Survival time tool to guide care planning in people with dementia
Survival time tool to guide care planning in people with dementia
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DOI：
10.1212/wnl.0000000000008745
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发表时间：
2020-02-04
期刊：
影响因子：
9.9
通讯作者：
Garcia-Ptacek, Sara
中科院分区：
文献类型：
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作者：
Haaksma, Miriam L.;Eriksdotter, Maria;Garcia-Ptacek, Sara
目的制定生存预测表，让医生和患者了解痴呆症诊断后的生存概率，并确定是否可以准确地预测痴呆症诊断后的生存率。方法我们进行了一项全国性的登记关联研究，包括瑞典各地的 829 个健康中心，即所有记忆诊所和大约 75% 的初级保健机构。使用的数据包括 2007 年至 2015 年间 50,076 名年龄≥ 65 岁且在瑞典痴呆症登记处登记的 50,076 名痴呆症患者的认知功能数据，最长随访时间为 9.7 年，直至 2016 年。社会人口因素、合并症负担、药物使用和死亡日期均从全国登记处获得。使用 Cox 比例风险回归模型创建表格，描述不同危险因素概况的 3 年生存概率。结果 截至 2016 年 8 月，我们队列中的 20,828 名患者 (41.6%) 死亡。女性诊断痴呆后的中位生存时间为 5.1 年（四分位距 2.9-8.0），男性为 4.3 年（四分位距 2.3-7.0）年。死亡率的预测因素包括年龄较大、男性、合并症负担增加、诊断时认知功能较低、诊断为非阿尔茨海默氏痴呆、独居和使用更多药物。开发的预测表产生的 c 指数为 0.70（95% 置信区间 [CI] 0.69-0.71）至 0.72（95% CI 0.71-0.73），并显示出良好的校准效果。 结论 可以非常准确地预测痴呆症诊断后的三年生存率。本研究中开发的生存预测表可以帮助临床医生和患者共同决策和预先护理计划。
ObjectiveTo develop survival prediction tables to inform physicians and patients about survival probabilities after the diagnosis of dementia and to determine whether survival after dementia diagnosis can be predicted with good accuracy.MethodsWe conducted a nationwide registry-linkage study including 829 health centers, i.e., all memory clinics and approximate to 75% of primary care facilities, across Sweden. Data including cognitive function from 50,076 people with incident dementia diagnoses >= 65 years of age and registered with the Swedish Dementia Register in 2007 to 2015 were used, with a maximum follow-up of 9.7 years for survival until 2016. Sociodemographic factors, comorbidity burden, medication use, and dates of death were obtained from nationwide registries. Cox proportional hazards regression models were used to create tables depicting 3-year survival probabilities for different risk factor profiles.ResultsBy August 2016, 20,828 (41.6%) patients in our cohort had died. Median survival time from diagnosis of dementia was 5.1 (interquartile range 2.9-8.0) years for women and 4.3 (interquartile range 2.3-7.0) years for men. Predictors of mortality were higher age, male sex, increased comorbidity burden and lower cognitive function at diagnosis, a diagnosis of non-Alzheimer dementia, living alone, and using more medications. The developed prediction tables yielded c indexes of 0.70 (95% confidence interval [CI] 0.69-0.71) to 0.72 (95% CI 0.71-0.73) and showed good calibration.ConclusionsThree-year survival after dementia diagnosis can be predicted with good accuracy. The survival prediction tables developed in this study may aid clinicians and patients in shared decision-making and advance care planning.