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Bonares M, Fisher S, Quinn K, Wentlandt K, Tanuseputro P. Study protocol for the development and validation of a clinical prediction tool to estimate the risk of 1-year mortality among hospitalized patients with dementia. Diagn Progn Res 2024; 8:5. [PMID: 38500236 PMCID: PMC10949607 DOI: 10.1186/s41512-024-00168-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 02/05/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Patients with dementia and their caregivers could benefit from advance care planning though may not be having these discussions in a timely manner or at all. A prognostic tool could serve as a prompt to healthcare providers to initiate advance care planning among patients and their caregivers, which could increase the receipt of care that is concordant with their goals. Existing prognostic tools have limitations. We seek to develop and validate a clinical prediction tool to estimate the risk of 1-year mortality among hospitalized patients with dementia. METHODS The derivation cohort will include approximately 235,000 patients with dementia, who were admitted to hospital in Ontario from April 1st, 2009, to December 31st, 2017. Predictor variables will be fully prespecified based on a literature review of etiological studies and existing prognostic tools, and on subject-matter expertise; they will be categorized as follows: sociodemographic factors, comorbidities, previous interventions, functional status, nutritional status, admission information, previous health care utilization. Data-driven selection of predictors will be avoided. Continuous predictors will be modelled as restricted cubic splines. The outcome variable will be mortality within 1 year of admission, which will be modelled as a binary variable, such that a logistic regression model will be estimated. Predictor and outcome variables will be derived from linked population-level healthcare administrative databases. The validation cohort will comprise about 63,000 dementia patients, who were admitted to hospital in Ontario from January 1st, 2018, to March 31st, 2019. Model performance, measured by predictive accuracy, discrimination, and calibration, will be assessed using internal (temporal) validation. Calibration will be evaluated in the total validation cohort and in subgroups of importance to clinicians and policymakers. The final model will be based on the full cohort. DISCUSSION We seek to develop and validate a clinical prediction tool to estimate the risk of 1-year mortality among hospitalized patients with dementia. The model would be integrated into the electronic medical records of hospitals to automatically output 1-year mortality risk upon hospitalization. The tool could serve as a trigger for advance care planning and inform access to specialist palliative care services with prognosis-based eligibility criteria. Before implementation, the tool will require external validation and study of its potential impact on clinical decision-making and patient outcomes. TRIAL REGISTRATION NCT05371782.
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Affiliation(s)
- Michael Bonares
- Department of Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
- Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Stacey Fisher
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
- ICES Ottawa, Ottawa, ON, Canada
| | - Kieran Quinn
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Sinai Health System, Toronto, ON, Canada
- ICES Toronto, Toronto, ON, Canada
| | - Kirsten Wentlandt
- Department of Supportive Care, University Health Network, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Peter Tanuseputro
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
- ICES Ottawa, Ottawa, ON, Canada
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Co M, Couch E, Gao Q, Martinez A, Das-Munshi J, Prina M. Differences in survival and mortality in minority ethnic groups with dementia: A systematic review and meta-analysis. Int J Geriatr Psychiatry 2021; 36:1640-1663. [PMID: 34324226 DOI: 10.1002/gps.5590] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/12/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Although there are disparities in both risk of developing dementia and accessibility of dementia services for certain minority ethnic groups in the United States and United Kingdom, disparities in survival after a dementia diagnosis are less well-studied. Our objective was to systematically review the literature to investigate racial/ethnic differences in survival and mortality in dementia. METHODS We searched Embase, Ovid MEDLINE, Global Health and PsycINFO from inception to November 2018 for studies comparing survival or mortality over time in at least two race/ethnicity groups. Studies from any country were included but analysed separately. We used narrative synthesis and random-effects meta-analysis to synthesise findings. The Newcastle-Ottawa Scale was used to assess quality and risk of bias in individual studies. RESULTS We identified 22 articles, most from the United States (n = 17), as well as the United Kingdom (n = 3) and the Netherlands (n = 1). In a meta-analysis of US studies, hazard of mortality was lower in Black/African American groups (Pooled Hazard Ratio = 0.86, 95% CI = 0.82-0.91, I2 = 17%, from four studies) and Hispanic/Latino groups (Pooled HR = 0.65, 95% CI = 0.50-0.84, I2 = 86%, from four studies) versus comparison groups. However, study quality was mixed, and in particular, quality of reporting of race/ethnicity was inconsistent. CONCLUSION Literature indicates that Black/African American and Hispanic/Latino groups may experience lower mortality in dementia versus comparison groups in the United States, but further research, using clearer and more and consistent reporting of race/ethnicity, is necessary to understand what drives these patterns and their implications for policy and practice.
