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Letter to the Editor| Volume 19, ISSUE 12, P1137-1138, December 2018

Utility of the Identification of Seniors at Risk Score to Predict In-Hospital Mortality in Older Patients With Heart Failure

Published:August 22, 2018DOI:https://doi.org/10.1016/j.jamda.2018.07.003
Utility of the Identification of Seniors at Risk Score to Predict In-Hospital Mortality in Older Patients With Heart Failure
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      Heart failure (HF) is a life-threatening medical condition that requires urgent evaluation and treatment.
      • Llorens P.
      • Manito Lorite N.
      • Manzano Espinosa L.
      • et al.
      Consensus to improve comprehensive care for patients with acute heart failure.
      Emergencias. 2015; 27: 245-266
      The decision to enter an intensive care unit is usually individual and based on risk models of the specific process.
      • Colprim D.
      • Martin R.
      • Parer M.
      • et al.
      Direct admission to intermediate care for older adults with reactivated chronic diseases as an alternative to conventional hospitalization.
      J Am Med Dir Assoc. 2013; 14: 300-302
      In clinical practice, this decision making can be extremely complex, especially for older patients with HF without dependence on the activities of established daily life or the existence of advanced guidelines limiting the therapeutic effort.
      • Tse G.
      • Gong M.
      • Wong S.H.
      • et al.
      Frailty and clinical outcomes in advanced heart failure patients undergoing left ventricular assist device implantation: A systematic review and meta-analysis.
      J Am Med Dir Assoc. 2018; 19: 255-261
      , 
      • Alegre O.
      • Formiga F.
      • López-Palop R.
      • et al.
      An easy assessment of frailty at baseline independently predicts prognosis in very elderly patients with acute coronary syndromes.
      J Am Med Dir Assoc. 2018; 19: 296-303
      Frailty is considered a dynamic state of vulnerability that if not detected and treated early can trigger adverse outcomes such as death, dependency, or institutionalization.
      • Chong E.
      • Ho E.
      • Baldevarona-Llego J.
      • et al.
      Frailty in hospitalized older adults: Comparing different frailty measures in predicting short- and long-term patient outcomes.
      J Am Med Dir Assoc. 2018; 19: 450-457
      , 
      • Vermeiren S.
      • Vella-Azzopardi R.
      • Beckwée D.
      • et al.
      Frailty and the prediction of negative health outcomes: A meta-analysis.
      J Am Med Dir Assoc. 2016; 17: 1163.e1-1163.e17
      The Identification of Seniors at Risk (ISAR) scale is related to a wide range of short-term adverse outcomes and is a tool for screening high-risk older adults discharged directly from the emergency department.
      • Rivero-Santana A.
      • Del Pino-Sedeno T.
      • Ramallo-Fariña Y.
      • et al.
      Usefulness of scoring risk for adverse outcomes in older patients with the identification of Seniors at risk scale and the triage risk screening tool: A meta-analysis.
      Emergencias. 2017; 29 ([in Spanish]): 49-60
      The results of the ISAR scale in hospitalization areas are debated, and there are no data on their prognostic value in older patients with HF admitted to a hospitalization facility.
      • Rivero-Santana A.
      • Del Pino-Sedeno T.
      • Ramallo-Fariña Y.
      • et al.
      Usefulness of scoring risk for adverse outcomes in older patients with the identification of Seniors at risk scale and the triage risk screening tool: A meta-analysis.
      Emergencias. 2017; 29 ([in Spanish]): 49-60
      The objective of the present study was to determine whether the ISAR scale is a tool to help predict in-hospital mortality in older adults hospitalized for HF.
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      References

        • Llorens P.
        • Manito Lorite N.
        • Manzano Espinosa L.
        • et al.
        Consensus to improve comprehensive care for patients with acute heart failure.
        Emergencias. 2015; 27: 245-266
        View in Article
        • Colprim D.
        • Martin R.
        • Parer M.
        • et al.
        Direct admission to intermediate care for older adults with reactivated chronic diseases as an alternative to conventional hospitalization.
        J Am Med Dir Assoc. 2013; 14: 300-302
        View in Article
        • Tse G.
        • Gong M.
        • Wong S.H.
        • et al.
        Frailty and clinical outcomes in advanced heart failure patients undergoing left ventricular assist device implantation: A systematic review and meta-analysis.
        J Am Med Dir Assoc. 2018; 19: 255-261
        View in Article
        • Alegre O.
        • Formiga F.
        • López-Palop R.
        • et al.
        An easy assessment of frailty at baseline independently predicts prognosis in very elderly patients with acute coronary syndromes.
        J Am Med Dir Assoc. 2018; 19: 296-303
        View in Article
        • Chong E.
        • Ho E.
        • Baldevarona-Llego J.
        • et al.
        Frailty in hospitalized older adults: Comparing different frailty measures in predicting short- and long-term patient outcomes.
        J Am Med Dir Assoc. 2018; 19: 450-457
        View in Article
        • Vermeiren S.
        • Vella-Azzopardi R.
        • Beckwée D.
        • et al.
        Frailty and the prediction of negative health outcomes: A meta-analysis.
        J Am Med Dir Assoc. 2016; 17: 1163.e1-1163.e17
        View in Article
        • Rivero-Santana A.
        • Del Pino-Sedeno T.
        • Ramallo-Fariña Y.
        • et al.
        Usefulness of scoring risk for adverse outcomes in older patients with the identification of Seniors at risk scale and the triage risk screening tool: A meta-analysis.
        Emergencias. 2017; 29 ([in Spanish]): 49-60
        View in Article
        • Ponikowski P.
        • Voors A.A.
        • Anker S.A.
        • et al.
        2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.
        Eur Heart J. 2016; 37: 2129-2200
        View in Article
        • Hogan D.B.
        • Maxwell C.J.
        • Afilalo J.
        • et al.
        A scoping review of frailty and acute care in middle-aged and older individuals with recommendations for future research.
        Can Geriatr J. 2017; 20: 22-37
        View in Article
        • Michel J.P.
        • Sadana R.
        “Healthy aging” concepts and measures.
        J Am Med Dir Assoc. 2017; 18: 460-464
        View in Article

      Article info

      Publication history

      Published online: August 22, 2018

      Footnotes

      The authors declare no conflicts of interest.

      Identification

      DOI: https://doi.org/10.1016/j.jamda.2018.07.003

      Copyright

      © 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

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