Association of Hospital Admission Risk Profile Score with Mortality in Hospitalized Older Adults

Abstract

ObjectivesTo evaluate the association of the Hospital Admission Risk Profile (HARP) score with mortality after discharge in a population of hospitalized older adults.DesignRetrospective cohort study.ParticipantsHospitalized patients aged 70 years or older.MeasurementsPatient age at the time of admission, modified Folstein Mini-Mental Status Exam score, and self-reported instrumental activities of daily living 2 weeks prior to admission were used to calculate a HARP score. The primary outcome assessed was overall mortality up to 365 days after hospital discharge. Cox proportional hazard analyses evaluated the association between HARP score and mortality adjusting for age, sex, and comorbidities associated with increased mortality.ResultsOf the 474 patients, 165 (34.8%) had a low HARP score, 177 (37.4%) had an intermediate, and 132 (27.8%) had a high score. HARP score was not associated with differences in 30-day readmission rates. High HARP score patients had higher mortality when compared to patients with low HARP scores at all time frames (30 days: 12.9% vs 1.8%, p < .05; 90 days: 19.7% vs 4.8%, p < .05; 365 days: 34.8% vs 16.9%, p < .05). In fully adjusted Cox proportional models, patients with high HARP scores had a 3.5 times higher odds of mortality when compared to low HARP score patients.ConclusionThe HARP score is a simple and easy to use instrument that identifies patients at increased risk for mortality after hospital discharge. Early identification of patients at increased risk for mortality has the potential to help guide treatment decisions following hospital discharge and provides additional information to providers and patients for shared decision making and may help in clarifying and achieving patient and family goals of care.

Clinical value of Hospital Admission Risk Profile (HARP) and the Identification of Seniors at Risk (ISAR) scales to predict hospital-associated functional decline in an acute geriatric unit in Colombia

“…In fully adjusted Cox proportional models, mortality odds in those patients was 3.5 times higher compared to patients with low HARP scores. This finding suggests that HARP allows for identifying patients with a high risk of hospital-associated functional decline and mortality after discharge 22 . In addition, the same authors reported that the scale measured at admission could identify patients with a higher risk of requiring a skilled nursing or acute rehabilitation facility at discharge.…”

“…En modelos proporcionales de Cox ajustados, la probabilidad de mortalidad en esos pacientes fue 3.5 veces mayor en comparación con los pacientes con puntajes HARP bajos. Este hallazgo sugiere que la escala HARP permite identificar pacientes con alto riesgo de deterioro funcional hospitalario y mortalidad después del alta 22 . Además, los mismos autores informaron que la escala medida al ingreso podría identificar a los pacientes con mayor riesgo de requerir una unidad de enfermería especializada o de rehabilitación aguda al alta.…”

Microbiota in the pathogenesis of COPD and its impact on the course of the disease

“…В настоящее время не вызывает сомнения, что ре шающая роль в прогрессировании, госпитализации и смерти больных ХОБЛ принадлежит обострениям [6,7] При этом среди множества причин обострений на пер вом месте находится воздействие инфекционного фак тора [8]. Наряду с этим имеют значение снижение ле гочной функции, влияние аэрополлютантов, слабая приверженность к поддерживающей фармакотерапии, декомпенсация сопутствующих заболеваний (прежде всего, сердечнососудистой патологии) [6,[9][10][11].…”

Associations of Performance-Based Functional Assessments and Adverse Outcomes in CKD

“…(5) , (6) , (7) , (8) , (9) However, performance-based functional assessments to assess CKD outcomes have been inadequately studied. (10) Previous reports indicate performance on many performance-based functional assessments is linked to survival in numerous disease populations (11) , (12), but to our knowledge the association of performance-based functional assessments with outcomes in CKD patients, including ESKD and death, have not been fully evaluated.…”