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Affiliation(s)
- Melissa Co
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Elyse Couch
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Qian Gao
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Andrea Martinez
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jayati Das-Munshi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Trust, London, UK
| | - Matthew Prina
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Seixas AA, Turner AD, Bubu OM, Jean-Louis G, de Leon MJ, Osorio RS, Glodzik L. Obesity and Race May Explain Differential Burden of White Matter Hyperintensity Load. Clin Interv Aging 2021; 16:1563-1571. [PMID: 34465985 PMCID: PMC8402977 DOI: 10.2147/cia.s316064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 06/10/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Compared to European Americans, research indicates that African Americans have higher white matter hyperintensity (WMH) load; however, the clinical and biological bases underlying this higher burden are poorly understood. We hypothesize that obesity may explain differences in WMH between African and European Americans. METHODS Participants enrolled in longitudinal brain aging studies (n=292; 61% Female; 92% European American; mean age=69.6±7.7) completed evaluations including medical exams, neuroimaging, and sociodemographic surveys. Overweight/obese status defined as body mass index ≥30 kg/m2, and WMH load, captured by FLAIR images, as sum of deep and periventricular volumes, scored using the Fazekas scale (0-6), WMH≥4 considered high. RESULTS Logistic regression analyses, adjusted for age, sex, hypertension, and smoking history, indicated that age and interaction between race and obesity were significant predictors of WMH, demonstrating that obesity significantly moderated the relationship between race and WMH. Age independently increased the odds of high WMH by 16% (OR=1.16, 95% CI=1.09-1.23, p<0.001). Stratified analysis indicates that older European Americans had increased WMH (OR=1.17, 95% CI=1.09-1.23, p<0.001), while obese African Americans had increased WMH (OR=27.65, 95% CI=1.47-519.13, p<0.05). In a case controlled subgroup matched by age, sex, and education (n=48), African Americans had significantly higher WMH load (27% vs 4%, Χ 2=5.3, p=0.02). CONCLUSION Results denote that age predicted WMH among European Americans, while obesity predicted WMH among African Americans. Matched sample analyses indicate that obesity increases the odds of WMH, though more pronounced in African Americans. These findings suggest that obesity may explain the differential burden of white matter hyperintensity load, signifying public health and clinical importance.
