Predictors of intrahospital mortality of patients older than 80 years hospitalized in a modern intensive cardiac care unit

    Authors

    Abstract

    **Introduction:** Despite intensive treatment mortality in elderly patients presenting with acute cardiac diseases remains high. (1) The aim of this study was to investigate factors associated with intrahospital mortality of patients older than 80 years who were hospitalized in intensive cardiac care unit. **Patients and Methods**: We analyzed data from patients older than 80 years who were hospitalized in the Intensive Cardiac Care Unit of University Hospital Centre Zagreb in the period from 1st January 2015 to 31st December 2017. **Results**: We identified 243 patients older that 80 years (13.39% of total number of hospitalized patients in that period), 146 being women (60.1%). Most common leading diagnosis was acute myocardial infarction (n=107; 44%). All patients’ characteristics are displayed in **Table 1**. Intrahospital mortality was 21.4%. Results indicate that primary diagnosis, the severity of it’s presentation and the use of more invasive treatment are the main predictors of elderly patients’ mortality in intensive cardiac care unit (**Table 2**). ### TABLE 1: Patient characteristics. | **Patients’ characteristics** | | | --- | --- | | N (share in total number of patients hospitalized in CCU, %) Age (years), mean (min-max) Men, n (%) | 243 (13.39) 84.21 (80-98) 97 (39.9) | | **Comorbidities** Arterial hypertension, n (%) Diabetes mellitus, n (%) Atrial fibrillation, n (%) Previous MI or stroke, n (%) BMI (kg/m2), mean (min – max) | 210 (86.4) 68 (28.0) 85 (35.0) 57 (24.1) 26.65 (15.4-47.9) | | **Primary diagnosis** Myocardial infarction, n (%) Pulmonary oedema, n (%) Arrhythmia, n (%) Pulmonary embolism, n (%) TAVI, n (%) Cardiorespiratory arrest, n (%) Other, n (%) | 107 (44.0) 37 (15.2) 28 (11.5) 1 (0.4) 30 (12.3) 15 (6.2) 25 (10.3) | | **Disease presentation** Shock, n (%) Creatinine (mcg/L), mean (min-max) Ejection fraction (%), mean (min-max) | 30 (12.3) 121.99 (36-664) 46.12 (10-74) | | **Treatment course** Nosocomial pneumonia, n (%) Dialysis procedure, n (%) Mechanical ventilation, n (%) Inotropic medication, n (%) CCU hospitalization duration (days), mean (min-max) Reanimation, n (%) In-hospital death, n (%) | 11 (4.5) 16 (6.6) 92 (37.9) 58 (23.9) 2.37 (0. 04-27) 46 (18.9) 52 (21.4) | [†] BMI – body mass index; CCU – coronary care unit; MI – myocardial infarction; TAVI – transcatheter aortic valve implantation ### TABLE 2: Intrahospital mortality predictors. | **Univariabile and multivariable predictors of in-hospital mortality** | **Univariabile and multivariable predictors of in-hospital mortality** | **Univariabile and multivariable predictors of in-hospital mortality** | **Univariabile and multivariable predictors of in-hospital mortality** | | --- | --- | --- | --- | | Predictors | Univariable analysis P | Multivariable analysis | | | OR | P | | | | Gender Primary diagnosis (MI, arrest) Shock Reanimation Inotropic support Mechanical ventilation Nosocomial pneumonia Dialysis procedure Severe valvular disease Arterial hypertension Diabetes mellitus Atrial fibrillation Peripheral artery disease Previous MI or stroke BMI LVEF | 0.427 **0.005** **<0.001** **<0.001** **<0.001** **<0.001** **0.014** **0.002** 0.260 **<0.001** 0.589 0.950 0.214 0.115 0.578 **0.004** | | | | Shock Reanimation Inotropic support Dialysis procedure | | 22.302 15.051 3.003 6.938 | **<0.001** **<0.001** 0.059 **0.016** | [†] BMI – body mass index; LVEF – left ventricular ejection fraction; MI – myocardial infarction **Conclusion:** The share of patients older than 80 years in the total number of hospitalized patients in intensive care units is not negligible. Using intensive treatment in patients of advanced age requires individual assessment of its usefulness and treatment goals. It is necessary to develop adequate, preferably locally applicable models for assessing the condition of this sensitive and significant group of patients to rationalize resources and optimize treatment of severe acute cardiac diseases in individuals of advanced age.

