Usefulness of the multidimensional prognostic index (MPI) in evaluating the efficacy of warfarin treatment in older patients with atrial fibrillation

Sex differences in the prognostic impact of coexisting atrial fibrillation (AF) in older patients with heart failure (HF) have not been well-studied. This study, therefore, compared sex differences in the association between AF and its 90-day adverse outcomes (hospital readmissions and emergency room (ER) visits) among older adults with HF. Of the 250 older adult patients, the prevalence rates of coexisting AF between male and female HF patients were 46.0% and 31.0%, respectively. In both male and female older patients, patients with AF have a significantly higher readmission rate (male 46.0%, and female 34.3%) than those without AF (male 6.8%, and female 12.8%). However, there are no significant differences in the association between AF and ER visits in both male and female older HF patients. The multivariate logistic analysis showed that coexisting AF significantly increased the risk of 90-day hospital readmission in both male and female older patients. In addition, older age in males and longer periods of time after an HF diagnosis in females were associated with an increased risk of hospital readmission. Consequently, prospective cohort studies are needed to identify the impact of coexisting AF on short- and long-term outcomes in older adult HF patients by sex.

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Using the Multidimensional Prognostic Index to Predict Clinical Outcomes of Hospitalized Older Persons: A Prospective, Multicenter, International Study

The Journals of Gerontology Series A ◽

10.1093/gerona/gly239 ◽

2018 ◽

Vol 74 (10) ◽

pp. 1643-1649 ◽

Cited By ~ 12

Author(s):

Alberto Pilotto ◽

Nicola Veronese ◽

Julia Daragjati ◽

Alfonso J Cruz-Jentoft ◽

Maria Cristina Polidori ◽

...

Keyword(s):

Home Care ◽

Older Patients ◽

Risk Group ◽

Prognostic Index ◽

Home Care Services ◽

Cognitive Status ◽

Public Hospitals ◽

Mortality Data ◽

Care Services ◽

Overall Mortality

Abstract Background Multidimensional Prognostic Index (MPI) is useful as a prognostic tool in hospitalized older patients, but our knowledge is derived from retrospective studies. We therefore aimed to evaluate in a multicenter, longitudinal, cohort study whether the MPI at hospital admission is useful to identify groups with different mortality risk and whether MPI at discharge may predict institutionalization, rehospitalization, and use of home care services during 12 months. Methods This longitudinal study, carried out between February 2015 and August 2017, included nine public hospitals in Europe and Australia. A standardized comprehensive geriatric assessment including information on functional, nutritional, cognitive status, risk of pressure sores, comorbidities, medications, and cohabitation status was used to calculate the MPI and to categorize participants in low, moderate, and severe risk of mortality. Data regarding mortality, institutionalization, rehospitalization, and use of home care services were recorded through administrative information. Results Altogether, 1,140 hospitalized patients (mean age 84.1 years, women = 60.8%) were included. In the multivariable analysis, compared to patients with low risk group at admission, patients in moderate (odds ratio [OR] = 3.32; 95% CI: 1.79–6.17; p < .001) and severe risk (OR = 10.72, 95% CI: 5.70–20.18, p < .0001) groups were at higher risk of overall mortality. Among the 984 older patients with follow-up data available, those in the severe-risk group experienced a higher risk of overall mortality, institutionalization, rehospitalization, and access to home care services. Conclusions In this cohort of hospitalized older adults, higher MPI values are associated with higher mortality and other negative outcomes. Multidimensional assessment of older people admitted to hospital may facilitate appropriate clinical and postdischarge management.

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Using the multidimensional prognostic index for treatment decisions and monitoring in frail older patients

Geriatric Care ◽

10.4081/gc.2017.7059 ◽

2017 ◽

Vol 3 (3) ◽

Cited By ~ 1

Author(s):

Arduino A. Mangoni

Keyword(s):

Clinical Guidelines ◽

Older Patients ◽

Management Strategies ◽

Treatment Strategies ◽

Prognostic Index ◽

End Points ◽

Disease States ◽

Safe Management ◽

Limited Life ◽

Poor Functional Status

The routine applicability of clinical guidelines and disease-specific end-points in frail older patients is problematic because of the exclusion of this group from clinical trials, their limited life expectancy, the co-existence of multiple disease states and poor functional status, and the presence of complex drug-drug and drug-disease interactions. In this context, the use of patient-centred end-points that include measures of quality of life might be particularly useful for designing tailored treatment strategies, monitor progress and, ultimately, improve outcomes. The multidimensional prognostic index, an objective, quantifiable, and validated scoring system based on core domains of the comprehensive geriatric assessment, might represent an important tool for the development of clinical guidelines that take into account measures of frailty and patientcentred end-points. However, research is warranted to investigate whether this approach leads to more effective and safe management strategies in old age.

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