Determinants of In-Hospital Mortality in Elderly Patients Aged 80 Years or above with Acute Heart Failure: A Retrospective Cohort Study at a Single Rural Hospital.
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ABSTRACT:
SUBMITTER: Watanabe Y
PROVIDER: S-EPMC8038161 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundFew studies have addressed health-related quality of life in community-dwelling individuals aged 80 years and above and very few self-assessment quality of life questionnaires have been formally validated in these populations. This study aimed to validate a French version of the LEIPAD, a self-administered questionnaire assessing the health-related quality of life of people aged 80 years and over.MethodA cross-sectional study of people aged 80 years and over living at home in France was conducted. All subjects recruited were sent a letter explaining the study and requesting their consent to take part. Those who accepted then received the questionnaires, including the LEIPAD, which assesses health-related quality of life in the subjects aged 65 years and above. We assessed its psychometric properties: data completeness, score distribution, floor and ceiling effects, internal consistency, item-total correlations, inter-scale correlations, reliability and convergent validity with the Medical Outcome Study Short-Form 36 (SF-36).ResultsThe results obtained from 184 older people (mean age of 83.9 years, standard deviation 3.3) showed very good acceptability (missing data between 1.1% and 11.4% for LEIPAD scales) Factor analysis of the instrument confirmed the multi-dimensional structure in seven independent scales similar to the original version. Good internal consistency (Cronbach's alpha ranging from 0.68 to 0.87) and strong test-retest reliability of the LEIPAD scales (intraclass correlation coefficients ranging from 0.77 to 0.95) were found. Convergent validity with the SF-36 showed moderate to strong correlations, consistent with the hypotheses stated.ConclusionsThe validation of this specific questionnaire will make it possible to investigate individually the health-related quality of life of French older people living at home and will enable French-speaking investigators to contribute to national and international research projects.
| S-EPMC6424406 | biostudies-literature
Project description:BackgroundIschaemic heart disease remains the main cause of death in the world. With increasing age, frailty and comorbidities, senior patients aged 80 years old and above who undergo percutaneous coronary intervention (PCI) are at higher risk of mortality and other complications.AimsWe aimed to examine the overall outcomes for this group of patients.MethodsFour databases (PUBMED, EMBASE, SCOPUS and CENTRAL) were searched. Studies with patients aged 80 years old and above who underwent PCI for all indications were included. Pooled outcomes of all-cause death, cardiac death, in-hospital death, subsequent stroke/transient ischaemic attack (TIA), subsequent myocardial infarction (MI), subsequent congestive cardiac failure (CCF), and overall major adverse cardiac events (MACE) were obtained for meta-analysis.ResultsFrom 2,566,004 patients, the pooled cumulative incidence of death was 19.22%, cardiac death was 7.78%, in-hospital death was 7.16%, subsequent stroke/TIA was 1.54%, subsequent MI was 3.58%, subsequent CCF was 4.74%, and MACE was 17.51%. The mortality rate of all patients was high when followed up for 3 years (33.27%). ST-elevation myocardial infarction patients had more outcomes of in-hospital death (14.24% vs 4.89%), stroke/TIA (1.93% vs 0.12%), MI (3.68 vs 1.55%) and 1-year mortality (26.16% vs 13.62%), when compared to non-ST-elevation myocardial infarction patients.ConclusionsThere was a high mortality rate at 1 year and 3 years post-PCI in the overall population of senior patients aged 80 years old and above, regardless of indication. This necessitates further studies to explore the implications of these observations.
