Comprehensive geriatric assessment and hospital mortality among older adults with decompensated heart failure

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• 作者：Carlos Rodrí ; guez-Pascual ; MD ; PhD^a ; ^b ; ^{carlos.rodriguez.pascual@sergas.es} ; Arturo Vilches-Moraga ; MD^a ; ^b ; ^{arturo.vilches.moraga@sergas.es} ; Emilio Paredes-Galá ; n ; MD^c ; ^{emilio.paredes.galan@sergas.es} ; Ana Isabel Ferrero-Marinez ; NP^a ; ^b ; ^{ana.isabel.ferrero.martinez@sergas.es} ; Marta Torrente-Carballido ; PsyD^a ; ^b ; ^{martatorrent@hotmail.com} ; Fernando Rodrí ; guez-Artalejo ; MD ; PhD^d ; ^{fernando.artalejo@uam.es}
• 刊名：American Heart Journal
• 出版年：2012
• 出版时间：November, 2012
• 年：2012
• 卷：164
• 期：5
• 页码：756-762
• 全文大小：134 K

文摘

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Background

The aim of this study is to assess whether a simple comprehensive geriatric assessment (CGA) score predicts hospital mortality among very elderly patients admitted with heart failure (HF).

Methods

This is a prospective follow-up of 581 individuals aged ¡Ý75 years admitted for decompensated HF to an acute geriatric unit from October 2006 to September 2009.

A CGA score (range, 0-10) was constructed using baseline individual data on 5 domains: dependence in activities of daily living (Katz index), mobility (qualitative mobility scale), cognition (Mini-Mental State Examination), comorbidity (Charlson index), and number of prescribed medications.

Results

Mean age of patients was 85.8 ¡À 5.8 years, 67 % were women, and 75 % had preserved ventricular function (ejection fraction >45 % ). Fifty percent of patients required assistance in ¡Ý1 activities of daily living, 66 % had mobility problems, 45 % had cognitive impairment, the mean Charlson index was 3.97 ¡À 3.01, and 36 % had >7 medications prescribed. As a result, the mean CGA score was 4.8 ¡À 2.2. Hospital mortality was 8.2 % . In multivariate analysis, variables associated with hospital mortality included New York Heart Association functional class III (odds ratio [OR] 4.1, 95 % CI 1.5-10.8), class IV (OR 19.6, 95 % CI 6.3-61), pulmonary edema on chest radiography (OR 3.0, 95 % CI 1.3-6.6), renal failure (OR 2.8, 95 % 1.2-6.2), and the CGA score (OR 1.2, 95 % CI 1.02-1.4 for each point of increment). The area under the receiver operating characteristic curve was 0.856 (95 % CI 0.790-0.921), and the model classified 93.4 % of cases correctly.

Conclusions

In our cohort of very old patients with HF, a simple CGA score predicts hospital mortality.