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In-hospital mortality risk score for very old patients hospitalized with decompensated chronic heart failure

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Abstract

Objective

To derive a risk score to predict in-hospital mortality for very old patients with decompensated chronic heart failure (DCHF).

Methodology

Retrospective cohort study that included patients ≥ 80 years admitted to a Geriatric Acute Care Unit with DCHF between January 2012 and December 2014. We analyzed 70 candidate risk factors and in-hospital mortality. We derived a risk model using multivariate logistic regression model and constructed a scale for scoring risk. We used bootstrapping techniques for the internal validation.

Results

We included 629 patients with mean age of 90 (SD5) years, 470 (73.1%) being women. Eighty-six (13.7%) patients died during the hospitalization. Factors included in the final risk model were NYHA class III–IV, severe functional dependence (Katz activities of daily living index < 2), infection as cause of exacerbation of heart failure, number of medications ≥ 8, albumin < 3 mg/dL, glomerular filtration rate < 60 mL/min, level of potassium in blood > 5.5 mEq/L and red blood cell distribution width (RDW) > 17%. In-hospital mortality in risk groups was 3.0, 4.6, 9.5, 15.1 and 36.3%, respectively. The area under ROC curve risk for score after bootstrapping was 0.77 (95%: CI 0.70–0.83).

Conclusion

This risk score could be useful for stratifying risk for in-hospital mortality among very old patients admitted to hospital for DCHF.

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Acknowledgements

Sponsor’s role: This study was partially supported by grants from the Instituto de Salud Carlos III supported with funds from the Spanish Ministry of Health and FEDER (PI15/00773).

Author information

Author notes

  1. J. Marttini Abarca and L. Fernández Arana contributed equally to this study.

Authors and Affiliations

  1. Geriatric Department, Clínico San Carlos Hospital, Madrid, Spain

    J. Marttini Abarca, L. Fernández Arana, E. Lueje Alonso, A. Pérez Rodriguez, T. Wu Lai & P. Gil Gregorio

  2. Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Calle Profesor Martín-Lagos s/n, 28040, Madrid, Spain

    F. Javier Martín-Sánchez

  3. Methodological Support to the Research Unit, Preventive Medicine Department, Clínico San Carlos Hospital, Madrid, Spain

    M. Fuentes-Ferrer

  4. Innovation Support Unit, Foundation for Biomedical Research, Clínico San Carlos Hospital, Madrid, Spain

    J. C. Nazario Arancibia

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  1. J. Marttini Abarca
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  2. L. Fernández Arana
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  3. F. Javier Martín-Sánchez
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  9. P. Gil Gregorio
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Contributions

All authors were involved in the deliberations regarding key concepts and design, analysis, and interpretation of evidence, as well as in the preparation of this manuscript.

Corresponding author

Correspondence to F. Javier Martín-Sánchez.

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Conflict of interest

The authors have no conflicts of interest to declare.

Ethical approval

The present study was approved by the Ethical and Clinical Investigation Committee (CEIC) of the hospital in accordance with ethical principles of the Declaration of Helsinki.

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For this type of study formal consent is not required.

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Marttini Abarca, J., Fernández Arana, L., Martín-Sánchez, F.J. et al. In-hospital mortality risk score for very old patients hospitalized with decompensated chronic heart failure. Eur Geriatr Med 9, 61–69 (2018). https://doi.org/10.1007/s41999-017-0008-0

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  • DOI: https://doi.org/10.1007/s41999-017-0008-0

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