Five‐Year Risk of Mechanical Ventilation in Community‐Dwelling Adults: The Framingham–Intermountain Anticipating Life Support Study. Issue 10 (12th October 2015)

• Record Type: Journal Article
• Authors: Walkey, Allan J.; Pencina, Karol M.; Knox, Daniel; Kuttler, Kathryn G.; D'Agostino, Ralph B.; Benjamin, Emelia J.; Brown, Samuel M.
• Is Part Of: Journal of the American Geriatrics Society. Volume 63:Issue 10(2015:Oct.)
• Page Start: 2082
• Page End: 2088
• Publication Date: 2015-10-12
• Subjects: Geriatrics -- Periodicals; 618.97
• DOI: 10.1111/jgs.13673
• Languages: English
• ISSNs: 0002-8614

Abstract

<abstract abstract-type="main" id="jgs13673-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jgs13673-sec-0001" sec-type="section"> <title>Objectives</title> <p>To develop a quantitative tool for identifying outpatients most likely to require life support with mechanical ventilation within 5 years.</p> </sec> <sec id="jgs13673-sec-0002" sec-type="section"> <title>Design</title> <p>Retrospective cohort study.</p> </sec> <sec id="jgs13673-sec-0003" sec-type="section"> <title>Setting</title> <p>Framingham Heart Study (FHS) 1991 to 2009 and Intermountain Healthcare clinics 2008 to 2013.</p> </sec> <sec id="jgs13673-sec-0004" sec-type="section"> <title>Participants</title> <p>FHS participants (n = 3, 666; mean age 74; 58% female) in a derivation cohort and Intermountain Healthcare outpatients aged 65 and older (n = 88, 302; mean age 73, 57% female) in an external validation cohort.</p> </sec> <sec id="jgs13673-sec-0005" sec-type="section"> <title>Measurements</title> <p>Information on demographic characteristics and comorbidities collected during FHS examinations to derive a 5‐year risk score for receiving mechanical ventilation in an intensive care unit, with external validation using administrative data from outpatients seen at Intermountain Healthcare. A sensitivity analysis investigating model performance for a composite outcome of mechanical ventilation or death was performed.</p> </sec> <sec id="jgs13673-sec-0006" sec-type="section"> <title>Results</title> <p>Eighty (2%) FHS participants were mechanically ventilated within 5 years after a FHS examination. Age, sex, diabetes mellitus, hypertension, atrial fibrillation, alcohol use, chronic pulmonary disease, and hospitalization within the prior year predicted need for mechanical ventilation within 5 years (c‐statistic = 0.74, 95% confidence interval (CI) = 0.68–0.80). One thousand seven hundred twenty‐five (2%) Intermountain Healthcare outpatients underwent mechanical ventilation. The validation model c‐statistic was 0.67 (95% CI = 0.66–0.68). Approximately 1% of individuals identified as low risk and 5% to 12% identified as high risk required mechanical ventilation within 5 years. Sensitivity analysis demonstrated a c‐statistic of 0.75 (95% CI = 0.75–0.75) for risk prediction of a composite outcome of mechanical ventilation or death.</p> </sec> <sec id="jgs13673-sec-0007" sec-type="section"> <title>Conclusion</title> <p>A simple risk score using clinical examination data or administrative data may be used to predict 5‐year risk of mechanical ventilation or death. Further study is necessary to determine whether use of a risk score enhances advance care planning or improves quality of care of older adults.</p> </sec> </abstract>