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European Geriatric Medicine

, Volume 9, Issue 4, pp 515–522 | Cite as

Long-term prognostic value of functional status and delirium in emergency patients with decompensated heart failure

  • Rizzi Miguel Alberto
  • Ruiz Domingo
  • Alquezar Aitor
  • Herrera Mateo Sergio
  • Piñera Pascual
  • Puig Mireia
  • Benito Salvador
  • Torres Olga Herminia
Research Paper
  • 21 Downloads

Abstract

Aims

Heart failure (HF) is prevalent in older adults and is associated with impaired physical and cognitive function. However, these factors are rarely included in studies about long-term prognosis of HF. The aim of the study was to determine whether functional status and delirium at admission (prevalent delirium) would predict 1-year mortality in patients with decompensated HF (DHF).

Methods

We performed a prospective observational study in adult patients with DHF attended at two Spanish Emergency Departments (ED) in the context of the Epidemiology Acute HF Emergency project. Functional status was assessed by Barthel Index (BI) and prevalent delirium by the Brief Confusion Assessment Method within the first 24 h of admission. We used Kaplan–Meier survival curves for delirium and multivariable Cox regression models to estimated hazard ratio (HR) and survival probability for death while adjusting for six potential confounders.

Result

We enrolled 239 patients (age 81.7 ± 9.4 years, women 61.1%). BI < 60 was 23.4 and 14.6% of patients had delirium. Age (HR 1.046 CI 95% 1.014–1.080, p < 0.004) and BI (HR 0.979 CI 95% 0.972–0.979, p < 0.001) were independently associated with 1-year mortality. In patients without severe functional dependence at admission, delirium (HR 3.579 CI 95% 1.730–7.403, p < 0.001) and age (HR 1.051 CI 95% 1.014–1.090, p = 0.007) independently predicted long-term mortality.

Conclusion

Age and functional dependence are strong predictors of long-term mortality in patients with DHF. In patients without severe functional dependence, delirium—a potentially modifiable risk factor—identified a subgroup of patients with higher mortality. Evaluating functional status and delirium in ED could improve decision-making and future care of patients with DHF.

Keywords

Heart failure Delirium Functional status Long-term prognosis Emergency department 

Notes

Acknowledgements

The authors thank Carolyn Newey for editorial assistance and members of EAHFE Project of the Work Group ICA-SEMES: Pablo Herrero (Hospital Universitario Central de Asturias, Oviedo). Javier Jacob (Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona). Francisco Javier Martín-Sánchez (Hospital Clínico San Carlos, Madrid). Pere Llorens (Hospital General de Alicante, Alicante). Marta Fuentes (Hospital Universitario de Salamanca). José Vallés (Hospital La Fe de Valencia). Víctor Gil, Rosa Escoda (Hospital Clínic de Barcelona). José Pavón, Ana Bella Álvarez (Hospital Dr. Negrín de Las Palmas de Gran Canaria). Antonio Noval (Hospital Insular de Las Palmas de Gran Canaria). José M. Torres (Hospital Reina Sofía de Córdoba). Maria Luisa López-Grima, Amparo Valero (Hospital Dr. Peset de Valencia). Alfons Aguirre (Hospital del Mar de Barcelona). Helena Sancho, Paco Ruiz (Hospital de Valme de Sevilla). Antonio Giménez, José Miguel Franco (Hospital Miguel Servet de Zaragoza). Sergio Pardo (Hospital San Juan de Alicante). Ana Belen Mecina (Hospital de Alcorcón). Josep Tost (Consorci Sanitari de Terrassa). Jordi Fabregat, (Hospital Mutua de Terrasa). Susana Sánchez (Hospital Rio Ortega de Valladolid). Raquel Torres Garate (Hospital Severo Ochoa). Fernando Richard (Hospital de Burgos). Javier Lucas (Hospital General de Albacete). Irene Cabello (Hospital Universitari de Bellvitge, Barcelona).

Compliance with ethical standards

Conflict of interest

All the authors declare that they have no conflict of interest.

Ethical approval

The ethics committees at each centre approved the complete protocol and the study was performed in accordance with the Declaration of Helsinki.

Informed consent

All patients, relatives, or caregivers gave written informed consent to participate in the study.

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Copyright information

© European Geriatric Medicine Society 2018

Authors and Affiliations

  • Rizzi Miguel Alberto
    • 1
    • 5
  • Ruiz Domingo
    • 4
  • Alquezar Aitor
    • 1
  • Herrera Mateo Sergio
    • 1
  • Piñera Pascual
    • 3
  • Puig Mireia
    • 1
    • 5
  • Benito Salvador
    • 1
    • 5
  • Torres Olga Herminia
    • 2
    • 5
  1. 1.Emergency DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
  2. 2.Department of Geriatrics, Internal Medicine Service, Hospital de la Santa Creu i Sant PauUniversidad Autónoma de BarcelonaBarcelonaSpain
  3. 3.Hospital Reina SofiaMurciaSpain
  4. 4.Internal Medicine DepartmentHospital San Juan de DiosManresaSpain
  5. 5.Medicine DepartmentUniversidad Autónoma de BarcelonaBarcelonaSpain

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