Bell Susan P, Schnelle John, Nwosu Samuel K, Schildcrout Jonathan, Goggins Kathryn, Cawthon Courtney, Mixon Amanda S, Vasilevskis Eduard E, Kripalani Sunil
Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA Division of General Internal Medicine and Public Health, Department of Medicine, Center for Quality Aging, Vanderbilt University, Nashville, Tennessee, USA.
Division of General Internal Medicine and Public Health, Department of Medicine, Center for Quality Aging, Vanderbilt University, Nashville, Tennessee, USA.
BMJ Open. 2015 Aug 27;5(8):e008122. doi: 10.1136/bmjopen-2015-008122.
To identify vulnerable cardiovascular patients in the hospital using a self-reported function-based screening tool.
Prospective observational cohort study of 445 individuals aged ≥ 65 years admitted to a university medical centre hospital within the USA with acute coronary syndrome and/or decompensated heart failure.
Participants completed an inperson interview during hospitalisation, which included vulnerable functional status using the Vulnerable Elders Survey (VES-13), sociodemographic, healthcare utilisation practices and clinical patient-specific measures. A multivariable proportional odds logistic regression model examined associations between VES-13 and prior healthcare utilisation, as well as other coincident medical and psychosocial risk factors for poor outcomes in cardiovascular disease.
Vulnerability was highly prevalent (54%) and associated with a higher number of clinic visits, emergency room visits and hospitalisations (all p<0.001). A multivariable analysis demonstrating a 1-point increase in VES-13 (vulnerability) was independently associated with being female (OR 1.55, p=0.030), diagnosis of heart failure (OR 3.11, p<0.001), prior hospitalisations (OR 1.30, p<0.001), low social support (OR 1.42, p=0.007) and depression (p<0.001). A lower VES-13 score (lower vulnerability) was associated with increased health literacy (OR 0.70, p=0.002).
Vulnerability to functional decline is highly prevalent in hospitalised older cardiovascular patients and was associated with patient risk factors for adverse outcomes and an increased use of healthcare services.
使用基于自我报告功能的筛查工具识别医院中易患心血管疾病的患者。
对445名年龄≥65岁、因急性冠状动脉综合征和/或失代偿性心力衰竭入住美国一家大学医学中心医院的患者进行前瞻性观察队列研究。
参与者在住院期间完成了一次面对面访谈，内容包括使用脆弱老年人调查（VES-13）评估脆弱功能状态、社会人口统计学、医疗保健利用情况以及特定患者的临床指标。多变量比例优势逻辑回归模型检验了VES-13与先前医疗保健利用之间的关联，以及心血管疾病不良结局的其他同时存在的医学和社会心理风险因素。
脆弱性非常普遍（54%），且与更多的门诊就诊、急诊就诊和住院次数相关（所有p<0.001）。多变量分析表明，VES-13（脆弱性）增加1分与女性（比值比1.55，p=0.030）、心力衰竭诊断（比值比3.11，p<0.001）、先前住院（比值比1.30，p<0.001）、社会支持低（比值比1.42，p=0.007）和抑郁（p<0.001）独立相关。VES-13得分较低（脆弱性较低）与健康素养提高相关（比值比0.70，p=0.002）。
住院老年心血管患者中功能下降的脆弱性非常普遍，且与不良结局的患者风险因素以及医疗服务使用增加相关。