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Grants
- R01 AG013616 NIA NIH HHS
- RF1 AG057570 NIA NIH HHS
- K23 AG068534 NIA NIH HHS
- L30 AG064670 NIA NIH HHS
- R01 HL142066 NHLBI NIH HHS
- R01 AG022374 NIA NIH HHS
- R01 HL111724 NHLBI NIH HHS
- R56 AG058913 NIA NIH HHS
- R01 NS104364 NINDS NIH HHS
- R01 AG067523 NIA NIH HHS
- R25 HL105444 NHLBI NIH HHS
- P30 AG066512 NIA NIH HHS
- K01 HL135452 NHLBI NIH HHS
- R01 HL152453 NHLBI NIH HHS
- R01 MD007716 NIMHD NIH HHS
- R01 AG012101 NIA NIH HHS
- R01 AG056031 NIA NIH HHS
- K07 AG052685 NIA NIH HHS
- the National Institutes of Health: K01HL135452, K07AG052685, R01HL152453, R01MD007716, R01HL142066, R01AG067523, R01AG056031, R01NS104364, MdeL (RF1AG057570, R56 AG058913, R01 AG012101, R01 AG022374, R01 AG013616), R01 HL111724, R01AG05653, R01AG056031, and R25HL105444
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Affiliation(s)
- Azizi A Seixas
- New York University Grossman School of Medicine, Department of Population Health, New York, NY, 10016, USA
- New York University Grossman School of Medicine, Department of Psychiatry, New York, NY, 10016, USA
| | - Arlener D Turner
- New York University Grossman School of Medicine, Department of Psychiatry, New York, NY, 10016, USA
| | - Omonigho Michael Bubu
- New York University Grossman School of Medicine, Department of Population Health, New York, NY, 10016, USA
- New York University Grossman School of Medicine, Department of Psychiatry, New York, NY, 10016, USA
| | - Girardin Jean-Louis
- New York University Grossman School of Medicine, Department of Population Health, New York, NY, 10016, USA
- New York University Grossman School of Medicine, Department of Psychiatry, New York, NY, 10016, USA
| | - Mony J de Leon
- Weill Cornell Medicine, Department of Radiology, New York, NY, 10021, USA
| | - Ricardo S Osorio
- New York University Grossman School of Medicine, Department of Psychiatry, New York, NY, 10016, USA
| | - Lidia Glodzik
- Weill Cornell Medicine, Department of Radiology, New York, NY, 10021, USA
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Co M, Couch E, Gao Q, Mac-Ginty S, Das-Munshi J, Prina M. Access to Health Services in Older Minority Ethnic Groups with Dementia: A Systematic Review. J Am Geriatr Soc 2020; 69:822-834. [PMID: 33230815 PMCID: PMC7984264 DOI: 10.1111/jgs.16929] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/11/2020] [Accepted: 10/13/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES While it is acknowledged that minority ethnic (ME) groups across international settings face barriers to accessing care for dementia, it is not clear whether ME groups access services less frequently as a result. The objective of this review is to examine whether ME groups have longer delays before accessing dementia/memory services, higher use of acute care and crisis services and lower use of routine care services based on existing literature. We also examined whether ME groups had higher dementia severity or lower cognition when presenting to memory services. DESIGN Systematic review with narrative synthesis. SETTING Nonresidential medical, psychiatric, memory, and emergency services. PARTICIPANTS Twenty studies totaling 94,431 older adults with dementia or mild cognitive impairment. MEASUREMENTS We searched Embase, Ovid MEDLINE, Global Health, and PsycINFO from inception to November 2018 for peer-reviewed observational studies which quantified ethnic minority differences in nonresidential health service use in people with dementia. Narrative synthesis was used to analyze findings. RESULTS Twenty studies were included, mostly from the U.S. (n = 13), as well as the UK (n = 4), Australia (n = 1), Belgium (n = 1), and the Netherlands (n = 1). There was little evidence that ME groups in any country accessed routine care at different rates than comparison groups, although studies may have been underpowered. There was strong evidence that African American/Black groups had higher use of hospital inpatient services versus U.S. comparison groups. Primary care and emergency services were less well studied. Study quality was mixed, and there was a large amount of variability in the way ethnicity and service use outcomes were ascertained and defined. CONCLUSION There is evidence that some ME groups, such as Black/African American groups in the U.S., may use more acute care services than comparison populations, but less evidence for differences in routine care use. Research is sparse, especially outside the U.S.
