Clinical features and short-term prognosis in the very elderly, >90 year-old, patients hospitalized with heart failure. A population-based study (2016–2019)

Background

Heart failure (HF) is a main health problem in western countries, and a major cause of hospitalizations and death, particularly in older people. Few data are available about clinical features and prognosis of very old patients, those aged 90 or more years.

Purpose

To analyse the clinical features and short-term prognosis (in-hospital mortality and 30-day readmission rate) of patients aged 90 or more years hospitalized with HF in Spain in the last years.

Methods

We conducted a retrospective analysis of patients discharged with an ICD-10 main diagnosis of HF from the Spanish National Health System (SNHS) public hospitals between 2016 and 2019, using as source of data the Minimum Basic Data Set of the SNHS. A comparison of clinical profile, in-hospital mortality and 30-day cardiovascular readmission rate between patients aged 75 to 89 years and those with 90 or more years was performed.

Results

From 2016 to 2019, 354,792 episodes of people older than 74-year and principal diagnosis of HF were included, being 59.2% female. Mean age of the whole population was 85.2±5.5 years, crude in-hospital mortality rate was 12.7% and crude cardiovascular 30-day readmission rate, 11.8%. The very older patients' subgroup (90 or more year-old) comprised 78.777 patients (22.2%). Table 1 shows the differences in clinical features between these patients and those aged 75 to 89 (77.8%). Patients aged 90 or more years were female in a higher proportion and showed a higher prevalence of cognitive impairment and renal failure, but a lower prevalence of most comorbidities (coronary artery revascularization, valve heart disease, cancer, diabetes mellitus, chronic liver disease). The diagnosis of previous myocardial infarction, stroke and systemic hypertension was similar in both groups (Table 1). Crude 30-day cardiovascular readmission rate was slightly but significantly lower in the oldest subgroup (10.9% vs 12%, p<0.001), while crude in-hospital mortality was higher (18.5% vs 11%, p<0.001).

Conclusions

Patients aged 90 or more years represents almost a fourth part of elderly patients hospitalized with HF in Spain within the last years. In general, prevalence of comorbidities and associated heart disease was similar or lower, but in-hospital mortality was twice higher, as compared with less older patients.

Funding Acknowledgement

Type of funding sources: None.

1-year hospital readmissions due to cardiovascular causes after a heart failure episode in elderly patients in Spain

Background

The prevalence of heart failure (HF) increases with age, one of the leading causes of hospitalization and death in the elderly. However, there are little data about the long-term readmission rate of elderly patients after an episode of HF admission in Spain.

Purpose

Study 1-year hospital readmissions due to cardiovascular causes in patients ≥75 years discharged to a hospital due to HF in Spain.

Methods

We performed a retrospective analysis of the Minumum basic dataset of Spain, including all episodes of HF discharged from public hospitals in Spain between 2016 and 2019. The codification was made with ICD-10. We selected patients ≥75 years with HF as the principal diagnosis. We analyzed predictors of readmissions 365 days after the index episode of HF hospitalization with Poisson regression.

Results

236,463 index episodes of HF in>75 years were included. 59.1% were female, and the mean age was 85 (SD 5.6) years. 35.0% had HF-pef, 4.3% HF-ref, and 60.7% had unknown LVEF HF.

39.6% of patients had at least one readmission (mean 1.7 readmissions by year for these patients), with no differences in sex or age. Patients with non-cardiovascular comorbidities (renal failure, chronic lung disorders, and severe hematological disorders) as well as coronary atherosclerosis and diabetes were more likely to be readmitted (Table 1).

Conclusions

After a hospital discharge for HF in patients ≥75 years, the crude ratio of readmission due to cardiovascular causes at 1-year was 39.6%. Readmissions were more likely in patients with non-cardiovascular comorbidities, predominantly renal, hematological, and chronic respiratory disorders, and those with diabetes and coronary atherosclerosis.

Funding Acknowledgement

Type of funding sources: None.

PSVIII-7 Impact of Virginiamycin on Rumen Fermentation and Methane Production in a Lactation Diet

To further understand the mode of action of virginiamycin (VM), an in vitro rumen fermentation study was conducted to determine the effects of VM on rumen fermentation and methane production using lactation diets. VM is approved for the control of liver abscesses in the United States and in preventing or treating ruminal acidosis in other countries. Three ruminally cannulated Jersey heifers were adapted to 53:47 forage to concentrate ratio diet for two weeks before use as rumen fluid donors. The treatments were control (CON) and VM (25 ppm). Diet was dried, ground to 1mm and used as substrate. Rumen fluid was collected two hours after feeding. Substrate (0.5 g) was inoculated with 100 mL of a 3:1 McDougall’s buffer:ruminal fluid mixture for 24 h at 39°C and constant agitation. Each treatment was run in triplicate and in three runs. Data were analyzed with a mixed model including treatment as the fixed effect and experimental run as a random effect using SAS software 9.4. Statistical significance was set when P≤0.05. Maximum gas production was less (P < 0.01) in VM compared with CON (100 vs. 130 mL/g incubated DM). VM tended to reduce methane production per unit digested DM (6.71 vs. 9.88 mg/g digested DM; P=0.07) and per unit incubated DM (4.40 vs. 7.16 mg/g incubated DM; P=0.06). VM increased propionate molar % compared to CON (21.4 vs. 16.2%, P< 0.01). VM reduced acetate:propionate compared to CON (2.84 vs. 3.85, P = 0.01). VM reduced DMD (65.5 vs. 72.5%, P=0.02) without reducing total VFA concentration compared with CON. VM tended to increase pH compared with CON (6.73 vs. 6.68, P=0.07). VM reduced methane production, increased propionate proportion, and maintained rumen pH in an in vitro fermentation system using an early lactation diet.