| S-EPMC9706774 | biostudies-literature
Project description:IntroductionTo date, mainly due to age-related vulnerability and to coexisting comorbidities, older patients often face a more severe COVID-19. This study aimed to identify at Emergency Department (ED) admission the predictors of in-hospital mortality and suitable scores for death risk stratification among COVID-19 patients ≥ 80 years old.MethodsSingle-centre prospective study conducted in the ED of an university hospital, referral center for COVID-19 in central Italy. We included 239 consecutive patients ≥ 80 years old with laboratory-confirmed COVID-19. The primary study endpoint was all-cause in-hospital mortality. Multivariable Cox regression analysis was performed on significant variables at univariate analysis to identify independent risk factor for death. Overall performance in predicting mortality of WHO severity scale, APACHE II score, NEWS score, and CURB-65 was calculated.ResultsMedian age was 85 [82-89] and 112 were males (46.9%). Globally, 77 patients (32.2%) deceased. The presence of consolidations at chest x-ray and the hypoxemic respiratory failure were significant predictors of poor prognosis. Moreover, age ≥ 85 years, dependency in activities of daily living (ADL), and dementia were risk factors for death, even after adjusting for clinical covariates and disease severity. All the evaluated scores showed a fairly good predictive value in identifying patients who could experience a worse outcome.ConclusionsAmong patients ≥ 80 years old hospitalized with COVID-19, not only a worse clinical and radiological presentation of the disease, but also the increasing age, dementia, and impairment in ADL were strong risk factors for in-hospital death, regardless of disease severity.
| S-EPMC7904458 | biostudies-literature
Project description:Background and aimsThe average human life expectancy is increasing worldwide, thus the proportion of elderly gastric cancer patients is also increasing. In this case-control study, we investigated the clinical and oncologic outcomes of gastric cancer in patients over 80 years old.MethodsFrom January 2004 to December 2010, 291 patients aged over 80 years old (case group) were diagnosed and treated with gastric cancer at Asan Medical Center, Seoul, Korea. From the same period, 291 patients aged 18 to 80 years old were selected as the control group. The clinical findings and clinical outcomes of gastric cancer were retrospectively reviewed and compared between the two groups.ResultsThere were significant differences in the overall 5-year survival rate between the case and control groups (30.9% vs. 73.8%, respectively; P<0.001). In patients who received the curative treatment, overall 3- and 5-year survival rates showed 74.3% and 57.9% in case group and 91.6% and 86.5% in the control group. When analysis was confined to resectable elderly patients with a favorable performance, the curative resection group showed significantly better overall 3- and 5-year survival rates than the conservative treatment group (73.7% and 58.8% vs. 29.8% and 0%, respectively).ConclusionsAlthough elderly gastric cancer patients show an advanced stage at diagnosis and poor prognosis compared with non-elderly patients, elderly patients with good performance could benefit from curative resection. Thus, the clinical decision whether to undergo curative resection or conservative management should be made on an individualized basis.
| S-EPMC5152853 | biostudies-literature
Project description:Introduction:Endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) is well accepted. However, its adaptation for elderly patients is unclear. This study aimed to investigate the prognosis and long-term outcomes of ESD for EGC in elderly patients aged ≥80 years by comparing their findings to the findings of patients aged <80 years. Materials and Methods:The study included 533 patients (632 lesions). The patients were divided into an elderly group (age, ≥80 years; 108 patients; 128 lesions; mean age, 83.4 ± 2.7 years) and a nonelderly group (age, <80 years; 425 patients; 504 lesions; mean age, 69.6 ± 7.9 years). We compared patient and lesion characteristics, overall survival (OS), and disease-specific survival (DSS) between the 2 groups retrospectively. Multivariate analysis was performed to clarify the risk factors of death after ESD. Results:The rate of curative resection and adverse events was not significantly different between the groups. The mean survival time periods with regard to OS/DSS in the elderly and nonelderly groups were 75.8 ± 5.9 and 122.8 ± 2.6 months (P < 0.05)/120.0 ± 3.0 and 136.4 ± 0.6 months (not significant), respectively. In the elderly group, eGFR <30 ml/min/1.73 m2 was an independent risk factor of death (hazard ratio = 5.32; 95% confidence interval = 1.39-20.5; P=0.015). Conclusion:ESD for EGC can be performed safely and can achieve high curability with good prognosis in elderly patients aged ≥80 years. After ESD, close attention should be paid to elderly patients with severe chronic kidney disease.
