Prevalence of comorbidities and the prognostic value of the PROFUND index in a hospital cardiology unit

López-Garrido, Miguel A.; Martín-Portugués, I. Antequera; Becerra‐Muñoz, Víctor Manuel; Orellana-Figueroa, H.N.; Sánchez-Lora, F.J.; Morcillo‐Hidalgo, Luis; Gómez‐Doblas, Juan José; Teresa–Galván, Eduardo de; García‐Pinilla, José Manuel

doi:10.1016/j.rceng.2016.10.006

Cited by 6 publications

(3 citation statements)

References 20 publications

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“…These results are in line with those observed in comorbid patients admitted to internal medicine services, where the PROFUND index was also a good predictor of mortality at one year. These same findings have also been observed in cardiology and primary care settings [ 8 , 9 ].…”

Section: Discussionsupporting

confidence: 82%

Prognostic Significance of the PROFUND Index on One Year Mortality in Acute Heart Failure: Results from the RICA Registry

Méndez‐Bailón

Iguarán-Bermúdez

Formiga

et al. 2022

JCM

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Background: Heart failure (HF) is a syndrome with high prevalence, mainly affecting elderly patients, where the presence of associated comorbidities is of great importance. Methods: An observational study from a prospective registry was conducted. Patients identified from the National Registry of Heart Failure (RICA), which belongs to the Working Group on Heart Failure and Atrial Fibrillation of the Spanish Society of Internal Medicine (SEMI), were included. The latter is a prospective, multicenter registry that has been active since 2008. It includes individual consecutive patients over 50 years of age with a diagnosis of HF at hospital discharge (acute decompensated or new-onset HF). Results: In total, 5424 patients were identified from the registry. Forty-seven percent were men and mean left ventricular ejection fraction (LVEF) was 51.4%; 1132 had a score of 0 to 2 according to the PROFUND index, 3087 had a score of 3 to 6, and 952 patients had a score of 7 to 10 points. In the sample, 252 patients had a score above 11 points. At the end of the year of follow-up, 61% of the patients died. This mortality increased proportionally as the PROFUND index increased, specifically 75% for patients with PROFUND greater than 11. The Kaplan-Meier survival curve shows that survival at one year progressively decreases as the PROFUND index value increases. Thus, subjects with scores greater than seven (intermediate-high and high-risk) presented the worst survival with a log rank of 0.96 and a p < 0.05. In the regression analysis, we found a higher risk of death from any cause at one year in the group with the highest risk according to the PROFUND index (score greater than 11 points (HR 1.838 (1.410–2.396)). Conclusions: The PROFUND index is a good index for predicting mortality in patients admitted for acute HF, especially in those subjects at intermediate to high risk with scores above seven. Future studies should seek to determine whether the PROFUND index score is simply a prognostic marker or whether it can also be used to make therapeutic decisions for those subjects with very high short-term mortality.

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Section: Discussionsupporting

confidence: 82%

Prognostic Significance of the PROFUND Index on One Year Mortality in Acute Heart Failure: Results from the RICA Registry

Méndez‐Bailón

Iguarán-Bermúdez

Formiga

et al. 2022

JCM

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“…The instruments used to predict mortality have been the Charlson index and the PROFUND. This combination of instruments has been used in other studies in populations similar to those under study [ 20 , 39 , 40 , 41 ]. Furthermore, and since it is a retrospective study in which it is known which patients have died before the first year of admission to the Unit, a contribution of something more to the prognostic value of these instruments has been possible.…”

Section: Discussionmentioning

confidence: 99%

Palliative Care Needs and Clinical Features Related to Short-Term Mortality in Patients Enrolled in a Heart Failure Unit