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Affiliation(s)
- Melissa Co
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Elyse Couch
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Qian Gao
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Scarlett Mac-Ginty
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jayati Das-Munshi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Trust, London, UK
| | - Matthew Prina
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Dooley J, Booker M, Barnes R, Xanthopoulou P. Urgent care for patients with dementia: a scoping review of associated factors and stakeholder experiences. BMJ Open 2020; 10:e037673. [PMID: 32938596 PMCID: PMC7497532 DOI: 10.1136/bmjopen-2020-037673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/22/2020] [Accepted: 07/08/2020] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES People with dementia are more vulnerable to complications in urgent health situations due to older age, increased comorbidity, higher dependency on others and cognitive impairment. This review explored the factors associated with urgent care use in dementia and the experiences of people with dementia, informal carers and professionals. DESIGN Scoping review. The search strategy and data synthesis were informed by people with dementia and carers. DATA SOURCES Searches of CINAHL, Embase, Medline, PsycINFO, PubMed were conducted alongside handsearches of relevant journals and the grey literature through 15 January 2019. ELIGIBILITY CRITERIA Empirical studies including all research designs, and other published literature exploring factors associated with urgent care use in prehospital and emergency room settings for people with dementia were included. Two authors independently screened studies for inclusion. DATA EXTRACTION AND SYNTHESIS Data were extracted using charting techniques and findings were synthesised according to content and themes. RESULTS Of 2967 records identified, 54 studies were included in the review. Specific factors that influenced use of urgent care included: (1) common age-related conditions occurring alongside dementia, (2) dementia as a diagnosis increasing or decreasing urgent care use, (3) informal and professional carers, (4) patient characteristics such as older age or behavioural symptoms and (5) the presence or absence of community support services. Included studies reported three crucial components of urgent care situations: (1) knowledge of the patient and dementia as a condition, (2) inadequate non-emergency health and social care support and (3) informal carer education and stress. CONCLUSIONS The scoping review highlighted a wider variety of sometimes competing factors that were associated with urgent care situations. Improved and increased community support for non-urgent situations, such as integrated care, caregiver education and dementia specialists, will both mitigate avoidable urgent care use and improve the experience of those in crisis.
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Affiliation(s)
- Jemima Dooley
- Centre for Academic Primary Care, School for Social and Community Medicine, Bristol University, Bristol, UK
| | - Matthew Booker
- Centre for Academic Primary Care, School for Social and Community Medicine, Bristol University, Bristol, UK
| | - Rebecca Barnes
- Centre for Academic Primary Care, School for Social and Community Medicine, Bristol University, Bristol, UK
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6
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Golüke NM, Geerlings MI, van de Vorst IE, Vaartjes IH, de Jonghe A, Bots ML, Koek HL. Risk factors of mortality in older patients with dementia in psychiatric care. Int J Geriatr Psychiatry 2020; 35:174-181. [PMID: 31709606 PMCID: PMC7004037 DOI: 10.1002/gps.5232] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 10/05/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To examine the mortality risk, and its risk factors, of older patients with dementia in psychiatric care. METHODS We constructed a cohort of dementia patients through data linkage of four Dutch registers: the Psychiatric Case Register Middle Netherlands (PCR-MN), the hospital discharge register, the population register, and the national cause of death register. All dementia patients in PCR-MN aged between 60 and 100 years between 1 January 2000 and 31 December 2010 were included. Risk factors of mortality were investigated using Cox proportional hazard regression models with adjustment for age, sex, setting of care, nationality, marital status, dementia type, and psychiatric and somatic comorbidities. RESULTS In total, 4297 patients were included with a median age of 80 years. The 1-year, 3-year, and 5-year mortality were 16.4%, 44.4%, and 63.5%, respectively. Determinants that increased the 1-year mortality were: male sex (adjusted hazard ratio [HR]: 1.49; 95% confidence interval [95% CI], 1.26-1.76), higher age (HR 1.08; 95% CI, 1.07-1.09), inpatient psychiatric care (HR 1.52; 95% CI, 1.19-1.93), more somatic comorbidities (HR 1.67; 95% CI, 1.49-1.87), and cardiovascular disease separately (HR 1.54; 95% CI, 1.30-1.82). Results for 3-year and 5-year mortality were comparable. Living together/married increased the 3- and 5-year mortality, and Dutch nationality increased the 5-year mortality. There were no differences in mortality with different types of psychiatric comorbidity. CONCLUSION Mortality of dementia patients in psychiatric care was high, much higher than mortality in the general older population. The results of this study should raise awareness about their unfavourable prognosis, particularly older patients, men, inpatients, and patients with more somatic comorbidity.
