Atrial fibrillation (AF) and co-morbidity in elderly. A population based survey of 85 years old subjects

Baseline functional status as the strongest predictor of in-hospital mortality in elderly patients with non-valvular atrial fibrillation: Results of the NONAVASC registry

OBJECTIVES

Atrial fibrillation (AF) has been associated with higher mortality. We aimed to identify the baseline predictors of in-hospital mortality among elderly patients with non-valvular AF (NVAF) hospitalised for any reason.

METHODS

Observational, prospective and multicentre study was carried out on patients with NVAF over the age of 75, who had been admitted for any acute medical condition to Internal Medicine departments in Spain.

RESULTS

We evaluated 804 patients with a mean age of 85±5.1years, of which 53.9% were females. During the hospitalization 10.1% (n=81) of the patients died. The patients who died were older, had a greater percentage of institutionalization, worse previous basic functional status (Barthel Index), worse cognitive performance at admission and greater proportion of frailty and sarcopenia. Logistic regression multivariate analysis identified that the strongest determinants of in-hospital mortality were the baseline functional status (Barthel Index) (OR for total dependency 4.73, 95% CI 2.32-9.63), and admissions for stroke (OR 3.55, 95% CI 1.41-8.90) and acute renal failure (OR 1.93, 95% CI 1.12-3.32).

CONCLUSION

The overall in-hospital mortality of elderly patients with NVFA is high. Among all factors evaluated in the global geriatric assessment the baseline functional status was the strongest predictor for in-hospital mortality on this population.

High rate of mortality in Spanish community-dwelling population aged 85 with atrial fibrillation after three years of follow-up: The Octabaix study

AIM

To assess the possible association between three-year global mortality and atrial fibrillation (AF) in 328 community-dwelling participants aged 85 at baseline.

METHODS

Sociodemographic data, comorbidity and geriatric assessment tools, thromboembolic risk, and AF therapy were assessed. We compared the patients who survived with those who died.

RESULTS

At baseline, 41 (12.5%) of participants had permanent AF, and 13 of them died (31.7%) after the three-year follow-up period compared with 44 (15.3%) of the rest of cohort (P = 0.01). Cox regression analysis identified two significant clinical variables as independent predictors of three-year risk of global mortality: Lawton Index (hazard ratio 0.82, 95% confidence interval 0.75-0.91) and AF (hazard ratio 1.90, 95% confidence interval 1.01-3.56). None of the other of variables evaluated showed predictive value of global mortality in the AF patients.

CONCLUSION

In oldest old community-dwelling participants, AF is an independent risk factor for global mortality after a three-year follow-up period.

Health-related quality of life in relation to mobility and fall risk in 85-year-old people: a population study in Sweden

Optimal mobility is fundamental for healthy ageing and quality of life. This study is part of a cross-sectional population-based study of 85-year-old people residing in Linköping municipality, Sweden. The purpose was to describe 85-year-old peoples' health-related quality of life (HRQoL) in relation to mobility and fall risk while adjusting for gender and body mass index. Data collection included a postal questionnaire, a home visit and a reception visit. HRQoL was assessed with EQ-5D-3L, mobility with the Timed Up and Go test (TUG) and fall risk with the Downton Fall Risk Index (DFRI). All those who completed the DFRI, TUG and EQ-5D-3L were included in the present study (N = 327). Lower HRQoL was associated with longer time taken to complete TUG and higher fall risk in both genders but not with body mass index. Women had higher risk of falling, took a longer time to complete TUG and reported less physical activity compared with men. Health-care professionals should address mobility capacity and fall risk in order to maintain quality of life in elderly people. This is of utmost importance, especially for elderly women because impaired mobility, high risk of falling and occurrence of pain are common among women, and related to lower HRQoL.

Impact of comorbidity on 6-month hospital readmission and mortality after hip fracture surgery

OBJECTIVES

Impact of comorbidity on risk of readmission and death after hip fracture surgery has not been sufficiently explored. We planned to investigate the role of common diseases in predicting adverse events during recovery after hip surgery.

PATIENTS AND METHODS

We prospectively evaluated 272 consecutive patients (age, 82.6±8.9 years; 196 females, 72.1%) who underwent acute surgery for hip fracture at a regional university hospital. Baseline comorbidity and hospital stay were analysed. Number, timing and reasons for readmissions as well as mortality within 6 months after hospital discharge were recorded. An age- and sex-adjusted logistic regression model was applied to assess relations between comorbidity and relative risk of rehospitalisation or death.

RESULTS

Hypertension (44%), cognitive disorders (26%), and ischaemic heart disease (19%) were the most common comorbidities. The mean length-of-postoperative-stay was 12.7±7.9 days. Eighty-six patients (32%) were readmitted to hospital within 6 months from initial discharge and 36 patients (13%) died during that period. Increased risk of readmission was associated with hypertension (odds ratio (OR): 2.0, 95%CI, 1.2-1.9, p=0.009), and pacemaker treatment (OR: 6.6, 95%CI, 1.7-26.3, p=0.007), while there was a tendency towards readmission among men with prostate disease (OR: 5.0, 95%CI, 0.9-27.2, p=0.06). In contrast, mortality was predicted by ischaemic heart disease (OR: 2.2, 95%CI, 1.0-4.9, p=0.05), and malignancy (OR: 2.5, 95%CI, 1.1-5.7, p=0.04).

CONCLUSIONS

Common comorbidities are associated with higher risk of rehospitalisation and mortality following hip fracture surgery in the elderly. This information may be useful in postoperative risk assessment and prevention of negative outcomes.