| S-EPMC6754868 | biostudies-literature
Project description:Although there are over 1.34 billion Chinese in the world, nationwide spirometric reference values for Chinese are unavailable, which is usually based on Caucasian conversion. The aim of this study was to establish spirometric reference values for Chinese with a national wide sample.We enrolled healthy non-smokers in 24 centers in Northeast, North, Northwest, Southwest, South, East and Central China from January 2007 to June 2010. Spirometry was performed according to American Thoracic Society and European Respiratory Society guidelines. Reference equations were established using the Lambda-Mu-Sigma (LMS) method for forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC, peak expiratory flow (PEF) and maximal midexpiratory flow (MMEF). Popular Caucasian reference values adjusted with ethnic conversion factors were validated with Chinese measured spirometry data. The present study also compared with other published Chinese equations for spirometry.A total of 7,115 eligible individuals aged 4 to 80 years (50.9% females) were recruited. Reference equations against age and height by gender were established, including predicted values and lower limits of normal (LLNs). Validated with Chinese data, the mean percentage differences of Caucasian reference values adjusted with ethnic conversion factors were -10.2% to 1.8%, and the percentages of total subjects under LLNs were 0.1% to 8.9%. Compared with this study, the percentage differences of previous Chinese studies ranged from -17.8% to 11.4%, which were found to significantly overestimate or underestimate lung function.This study established new reference values for better interpretation of spirometry in Chinese aged 4 to 80 years, while Caucasian references with adjustment were inappropriate for Chinese.
| S-EPMC5720964 | biostudies-other
Project description:Clonal hematopoiesis of indeterminate potential (CHIP) is associated with increased risk of cancers and inflammation-related diseases. This phenomenon becomes common in persons aged ≥80 years, in whom the implications of CHIP are not well defined. We performed a mutational screening in 1794 persons aged ≥80 years and investigated the relationships between CHIP and associated pathologies. Mutations were observed in one-third of persons aged ≥80 years and were associated with reduced survival. Mutations in JAK2 and splicing genes, multiple mutations (DNMT3A, TET2, and ASXL1 with additional genetic lesions), and variant allele frequency ≥0.096 had positive predictive value for myeloid neoplasms. Combining mutation profiles with abnormalities in red blood cell indices improved the ability of myeloid neoplasm prediction. On this basis, we defined a predictive model that identifies 3 risk groups with different probabilities of developing myeloid neoplasms. Mutations in DNMT3A, TET2, ASXL1, or JAK2 were associated with coronary heart disease and rheumatoid arthritis. Cytopenia was common in persons aged ≥80 years, with the underlying cause remaining unexplained in 30% of cases. Among individuals with unexplained cytopenia, the presence of highly specific mutation patterns was associated with myelodysplastic-like phenotype and a probability of survival comparable to that of myeloid neoplasms. Accordingly, 7.5% of subjects aged ≥80 years with cytopenia had presumptive evidence of myeloid neoplasm. In summary, specific mutational patterns define different risk of developing myeloid neoplasms vs inflammatory-associated diseases in persons aged ≥80 years. In individuals with unexplained cytopenia, mutational status may identify those subjects with presumptive evidence of myeloid neoplasms.
| S-EPMC8617437 | biostudies-literature
Project description:Transcatheter aortic valve replacement (TAVR) is an effective treatment option for patients with severe symptomatic aortic stenosis. Nonetheless, there is a paucity of data regarding the differences in the clinical outcomes of TAVR procedures between elderly and super-elderly patients. This study aimed to compare the clinical characteristics and outcomes of patients aged 65 to 79 years and ≥80 years who underwent TAVR for aortic stenosis. The clinical characteristics and outcomes of 134 patients with aortic stenosis who underwent TAVR were analyzed. Patients were categorized into 2 groups: an elderly group (EG; 65-79 years) and a super-elderly group (SEG) (≥80 years). The in-hospital and follow-up clinical outcomes were compared between the 2 groups. The EG tended to be more overweight, obese, and diabetic than the SEG, whereas the SEG had a higher surgical risk but lower creatinine clearance, hematocrit level, and effective orifice area than the EG. However, no difference was found in in-hospital clinical outcomes between the 2 groups, except for atrial fibrillation. In the propensity score matching and inverse probability of treatment weighting-adjusted analyses, these results were similar. All follow-up clinical outcomes were similar, except for rehospitalization, which was statistically attenuated after propensity score matching and inverse probability of treatment weighting-adjusted analyses. TAVR was associated with similar safety outcomes in the EG (65-79 years) and the SEG (≥80 years). Advanced age is not negatively associated with clinical outcomes after the TAVR procedure.
