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Francesc Formiga

Publications and source records attributed to Francesc Formiga.

At least 19 recordsLinked to original sources
PubMed2007

Dying in hospital of terminal heart failure or severe dementia: the circumstances associated with death and the opinions of caregivers.

BACKGROUND: Improving the care provided to elderly patients affected by end-stage chronic diseases dying in acute hospitals is a health priority. We evaluated the circumstances related to death in end-stage non-cancer patients dying in two acute care hospitals, and their caregiver's opinions about the death. METHODS: Some 102 patients, over 64 years of age, with end-stage dementia (37%) or congestive heart failure (64%), were included in the study. Caregiver's opinions on the circumstances of death were obtained using a questionnaire. In addition, we collected data regarding written instructions on several items, including do not resuscitate (DNR) orders, decisions about care in terms of the level or intensity of interventions, information provided to relatives about the prognosis, total withdrawal of normal drug therapy, and provision of palliative care. RESULTS: Caregivers stated that the clinical information was accurate in 67.6% of cases, and the control of symptoms was good in 55%. However, the perception of pain persisted in 14% and uncontrolled dyspnoea in 45%. The end-of-life care was assessed as: excellent 30.5%, good 36%, fairly good 25.5%, bad 6%, and very bad 2%. DNR orders were specified in 89% of patients, decisions concerning the intensity of care in 64%, and 80% of relatives were aware of the prognosis. Drug therapy was withdrawn in 64% of cases, and terminal palliative care was initiated in 79.5%. CONCLUSION: Our results suggest that some aspects of the palliative care provided to elderly patients with end-stage chronic diseases, admitted to acute care hospitals, could be improved. Such aspects include the clinical information provided and the successful control of specific symptoms.

Aged, 80 and over↗
PubMed2006

Hospitalization due to acute heart failure. Role of the precipitating factors.

BACKGROUND AND AIMS: Many precipitating factors for decompensation of a chronic, stable heart failure (HF) have been described. OBJECTIVES: To evaluate the precipitating factors associated with HF decompensation among 293 patients admitted to a teaching hospital because of acute HF. RESULTS: 173 women and 120 men were included, and mean age was 76.7 years. In 221 patients (75%) there was some evidence of a factor that was potentially accountable for the decompensation of HF; a combination of two or more factors could be elicited in 100 patients. Except for a worse prior functional status, no differences were found between patients with and without identified precipitating factors. CONCLUSIONS: Precipitating factors may be identified in most patients suffering an acute episode of decompensation of HF. The majority of these factors appear to be preventable, and should thus be avoidable with a better, more comprehensive control of the HF patient.

Adult↗
PubMed2006

Predictors of in-hospital mortality present at admission among patients hospitalised because of decompensated heart failure.

Chronic heart failure (HF) is associated with a poor prognosis and causes considerable mortality. The aim of this study was to identify the admission characteristics useful to predict in-hospital mortality in patients admitted because of decompensation of HF. We evaluated 414 patients (age 76.2 years, 57% women). The hospital mortality rate was 11.1%. We identified 4 independent predictors of mortality: low Barthel index (odds ratio 1.03; 95% confidence interval 1.01-1.04), creatinine level >200 mumol/l (odds ratio 3.40; 95% confidence interval 1.51-7.66), peripheral oedema (odds ratio 3.12; 95% confidence interval 1.28-7.58) and the protective effect of the new onset of the disease (odds ratio 0.2; 95% confidence interval 0.08-0.77). In conclusion, the mortality of patients admitted to the hospital with an exacerbation of HF can be predicted if either poor functional capacity, renal insufficiency, peripheral oedema or previous diagnoses of HF are present. This clinical finding may help clinicians in their decision making in HF in the emergency room.

Aged↗
PubMed2006

Anemia in new-onset congestive heart failure inpatients admitted for acute decompensation.