    Keywords

    elderly, intensive treatment, intrahospital mortality

    DOI

    https://doi.org/10.15836/ccar2018.455

    Literature

    1. Andersen FH, Flaatten H, Klepstad P, Follestad T, Strand K, Krüger AJ, et al. Long-Term Outcomes After ICU Admission Triage in Octogenarians. Crit Care Med. 2017;45(4):e363–71. https://doi.org/10.1097/CCM.0000000000002098
    Cardiologia Croatica
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    Predictors of intrahospital mortality of patients older than 80 years hospitalized in a modern intensive cardiac care unit

    Extended Abstract
    Issue11-12
    Published
    Pages455
    PDF via DOIhttps://doi.org/10.15836/ccar2018.455
    elderly
    intensive treatment
    intrahospital mortality

    Authors

    Jure Samardžić*ORCIDMedicinski fakultet Sveučilišta u Zagrebu, Klinički bolnički centar Zagreb, Zagreb, Hrvatska
    Petra MjehovićORCIDMedicinski fakultet Sveučilišta u Zagrebu, Klinički bolnički centar Zagreb, Zagreb, Hrvatska
    Stefan KrižanacORCIDMedicinski fakultet Sveučilišta u Zagrebu, Klinički bolnički centar Zagreb, Zagreb, Hrvatska
    Marijan PašalićORCIDMedicinski fakultet Sveučilišta u Zagrebu, Klinički bolnički centar Zagreb, Zagreb, Hrvatska
    Jana Ljubas MačekORCIDMedicinski fakultet Sveučilišta u Zagrebu, Klinički bolnički centar Zagreb, Zagreb, Hrvatska
    Hrvoje JurinORCIDMedicinski fakultet Sveučilišta u Zagrebu, Klinički bolnički centar Zagreb, Zagreb, Hrvatska
    Ivo PlanincORCIDMedicinski fakultet Sveučilišta u Zagrebu, Klinički bolnički centar Zagreb, Zagreb, Hrvatska
    Dora FabijanovićORCIDMedicinski fakultet Sveučilišta u Zagrebu, Klinički bolnički centar Zagreb, Zagreb, Hrvatska
    Nina JakušORCIDMedicinski fakultet Sveučilišta u Zagrebu, Klinički bolnički centar Zagreb, Zagreb, Hrvatska
    Daniel LovrićORCIDMedicinski fakultet Sveučilišta u Zagrebu, Klinički bolnički centar Zagreb, Zagreb, Hrvatska
    Maja ČikešORCIDMedicinski fakultet Sveučilišta u Zagrebu, Klinički bolnički centar Zagreb, Zagreb, Hrvatska
    Boško SkorićORCIDMedicinski fakultet Sveučilišta u Zagrebu, Klinički bolnički centar Zagreb, Zagreb, Hrvatska
    Davor MiličićORCIDMedicinski fakultet Sveučilišta u Zagrebu, Klinički bolnički centar Zagreb, Zagreb, Hrvatska

