University of Applied Sciences Utrecht, Utrecht, Netherlands.
Age Ageing. 2014 Mar;43(2):218-21. doi: 10.1093/ageing/aft165. Epub 2013 Nov 4.
a growing number of older patients undergo cardiac surgery. Some of these patients are at increased risk of post-operative functional decline, potentially leading to reduced quality of life and autonomy, and other negative health outcomes. First step in prevention is to identify patients at risk of functional decline. There are no current published tools available to predict functional decline following cardiac surgery.
to validate the identification of seniors at risk-hospitalised patients (ISAR-HP), in older patients undergoing cardiac surgery.
a multicenter cohort study in cardiac surgery wards of two university hospitals with follow-up 3 months after hospital admission.
consecutive cardiac surgery patients, aged ≥65. Functional decline was defined as a decline of at least one point on the Katz ADL Index at follow-up compared with preadmission status.
475 patients were included, 16% of all patients and 20% of patients ≥70+ suffered functional decline. The amended prediction model predicted functional decline using four criteria: preadmission need for daily assistance in instrumental activities of daily living, use of a walking device, need for assistance in travelling and no education after age 14. Area under the receiver operating curve for patients ≥70 it was 0.73. For the amended ISAR-HP sensitivity, specificity, positive and negative predictive values were 85, 48, 29 and 93%, respectively.
the amended ISAR-HP used in older cardiac surgery patients showed good discriminative values at score ≥1, supporting the generalisability of this prediction model for this patient group.
越来越多的老年患者接受心脏手术。其中一些患者术后功能下降的风险增加，可能导致生活质量和自主性下降，以及其他负面健康结果。预防的第一步是识别有功能下降风险的患者。目前尚无可用的工具来预测心脏手术后的功能下降。
验证识别高危老年住院患者（ISAR-HP）在老年心脏手术患者中的作用。
这是一项在两家大学医院心脏外科病房进行的多中心队列研究，随访时间为住院后 3 个月。
连续接受心脏手术的患者，年龄≥65 岁。功能下降定义为与入院前相比，在随访时 Katz 日常生活活动指数至少下降 1 分。
共纳入 475 例患者，占所有患者的 16%，≥70 岁患者中有 20%出现功能下降。修订后的预测模型使用以下四项标准预测功能下降：入院前日常生活活动的工具性日常生活活动需要日常帮助、使用助行器、需要帮助旅行和 14 岁后未接受教育。年龄≥70 岁患者的受试者工作特征曲线下面积为 0.73。对于修订后的 ISAR-HP，敏感性、特异性、阳性预测值和阴性预测值分别为 85%、48%、29%和 93%。
在老年心脏手术患者中使用修订后的 ISAR-HP 评分≥1 时具有良好的区分度，支持该预测模型在该患者群体中的通用性。
