. In the case of the NEWS scale, the cut-off point ≥4 showed high sensitivity, while the cut-off point NEWS ≥ 8 showed high specificity.
NEWS score showed the highest predictive capacity for 30-day mortality. GYM score ≥1 showed a great sensitivity, while qSOFA ≥2 scores provide the highest specificity but lower sensitivity.
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