Rosenbaum Andrew N, Naksuk Niyada, Gharacholou Shahyar M, Brenes-Salazar Jorge A
Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota.
Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota.
Am J Cardiol. 2017 Oct 15;120(8):1421-1426. doi: 10.1016/j.amjcard.2017.07.028. Epub 2017 Jul 31.
There are limited data on outcomes of older adults admitted to cardiac intensive care units (CICU), and there are no data on outcomes after admission to the CICU in nonagenarians. Our purpose was to identify whether the Elders Risk Assessment (ERA) index could risk stratify older adults after CICU admission. We retrospectively identified 453 nonagenarians admitted to the CICU between 2004 and 2013. End points included mortality, length of stay, incidence of delirium, and discharge disposition. Average age of the cohort was 92 ± 2 years, and the average ERA score was 13 ± 6. A total of 258 patients were female (57%). Most common admission indication was acute decompensated heart failure (57%) followed by acute myocardial infarction (49%). Loss of independence was observed after CICU admission, with 66% of patients living independently before admission, decreasing to 47% at discharge. Overall length of stay was 6 ± 5 days and CICU stay was 2 ± 2 days. Fifteen percent of patients died before hospital discharge. Median survival was 452 (interquartile range 40 to 1,371) days. ERA score effectively predicted survival (log-rank test, p = 0.002). ERA score of 16 or greater and ERA score of 9 to 15 were both associated with increased risk of mortality compared with the reference (score 4 to 8): hazard ratio 2.00, 95% confidence interval 1.37 to 2.90, p = 0.003, and hazard ratio 1.48, 95% confidence interval 1.06 to 2.08, p = 0.02, respectively. In conclusion, nonagenarians admitted to CICU experience reasonable outcomes. The ERA score effectively risk stratifies nonagenarians admitted to the CICU and may help with identification of vulnerable patients at risk of adverse outcomes.
关于入住心脏重症监护病房（CICU）的老年人的预后数据有限，且没有关于九旬老人入住CICU后的预后数据。我们的目的是确定老年人风险评估（ERA）指数能否对CICU入院后的老年人进行风险分层。我们回顾性地确定了2004年至2013年间入住CICU的453名九旬老人。终点指标包括死亡率、住院时间、谵妄发生率和出院处置情况。该队列的平均年龄为92±2岁，平均ERA评分为13±6。共有258名患者为女性（57%）。最常见的入院指征是急性失代偿性心力衰竭（57%），其次是急性心肌梗死（49%）。CICU入院后观察到患者失去独立生活能力，入院前66%的患者能够独立生活，出院时降至47%。总体住院时间为6±5天，CICU住院时间为2±2天。15%的患者在出院前死亡。中位生存期为452天（四分位间距40至1371天）。ERA评分有效地预测了生存率（对数秩检验，p = 0.002）。与参考值（评分4至8）相比，ERA评分16或更高以及ERA评分9至15均与死亡风险增加相关：风险比分别为2.00，95%置信区间1.37至2.90，p = 0.003，以及风险比1.48，95%置信区间1.06至2.08，p = 0.02。总之，入住CICU的九旬老人预后尚可。ERA评分有效地对入住CICU的九旬老人进行了风险分层，可能有助于识别有不良结局风险的脆弱患者。
