CC Cardiol Croat Cardiologia Croatica Cardiol. Croat. 1848-543X 1848-5448 Croatian Cardiac Society CC_13(11-12)_455 10.15836/ccar2018.455 Extended Abstract Predictors of intrahospital mortality of patients older than 80 years hospitalized in a modern intensive cardiac care unit Predskazatelji unutarbolničke smrtnosti osoba starijih od 80 godina hospitaliziranih u modernoj intenzivnoj kardiološkoj jedinici https://orcid.org/0000-0002-9346-6402SamardžićJure*https://orcid.org/0000-0003-4908-4674MjehovićPetrahttps://orcid.org/0000-0003-1170-1155KrižanacStefanhttps://orcid.org/0000-0002-3197-2190PašalićMarijanhttps://orcid.org/0000-0001-7171-2206Ljubas MačekJanahttps://orcid.org/0000-0002-2599-553XJurinHrvojehttps://orcid.org/0000-0003-0561-6704PlanincIvohttps://orcid.org/0000-0003-2633-3439FabijanovićDorahttps://orcid.org/0000-0001-7304-1127JakušNinahttps://orcid.org/0000-0002-5052-6559LovrićDanielhttps://orcid.org/0000-0002-4772-5549ČikešMajahttps://orcid.org/0000-0001-5979-2346SkorićBoškohttps://orcid.org/0000-0001-9101-1570MiličićDavor Medicinski fakultet Sveučilišta u Zagrebu, Klinički bolnički centar Zagreb, Zagreb, Hrvatska University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia ADDRESS FOR CORRESPONDENCE: Jure Samardžić, Klinički bolnički centar, Kišpatićeva 12,, HR-10000 Zagreb, Croatia. / Phone: +385-98-537-864 / E-mail: jure.samardzic@gmail.com 112018 13 11-12 455 455 2810201805112018 2018 Croatian Cardiac Society KLJUČNE RIJEČI: stariji bolesniciintenzivno liječenjeunutarbolnička smrtnost KEYWORDS: elderlyintensive treatmentintrahospital mortality

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).

Patient characteristics.
Patients’ characteristics
N (share in total number of patientshospitalized in CCU, %)Age (years), mean (min-max)Men, n (%) 243 (13.39)84.21 (80-98)97 (39.9)
ComorbiditiesArterial 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 diagnosisMyocardial 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 presentationShock, n (%)Creatinine (mcg/L), mean (min-max)Ejection fraction (%), mean (min-max) 30 (12.3)121.99 (36-664)46.12 (10-74)
Treatment courseNosocomial 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
Intrahospital mortality predictors.
Univariabile and multivariable predictors of in-hospital mortality
Predictors Univariable analysisP Multivariable analysis
OR P
GenderPrimary diagnosis (MI, arrest)ShockReanimationInotropic supportMechanical ventilationNosocomial pneumoniaDialysis procedureSevere valvular diseaseArterial hypertensionDiabetes mellitusAtrial fibrillationPeripheral artery diseasePrevious MI or strokeBMILVEF 0.4270.005<0.001<0.001<0.001<0.0010.0140.0020.260<0.0010.5890.9500.2140.1150.5780.004
ShockReanimationInotropic supportDialysis procedure 22.30215.0513.0036.938 <0.001<0.0010.0590.016
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 AndersenFHFlaattenHKlepstadPFollestadTStrandKKrügerAJ Long-Term Outcomes After ICU Admission Triage in Octogenarians. Crit Care Med. 2017;45(4):e363–71. 10.1097/CCM.000000000000209827618269