59 Effects of Feeding Nutragen on Clinical Signs and Leukocytes in Calves Following Natural Exposure to Bovine Viral Diarrhea Virus and Subsequent Mannheimia Haemolytica Infection

Two experiments (EXP1 and EXP2) evaluated the effects of NutraGen (NG) on calf health following exposure to bovine viral diarrhea virus (BVDV) on d -3 and Mannheimia haemolytica (Mh) infection on d 0. For each EXP, steers (BW = 251 ± 38.2 kg) were randomly allocated to 1 of 3 treatments (TRT). Treatments included a placebo (CON; EXP1 n = 5; EXP2 n = 5), a placebo fed from d -18 to d -3 followed by NG fed from d -3 to d 28 (CHLG; EXP1 n = 5; EXP2 n = 6), and NG fed from d -18 to d 28 (PREC; EXP1 n = 6; EXP2 n = 5). There was no treatment by time interaction (TRT×TME) or TRT effect for rectal temperatures (RT) or clinical scores (CS) in EXP1 or CS in EXP2 (P ≥ 0.26). There was a TRT×TME for respiration rates (RR) during the first 24 h following Mh infection (P = 0.04), and a tendency for a TRT effect from d -3 to d 14, and overall in EXP1 (P ≤ 0.10). There was a tendency for a TRT×TME for RT from d -3 to d 14 in EXP2 (P = 0.04). There was a TRT effect for RR from d -3 to d 14 and overall in EXP2 (P ≤ 0.05). There was a TRT×TME for leukocytes during the first 24 h following Mh infection in EXP1 (P = 0.03) and overall in both EXP (P ≤ 0.001). There was no TRT×TME or TRT effect for neutrophils (NEU), lymphocytes (LYM), or NEU:LYM in EXP1 (P ≥ 0.19); however, there were multiple TRT×TME and TRT effects for NEU, LYM, and NEU:LYM in EXP2 (P ≤ 0.05). These experiments suggest that NG has the potential to alter clinical and cellular responses during a bovine respiratory disease challenge.

Temperament and character profiles of adolescent participants in the choking game

OBJECTIVE

The role of personality traits in self-asphyxial behaviors remains largely unexplored. The aim of this study was to explore temperament and character profiles of youth reporting participation in the choking game using Cloninger's biopsychosocial model of personality.

METHODS

Data were collected among French middle-school students (N=1771) aged 9-16 years (mean age=13.0, SD=1.3) and randomly selected from 13 public establishments located in different regions of France. Logistic regression models were run to identify Cloninger's temperamental and character dimensions associated with engagement in the choking game.

RESULTS

Descriptive analysis revealed that participants showed high scores of novelty-seeking (Cohen's d=0.293, p<0.001) and low levels of cooperativeness (Cohen's d=0.182, p<0.01), persistence (Cohen's d=0.182, p<0.05), and reward dependence (Cohen's d=0.241, p<0.01). However, multivariate modeling indicated that only the novelty-seeking dimension tended to slightly differentiate participants from non-participants within the global sample (OR=1.03, 95% CI: 1-1.06). When we compared girls and boys, we found a slight trend in association only in boys (OR=1.04, 95% CI: 1-1.08).

CONCLUSIONS

Our study, which contributes to the growing literature on the psychological correlates of choking activities and is the first to investigate the potential predictive role of personality traits in this risky behavior, suggests to some extent that (a) the choking game could possibly be influenced by some temperamental characteristics, and that (b) it might not have the same function according to the gender considered.

Dual disorders in liaison-consultation psychiatry. A descriptive study of patients with substance use disorder admitted to a general hospital

Introduction

Several studies describe that the coexistence of a substance use disorder with another psychiatric condition or “dual disorder” (DD) is associated with a worse evolution at all levels, including a greater burden of medical illnesses and greater mortality.

Objectives

To describe the presence of DD and related factors in patients admitted to a General Hospital that required assessment by a psychiatry service.

Methods

A descriptive study that includes patients admitted to the Hospital del Mar in Barcelona for all medical-surgical reasons and attended by the specific addiction psychiatry consultation service between January 2016 and October 2021. Sociodemographic and clinical data are collected including the history of consumption and the diagnosis of dual disorder. Chi-square test was used for comparison between groups.

Results

The sample was 1796 patients (Women: 345. Mean age: 50.3 years; SD: 12.6). 43.7% of the sample presented DD, with axis 1 disorders being the most frequent. There was an association of DD to factors as: being woman (54 vs 41.2% p <0.001), HIV positive serologies (54 vs 42.7% p <0.001), being homeless (49 vs 31.7% p <0.001) and cocaine consumption compared to other substances (53.4 vs 39.8% p <0.001).

Conclusions

In our sample, almost half of patients had DD. The representation of women was significantly lower, however they presented a higher proportion of DD. In this study we describe an association of DD with other biopsychosocial problems, and further studies are necessary to determine in which sense they are related and optimize patient care.

Disclosure

No significant relationships.