RT info:eu-repo/semantics/doctoralThesis
T1 Utilidad de la evaluación geriátrica integral en pacientes ingresados por insuficiencia cardiaca aguda
A1 Aguilar Iglesias, Lara
A2 Universidad de Valladolid. Escuela de Doctorado
K1 Cardiología
K1 Heart failure
K1 Insuficiencia cardiaca
K1 Geriatric syndromes
K1 Síndromes geriátricos
K1 3205.01 Cardiología
AB Heart failure (HF) is a growing pathology worldwide, with high incidence and prevalence in the population, especially among older patients. In these patients, frailty and other geriatric syndromes are highly prevalent. However, traditionally, frailty has been studied preferentially in the elderly population, being less valued in younger individuals.  The main objective of our study is to analyse in patients admitted for acute heart failure (AHF) the effect of frailty and other geriatric syndromes, measured by different clinical scales, on the incidence of hospital admissions for HF, emergency department visits or all-cause mortality in the first 6 months after hospital discharge. For this purpose, a prospective cohort study was conducted including all patients with AHF admitted to our Cardiology Department from July 2020 to May 2021. These patients underwent peripheral blood sampling on admission and before discharge from Cardiology. All patients underwent a transthoracic echocardiogram during admission by the Cardiac Imaging Unit of our centre. A complete geriatric assessment was performed the day before discharge by the project investigators. The FRAIL and SPPB scales, both validated in similar populations, were chosen as frailty scales. In addition, other aspects of geriatric assessment were analysed, such as comorbidity using the Charlson index, functional status using the Barthel scale and quality of life using the Minnesota questionnaire. At 1 month and 6 months, clinical data were collected by reviewing electronic medical records and telephone visits when necessary. All adverse cardiovascular events during follow-up were recorded: visits to the emergency department for decompensation of HF, admission for HF or death from any cause. A total of 202 patients were included. The mean age was 73 ± 12.32 years, and 100 (49.5%) of the patients were elderly (> 75 years). Only 78 patients (38.6%) were women, and 100 (49.5%) had previous HF. Frailty and dependency were found to have a major prognostic impact on patients admitted for AHF. Frail patients have a 12.6-fold increased risk of mortality in the first month after discharge (Hazard ratio (HR) 12.61; 95% confidence interval (CI) 1.57-101.47; p=0.017) compared to non-frail patients. Dependent patients have a higher risk of all-cause mortality at 1 month (HR 13.04; 95% CI 1.62-104.75; p=0.016) and 6 months (HR 7.18; 95% CI 1.99-25.86; p=0.003) as well as a higher risk of the combined event at 1 month (HR 5.93; 95% CI 1.63-21.50; p=0.007) and 6 months (HR 2.62; 95% CI 1.49-4.61; p=0.001). Age also ranks as a prognostic factor in the combined event at both 1 month (HR 13.45; 95% CI 1.78-101.73; p=0.012) and 6 months (HR 2.33; 95% CI 1.28-4.24; p=0.005). Frailty and other geriatric syndromes are highly prevalent in patients admitted for AHF.  In the first 6 months after discharge, 20 deaths (9.9%) were recorded for any cause and 58 patients (28.7%) presented with the combined event. In our study we can conclude that frailty is related to all-cause mortality at 1 month but not to all-cause mortality at 6 months and that dependency is related to all-cause mortality and to the combined event at 1 and 6 months.
YR 2024
FD 2024
LK https://uvadoc.uva.es/handle/10324/69487
UL https://uvadoc.uva.es/handle/10324/69487
LA spa
NO Escuela de Doctorado
DS UVaDOC
RD 28-nov-2024