    *Correspondence email: jure.samardzic@gmail.com

    Abstract

    **Introduction:** Despite intensive treatment mortality in elderly patients presenting with acute cardiac diseases remains high. (1) The aim of this study was to investigate factors associated with intrahospital mortality of patients older than 80 years who were hospitalized in intensive cardiac care unit. **Patients and Methods**: We analyzed data from patients older than 80 years who were hospitalized in the Intensive Cardiac Care Unit of University Hospital Centre Zagreb in the period from 1st January 2015 to 31st December 2017. **Results**: We identified 243 patients older that 80 years (13.39% of total number of hospitalized patients in that period), 146 being women (60.1%). Most common leading diagnosis was acute myocardial infarction (n=107; 44%). All patients’ characteristics are displayed in **Table 1**. Intrahospital mortality was 21.4%. Results indicate that primary diagnosis, the severity of it’s presentation and the use of more invasive treatment are the main predictors of elderly patients’ mortality in intensive cardiac care unit (**Table 2**). ### TABLE 1: Patient characteristics. | **Patients’ characteristics** | | | --- | --- | | N (share in total number of patients hospitalized in CCU, %) Age (years), mean (min-max) Men, n (%) | 243 (13.39) 84.21 (80-98) 97 (39.9) | | **Comorbidities** Arterial hypertension, n (%) Diabetes mellitus, n (%) Atrial fibrillation, n (%) Previous MI or stroke, n (%) BMI (kg/m2), mean (min – max) | 210 (86.4) 68 (28.0) 85 (35.0) 57 (24.1) 26.65 (15.4-47.9) | | **Primary diagnosis** Myocardial infarction, n (%) Pulmonary oedema, n (%) Arrhythmia, n (%) Pulmonary embolism, n (%) TAVI, n (%) Cardiorespiratory arrest, n (%) Other, n (%) | 107 (44.0) 37 (15.2) 28 (11.5) 1 (0.4) 30 (12.3) 15 (6.2) 25 (10.3) | | **Disease presentation** Shock, n (%) Creatinine (mcg/L), mean (min-max) Ejection fraction (%), mean (min-max) | 30 (12.3) 121.99 (36-664) 46.12 (10-74) | | **Treatment course** Nosocomial pneumonia, n (%) Dialysis procedure, n (%) Mechanical ventilation, n (%) Inotropic medication, n (%) CCU hospitalization duration (days), mean (min-max) Reanimation, n (%) In-hospital death, n (%) | 11 (4.5) 16 (6.6) 92 (37.9) 58 (23.9) 2.37 (0. 04-27) 46 (18.9) 52 (21.4) | [†] BMI – body mass index; CCU – coronary care unit; MI – myocardial infarction; TAVI – transcatheter aortic valve implantation ### TABLE 2: Intrahospital mortality predictors. | **Univariabile and multivariable predictors of in-hospital mortality** | **Univariabile and multivariable predictors of in-hospital mortality** | **Univariabile and multivariable predictors of in-hospital mortality** | **Univariabile and multivariable predictors of in-hospital mortality** | | --- | --- | --- | --- | | Predictors | Univariable analysis P | Multivariable analysis | | | OR | P | | | | Gender Primary diagnosis (MI, arrest) Shock Reanimation Inotropic support Mechanical ventilation Nosocomial pneumonia Dialysis procedure Severe valvular disease Arterial hypertension Diabetes mellitus Atrial fibrillation Peripheral artery disease Previous MI or stroke BMI LVEF | 0.427 **0.005** **<0.001** **<0.001** **<0.001** **<0.001** **0.014** **0.002** 0.260 **<0.001** 0.589 0.950 0.214 0.115 0.578 **0.004** | | | | Shock Reanimation Inotropic support Dialysis procedure | | 22.302 15.051 3.003 6.938 | **<0.001** **<0.001** 0.059 **0.016** | [†] BMI – body mass index; LVEF – left ventricular ejection fraction; MI – myocardial infarction **Conclusion:** The share of patients older than 80 years in the total number of hospitalized patients in intensive care units is not negligible. Using intensive treatment in patients of advanced age requires individual assessment of its usefulness and treatment goals. It is necessary to develop adequate, preferably locally applicable models for assessing the condition of this sensitive and significant group of patients to rationalize resources and optimize treatment of severe acute cardiac diseases in individuals of advanced age.

    Literature

    1. 1.
      Andersen FH, Flaatten H, Klepstad P, Follestad T, Strand K, Krüger AJ, et al. Long-Term Outcomes After ICU Admission Triage in Octogenarians. Crit Care Med. 2017;45(4):e363–71.DOI