et al. 2022

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(1) Background: Heart failure (HF) is a chronic and complex pathology requiring continuous patient management due to clinical instability, associated comorbidity, and extensive pharmacological treatment. Its unpredictable course makes the advanced stages challenging to recognize and raises the need for palliative care. This study aims to identify palliative care needs in HF patients and describe clinical features related to short-term mortality. (2) Methods: A descriptive, observational, cross-sectional, and retrospective study was carried out in an HF unit of a Spanish tertiary hospital. Patients’ socio-demographic and clinical data were collected from clinical records, and different instruments were used to establish mortality risks and patients’ needs for palliative care. Subsequently, univariate and bivariate descriptive analyses were performed. A binary logistic regression model helped to determine variables that could influence mortality 12 months after admission to the Unit. (3) Results: The studied population, sixty-five percent women, had an average age of 83.27 years. Among other clinical characteristics predominated preserved ejection fraction (pEF) and dyspnea NYHA (New York Heart Association) class II. The most prevalent comorbidities were hypertension and coronary heart disease. Forty-nine percent had a low–intermediate mortality risk in the following year, according to the PROFUND index. The NECPAL CCOMS-ICO© instrument identified subjects who meet the criteria for palliative care. This predictive model identified NECPAL CCOMS-ICO© results, using beta-blockers (BB) or AIIRA (Angiotensin II receptor antagonists) and low glomerular filtration rate (GFR) as explanatory variables of patients’ mortality in the following year. (4) Conclusions: The analysis of the characteristics of the population with HF allows us to identify patients in need of palliative care. The NECPAL CCOMS-ICO© instrument and the PROFUND have helped identify the characteristics of people with HF who would benefit from palliative management.

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“…Establishing an accurate prognostication is essential in the clinical care of vulnerable and frail populations. PROFUND index was originally developed to predict one-year mortality in hospital-based patients with multimorbidity, but its generalizability was subsequently demonstrated in other populations of patients with chronic conditions (in primary care polypathological patients, in other geographical areas, in patients with heart diseases, and in shorter as well as longer periods of follow-up) [37][38][39][40][41]. Recently a systematic review of prognostic tools in multimorbid populations found its quality as satisfactory [42].…”

Section: Discussionmentioning

confidence: 99%

Characterization of Patients with Chronic Diseases and Complex Care Needs: A New High-Risk Emergent Population

M¹,

L²,

J³

et al. 2022

J Biomed Res Environ Sci

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Background: To analyze the prevalence and main epidemiological, clinical and outcome features of in-Patients with Complex Chronic conditions (PCC) in internal medicine areas, using a pragmatic working definition. Methods: Prospective study in 17 centers from Spain, with 97 in-hospital, monthly prevalence cuts. A PCC was considered when criteria of polypathological patient (two or more major chronic diseases) were met, or when a patient suffered one major chronic disease plus one or more of nine predefined complexity criteria like socio-familial risk, alcoholism or malnutrition among others (PCC without polypathology). A complete set of baseline features as well as 12-months survival were collected. Then, we compared clinical, outcome variables, and PROFUND index accuracy between polypathological patients and PCC without polypathology. Results: The global prevalence of PCC was 61% (40% of them were polypathological patients, and 21% PCC withouth polypathology) out of the 2178 evaluated patients. Their median age was 82 (59.5% men), suffered 2.3 ± 1.1 major diseases (heart diseases (70.5%), neurologic (41.5%), renal (36%), and lung diseases (26%)), 5.5 ± 2.5 other chronic conditions, met 2.5 ± 1.5 complexity criteria, and presented functional decline (Barthel index 55 (25-90)). Compared to polypathological patients, the subgroup of PCC without polypathology were younger, with a different pattern of major diseases and comorbidities, a better functional status, and lower 12-months mortality rates ((36.2% vs 46.8%; p = .003; OR 0.7(0.48-0.86). The PROFUND index obtained adequate calibration and discrimination power (AUC-ROC 0.67 (0.63-0.69)) in predicting 12-month mortality of PCC. Conclusion: Patients with complex chronic conditions are highly prevalent in internal medicine areas; their clinical pattern has changed in parallel to socio-epidemiological modifications, but their death-risk is still adequately predicted by PROFUND index.

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Prevalence of comorbidities and the prognostic value of the PROFUND index in a hospital cardiology unit

Cited by 6 publications

References 20 publications

Prognostic Significance of the PROFUND Index on One Year Mortality in Acute Heart Failure: Results from the RICA Registry

Prognostic Significance of the PROFUND Index on One Year Mortality in Acute Heart Failure: Results from the RICA Registry

Palliative Care Needs and Clinical Features Related to Short-Term Mortality in Patients Enrolled in a Heart Failure Unit

Characterization of Patients with Chronic Diseases and Complex Care Needs: A New High-Risk Emergent Population

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