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Affiliation(s)
- Nienke M.S. Golüke
- Department of GeriatricsUniversity Medical Center UtrechtUtrechtThe Netherlands,Department of GeriatricsTergooi HospitalsBlaricumThe Netherlands
| | - Mirjam I. Geerlings
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | | | - Ilonca H. Vaartjes
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | | | - Michiel L. Bots
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Huiberdina L. Koek
- Department of GeriatricsUniversity Medical Center UtrechtUtrechtThe Netherlands
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Ma C, Bao S, Dull P, Wu B, Yu F. Hospital readmission in persons with dementia: A systematic review. Int J Geriatr Psychiatry 2019; 34:1170-1184. [PMID: 31087373 DOI: 10.1002/gps.5140] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 05/05/2019] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Hospital readmission in persons with dementia is becoming a critical safety and cost issue. The purpose of this review is to systematically assess published evidence on hospital readmissions in persons with dementia, including rate, clinical reasons, risk factors, and prevention programs. METHODS A systematic review of relevant literature was conducted. Literature were searched in PubMed, CINAHL, PsycINFO, and Embase as well as hand searching. Quality of reviewed studies were assessed independently by reviewers using quality assessment checklists. RESULTS Nineteen studies met the inclusion criteria and were reviewed. In persons with dementia, all-cause 30-day readmission rate was most frequently reported and ranged from 7% to 35%. Compared with those without dementia, persons with dementia had significantly higher rate of readmission. Reported risk factors of readmission varied across studies from patient sociodemographic and clinical status, history of health care utilization, to family caregivers. Reasons for readmission were rarely documented. Programs of home-based individualized care and interdisciplinary team care were used for preventing readmissions. Findings from some of the studies were limited by small sample sizes, single data source, and other methodologic flaws. CONCLUSIONS Persons with dementia are at high risk for hospital readmission, but many of the readmissions are potentially preventable. Multiple strategies such like identifying high-risk individuals and the clinical reasons for index admission and readmission and implementing home-based individualized care by interdisciplinary team can reduce preventable hospital readmissions. Future studies should use multiple national data sources and advanced methodology to identify risk factors and clinical reasons of hospital readmissions.
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Affiliation(s)
- Chenjuan Ma
- New York University Rory Meyers College of Nursing, New York, NY
| | - Silin Bao
- New York University Rory Meyers College of Nursing, New York, NY
| | - Peter Dull
- New York University Rory Meyers College of Nursing, New York, NY
| | - Bei Wu
- New York University Rory Meyers College of Nursing, New York, NY
| | - Fang Yu
- University of Minnesota School of Nursing, Minneapolis, MN
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Rodríguez-Mañero M, López-Pardo E, Cordero A, Kredieh O, Pereira-Vazquez M, Martínez-Sande JL, Martínez-Gomez A, Peña-Gil C, Novo-Platas J, García-Seara J, Mazón P, Laje R, Moscoso I, Varela-Román A, García-Acuña JM, González-Juanatey JR. Clinical profile and outcomes in octogenarians with atrial fibrillation: A community-based study in a specific European health care area. Int J Cardiol 2018; 243:211-215. [PMID: 28747024 DOI: 10.1016/j.ijcard.2017.03.149] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/17/2017] [Accepted: 03/29/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Age increases risk of stroke and bleeding. Clinical trial data have had relatively low proportions of elderly subjects. We sought to study a Spanish population of octogenarians with atrial fibrillation (AF) by combining different sources of electronic clinical records from an area where all medical centres utilized electronic health record systems. METHODS Data was derived from the Galician Healthcare Service information system. RESULTS From 383,000 subjects, AF was coded in 7990 (2.08%), 3640 (45.6%) of whom were ≥80 and 4350 (54.4%)<80. All CHA2DS2-VASc's components were more prevalent in the elderly except for diabetes. Of those ≥80, 2178 (59.8%) were women. Mean CHA2DS2-VASc was 4.2±1.1. Distribution of CHA2DS2-VASc components varied between genders. 2600 (71.4%) were on oral anticoagulant (OA). During a median follow up of 696days (124.23), all-cause mortality was higher in ≥80 (1011/3640 (27.8%) vs 350/4350 (8.05%) (p<0.001). There were differences in rate of thromboembolic (TE) and haemorrhagic events (2.3% vs 0.9%, p<0.01 and 2.5% vs 1.7%, p=0.01 respectively). In octogenarian, differences between genders were observed with regard to TE, but not in haemorrhagic or all-cause mortality rates. Age, heart failure, non-valvular AF, dementia, and OA were independent predictors of all-cause mortality. In regard to TE, female gender, hypertension, previous TE and OA were independent predictive factors. CONCLUSIONS Octogenarians with AF had very different characteristics and outcomes from their younger counterparts. These results also provide reassurance about the effectiveness of OA in preventing TE events and maintaining a reasonable haemorrhagic event rate in the extremely elderly.