BACKGROUND: Anemia may have important deleterious effects on patients with heart failure. We investigated the presence and causes of anemia among patients admitted because of new-onset congestive heart failure. The prognostic value of anemia was also evaluated. METHODS: We evaluated the presence of anemia, which was defined as hemoglobin concentrations lower than 13g/dl in men and lower than 12g/dl in women. One-year mortality and hospital readmission rates were also studied. RESULTS: A total of 103patients were included in the study. Their mean age was 78.5years and 53% were women. Mean hemoglobin levels were 12.4g/l. Forty-four patients (43%) had anemia at the time of hospital admission, 34 of them had true anemia and 10spurious anemia caused by hemodilution. Patients taking preadmission angiotensin-converting enzyme inhibitors had more severe anemia than those not taking them (p<0.01). The presence of anemia was not associated with an increase in mortality (p=0.3) or in readmission rates (p=0.1) after 1year of follow-up. CONCLUSIONS: Anemia is frequent in new-onset heart failure patients admitted for acute decompensation. However, the presence of anemia does not seem to be related to an increase in mortality or readmission in this small cohort.

Journal Article↗
PubMed2006

[Functional assessment of elderly patients admitted for heart failure].

The aim of our study was to evaluate the usefulness of functional assessment in very old patients admitted for heart failure. We assessed 188 patients aged >79 years. Their mean age was 84.6 (3.5) years, and 67% were female. Twenty-five patients (13%) died. Mortality was higher in those with more severe disability, with more comorbid conditions (as determined by the Charlson index), and with a low hematocrit and a high creatinine level. Logistic regression analysis showed that the Barthel index, the Charlson index, and the serum creatinine level were statistically significant factors. Functional assessment may help in the identification of elderly patients at a higher risk of death following hospital admission for heart failure.

Aged, 80 and over↗
PubMed2005

Functional outcomes of elderly patients after the first hospital admission for decompensated heart failure (HF). A prospective study.

Congestive HF is one of the most common discharge medical diagnoses in elderly hospitalized patients. We evaluate prospectively the usefulness of a global geriatric assessment to identify changes in the functional status of patients who experience their first hospitalization for a new diagnosis of HF. The Barthel Index (BI), the Older Americans Resource Scale (OARS), the Short Portable Mental Status Questionnaire (SPMSQ), and the short form of the Mini Nutritional Assessment (short-MNA) were used to estimate functional, cognitive, and nutritional status. The Charlson score (CS) was used to measure comorbidity. Eighty-eight patients (mean age 79 years; 57% women) were finally included; their median CS score was 2.1. Prior to the index admission, their mean BI score was 91, OARS 9.8, SPMSQ 1.8 errors, and short-MNA 10.7. Twenty-four patients (27%) died during the first year of follow-up. Low preadmission BI scores were predictive of mortality (p=0.02), but not of readmission (p=0.9). After one-year of follow-up BI scores remained lower than preadmission values in 64% of the surviving patients; for OARS scores the figure was 67%. In conclusion, a previous low functional capacity is associated with higher mortality but not with HF-related hospital readmission. Admission because of a new onset HF is often followed by a sustained functional decline both for the performance of basic and instrumental activities of the daily living.

Activities of Daily Living↗
PubMed2005

[Predisposing factors of delirium in hip fractured patients older than 84 years].

BACKGROUND AND OBJECTIVE: Our objective was to analyze those factors predisposing to delirium in patients older than 84 years who were admitted because of hip fracture. We also compared the prevalence of delirium in this population with a younger group. PATIENTS AND METHOD: One hundred and thirty patients (mean age 91.8 years) and 50 controls aged 65 to 84 years were included. RESULTS: Forty-three patients (33%) developed delirium. A poor previous functional capacity was the best marker identifying those at risk for developing delirium. Although the prevalence of delirium was higher in those older than 84 years, statistically significant differences were not reached. CONCLUSIONS: Disability prior to admission is the main risk factor predisposing to delirium during hospitalization in patients older than 84 years who are admitted because of hip fracture.

Aged↗