| S-EPMC9239624 | biostudies-literature
Project description:BackgroundSeveral guidelines have suggested alternative glycemic markers for hemoglobin A1c among older adults with limited life expectancy or multiple coexisting chronic illnesses. We evaluated associations between fructosamine, albumin-corrected fructosamine (AlbF), fasting plasma glucose (FPG), and mortality in the diabetic and nondiabetic subpopulations, and compared which marker better predicts mortality among participants aged 80 and older.MethodsIncluded were 2 238 subjects from the Healthy Ageing and Biomarkers Cohort Study (2012-2018) and 207 participants had diabetes at baseline. Multivariable Cox proportional hazards regression models investigated the associations of fructosamine, AlbF, FPG, and all-cause, cardiovascular disease (CVD), and non-CVD mortality in the diabetic and nondiabetic subpopulations. Restricted cubic splines explored potential nonlinear relations. C-statistic, integrated discrimination improvement (IDI), and net reclassification improvement (NRI) evaluated the additive value of different glycemic markers to predict mortality.ResultsOverall, 1 191 deaths were documented during 6 793 person-years of follow-up. In the linear model, per unit increases of fructosamine, AlbF, and FPG were associated with a higher risk of mortality in nondiabetic participants, with hazard ratios of 1.02 (1.00, 1.05), 1.27 (1.14, 1.42), and 1.04 (0.98, 1.11) for all-cause mortality, and 1.04 (1.00, 1.07), 1.38 (1.19, 1.59), and 1.10 (1.01, 1.19) for non-CVD mortality, respectively. Comparisons indicated that AlbF better predicts all-cause and non-CVD mortality in nondiabetic participants with significant improvement in IDI and NRI.ConclusionsHigher concentrations of fructosamine, AlbF, and FPG were associated with a higher risk of all-cause or non-CVD mortality among the very elderly where AlbF may constitute an alternative prospective glycemic predictor of mortality.
| S-EPMC9373969 | biostudies-literature
Project description:It remains unclear what the blood pressure target is and at which point in life it is appropriate for antihypertensive treatment. This study aimed to determine age-specific systolic blood pressure (SBP) targets. In a nationwide cohort of 296,470 hypertensive patients aged ≥75 years and a representative cohort of 259,028 hypertensives aged 45-74 years, multivariable-adjusted incidence rates of cardio-kidney composite events, overt dementia, and all-cause deaths were estimated across yearly-averaged on-treatment SBP levels according to age and the presence of 4 additional risk factors (diabetes, dyslipidemia, albuminuria, and smoking). For cardio-kidney events, on-treatment SBP showed positive curvilinear associations with higher risks at ≥135 mm Hg in most while an attenuated association in age ≥85 years. For overt dementia, SBP showed flat or slightly inverted associations in elderly while a small positive association in age 45-64 years. For all-cause mortality, SBP showed J-shaped associations having right-shifting tendency with age. For risk categories with ≥2, 1, and no additional risk factors, the respective mortality rate differences between SBP 145-154 mm Hg and 125-134 mm Hg were 4.6 (95% confidence interval [CI], 2.0 to 7.3), 1.2 (95% CI, -0.3 to 2.8), and 0.1 (95% CI, -1.4 to 1.8) per 1000 person-years in age ≥75 years and 2.9 (95% CI, 1.7 to 4.3), 0.7 (95% CI, 0.1 to 1.4), and 0.9 (95% CI, 0.2 to 1.6) per 1000 person-years in age 45-74 years. In conclusion, the BP target can be relaxed in very old patients and in elderly patients with few risk factors. However, strict BP control may be needed in patients with multiple risk factors even in those with advanced age.
| S-EPMC10833546 | biostudies-literature