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Affiliation(s)
- Moisés Rodríguez-Mañero
- Cardiology Department, Complejo Hospital Universitario de Santiago, Santiago de Compostela, IDIS (Instituto para el Desarrollo e Integración de la Salud), CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares), Santiago de Compostela, Spain.
| | - Estrella López-Pardo
- Xerencia de Xestión Integrada, Hospital Universitario Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Omar Kredieh
- University of Miami/JFK Medical Center Palm Beach Regional GME Consortium, Atlantis, FL, United States
| | - María Pereira-Vazquez
- Cardiology Department, Complejo Hospital Universitario de Santiago, Santiago de Compostela, IDIS (Instituto para el Desarrollo e Integración de la Salud), CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares), Santiago de Compostela, Spain
| | - Jose-Luis Martínez-Sande
- Cardiology Department, Complejo Hospital Universitario de Santiago, Santiago de Compostela, IDIS (Instituto para el Desarrollo e Integración de la Salud), CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares), Santiago de Compostela, Spain
| | - Alvaro Martínez-Gomez
- Cardiology Department, Complejo Hospital Universitario de Santiago, Santiago de Compostela, IDIS (Instituto para el Desarrollo e Integración de la Salud), CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares), Santiago de Compostela, Spain
| | - Carlos Peña-Gil
- Cardiology Department, Complejo Hospital Universitario de Santiago, Santiago de Compostela, IDIS (Instituto para el Desarrollo e Integración de la Salud), CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares), Santiago de Compostela, Spain
| | - José Novo-Platas
- Xerencia de Xestión Integrada, Hospital Universitario Santiago de Compostela, Santiago de Compostela, Spain
| | - Javier García-Seara
- Cardiology Department, Complejo Hospital Universitario de Santiago, Santiago de Compostela, IDIS (Instituto para el Desarrollo e Integración de la Salud), CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares), Santiago de Compostela, Spain
| | - Pilar Mazón
- Cardiology Department, Complejo Hospital Universitario de Santiago, Santiago de Compostela, IDIS (Instituto para el Desarrollo e Integración de la Salud), CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares), Santiago de Compostela, Spain
| | - Ricardo Laje
- Cardiology Department, Complejo Hospital Universitario de Santiago, Santiago de Compostela, IDIS (Instituto para el Desarrollo e Integración de la Salud), CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares), Santiago de Compostela, Spain
| | - Isabel Moscoso
- Cardiology Department, Complejo Hospital Universitario de Santiago, Santiago de Compostela, IDIS (Instituto para el Desarrollo e Integración de la Salud), CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares), Santiago de Compostela, Spain
| | - Alfonso Varela-Román
- Cardiology Department, Complejo Hospital Universitario de Santiago, Santiago de Compostela, IDIS (Instituto para el Desarrollo e Integración de la Salud), CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares), Santiago de Compostela, Spain
| | - Jose María García-Acuña
- Cardiology Department, Complejo Hospital Universitario de Santiago, Santiago de Compostela, IDIS (Instituto para el Desarrollo e Integración de la Salud), CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares), Santiago de Compostela, Spain
| | - José Ramón González-Juanatey
- Cardiology Department, Complejo Hospital Universitario de Santiago, Santiago de Compostela, IDIS (Instituto para el Desarrollo e Integración de la Salud), CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares), Santiago de Compostela, Spain
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