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.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The impact of intensive care in a private hospital on patients aged 80 and over: health-related quality of life, functional status and burden versus benefit.Intern Med J. 2016; 46: 694-702
- Understanding the treatment preferences of seriously ill patients.N Engl J Med. 2002; 346: 1061-1066
- Composite outcomes of chronically ill patients 4 months after hospital discharge.Am J Crit Care. 2009; 18: 456-465
- Risk factors for hospital and long-term mortality of critically ill elderly patients admitted to an intensive care unit.Biomed Res Int. 2014; 2014: 1-10
- Use of an electronic administrative database to identify older community dwelling adults at high-risk for hospitalization or emergency department visits: the elders risk assessment index.BMC Health Serv Res. 2010; 10: 338
- The relationship between Elder Risk Assessment (ERA) scores and cardiac revascularization: a cohort study in Olmsted County, Minnesota, USA.Clin Interv Aging. 2013; 8: 1209-1215
- Longitudinal changes in ICU admissions among elderly patients in the United States.Crit Care Med. 2016; 44: 1353-1360
- Temporal trends in the use of reperfusion therapy and outcomes in elderly patients with first ST elevation myocardial infarction.Eur Heart J Acute Cardiovasc Care. 2015; 4: 461-467
- Derivation and validation of automated electronic search strategies to extract Charlson comorbidities from electronic medical records.Mayo Clin Proc. 2012; 87: 817-824
- Clarifying confusion: the confusion assessment method: a new method for detection of delirium.Ann Intern Med. 1990; 113: 941-948
- The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults.Chest. 1991; 100: 1619-1636
- A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chronic Dis. 1987; 40: 373-383
- Change in disability after hospitalization or restricted activity in older persons.JAMA. 2010; 304: 1919-1928
- Intensive care unit use and mortality in the elderly.J Gen Intern Med. 2000; 15: 97-102
- The very elderly admitted to ICU: a quality finish.Crit Care Med. 2015; 43: 1352-1360
- Trends in severity of illness on ICU admission and mortality among the elderly.PLoS ONE. 2014; 9: 1-11
- Mortality and outcomes in very elderly patients 90 years of age or older admitted to the ICU.Respir Care. 2015; 60: 347-355
- Outcomes of early invasive treatment strategy in elderly patients with non-ST elevation acute coronary syndromes.J Cardiovasc Med. 2016; 17: 736-743
- Modalities of treatment and 30-day outcomes of unselected patients older than 75 years with acute ST-elevation myocardial infarction: data from the BLITZ study.J Cardiovasc Med (Hagerstown). 2008; 9: 1045-1051
- Implications and reasons for the lack of use of reperfusion therapy in patients with ST-segment elevation myocardial infarction: findings from the CRUSADE initiative.Am Heart J. 2010; 159: 757-763
- The outcomes and prognostic factors of the very elderly requiring prolonged mechanical ventilation in a single respiratory care center.Medicine (Baltimore). 2016; 95: e2479
- Factors influencing intensive care unit survival for critically ill elderly patients.Heart Lung. 1998; 27: 337-343
- Outcomes of critically ill elderly patients: is high-dependency care for geriatric patients worthwhile?.Crit Care Med. 1999; 27: 2351-2357
- Functional status and quality of life in elderly intensive care unit survivors.J Am Geriatr Soc. 2016; 64: 536-542
- A predictive model for delirium in hospitalized elderly medical patients based on admission characteristics.Ann Intern Med. 1993; 119: 474-481
- The impact of delirium on outcomes in acute, non-intubated cardiac patients.Eur Heart J Acute Cardiovasc Care. 2015; (2048872615624239 [pii])https://doi.org/10.1177/2048872615624239
- Characteristics of and outcomes for elderly patients with acute myocardial infarction: differences between females and males.Clin Interv Aging. 2016; 11: 1309-1316
- The feasibility of measuring frailty to predict disability and mortality in older medical intensive care unit survivors.J Crit Care. 2014; 29: 401-408
- Prevalence and impact of frailty on mortality in elderly ICU patients: a prospective, multicenter, observational study.Intensive Care Med. 2014; 40: 674-682
Article Info
Publication History
Published online: July 31, 2017
Accepted:
July 3,
2017
Received:
April 8,
2017
Footnotes
See page 1425 for disclosure information.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
