Fatores cardiorrespiratórios e funcionais como preditores de desfechos clínicos adversos em saúde para longevos

Abstract

Introduction: Point-of-care feasible tools to identify risk of clinical adverse health outcomes (CAHO) to stratify individuals according to risk can become the heath care more strategic. Objective: To investigate predictive factors for CAHO in a cardiorespiratory and functional assessment in oldest-old people (≥85 years old). Methodology: Observational prospective cohort study including subjects capable of independent walking (including walking aids), without hospitalization or chronic disease exacerbation three months ago, and who scored ≥16 points in the Mini Mental State Examination. We run razard ratio and survival analysis. Results: Our sample was constituted by 96 oldest-old, mean age 92.5±3.00 years old, 68% women. It was observed 89 medical appointments, 24 hospitalizations, 34 falls and 3 institutionalizations in the first year, while 18 died in 26.1±7.17 months of follow-up (19% out of the sample). Btype natriuretic peptide was predictor for hospitalization (>106pg/ml, HR 2.56, 95%CI 1.10- 6.00; p=0.030) and slight significant for mortality (>173pg/ml, HR 2.52, 95%CI 0.99-6.40; p=0.052); maximal inspiratory pressure <70% from expected (HR 0.64 95%CI 0.42-0.97; p=0.036), 5-degree dyspnea comparing to 1-degree by Medical Research Council (HR 2.66, 95%CI 1.14-6.17; p=0.023), and forced expiratory volume in the first second ≥46% from expected (HR 0.30, 95%CI 0.09-0.96; p=0.042), for medical appointment; and, the ease to perform functional activities score ≥18 out of 36 points (HR 0.34, 95%CI 0.12-0.96; p=0.042) and 5-degree dyspnea compared with 1-degree (HR 4.09, 95%CI 1.55-10.77; p= 0.004), for fall. Conclusion: The point-of-care home assessment predicted CAHO. The cardiorespiratory factors presented different and complementary predictions to screen CAHO widely. For the primary health care, the findings suggest that preventive interventions aiming at cardiorespiratory diseases management should be considered as a priority for healthy in the longevity, because these diseases can cause important CAHO in one-year period, and a lot of them can be prevented.