Prognostic Indices for Older Adults: A Systematic Review
By L. Yourman, Sei J. Lee, M. Schonberg, E. Widera, Alexander K. Smith. Journal of the American Medical Association (JAMA), 2012
719 citations recorded by the source corpus.
Context To better target services to those who may benefit, many guidelines recommend incorporating life expectancy into clinical decisions. Objectives We conducted a systematic review to help physicians assess the quality and limitations of prognostic indices for mortality in older adults. Data Sources We searched MEDLINE, EMBASE, Cochrane, and Google Scholar through November 2011. Study Selection We included indices if they were validated and predicted absolute risk of mortality in patients whose average age was ≥ 60. We excluded indices that estimated ICU, disease-specific, or in-hospital mortality. Data Extraction For each prognostic index, we extracted data on clinical setting, potential for bias, generalizability, and accuracy. Results We reviewed 21,593 titles to identify 16 indices that predict risk of mortality from 6-months to 5 years for older adults in a variety of clinical settings: the community (six indices), the nursing home (two indices), and the hospital (eight indices). At least 1 measure of transportability was tested for all but 3 indices. By our measures, no study was free from potential bias. While 13 indices had c-statistics ≥ 0.70, none of the indices had c-statistics ≥ 0.90. Only two indices were independently validated by investigators who were not involved in the index’s development. Conclusion We identified several indices for predicting overall mortality in different patient groups; future studies need to independently test their accuracy in heterogeneous populations and their ability to improve clinical outcomes before their widespread use can be recommended.
Subfields: Cardiology and Cardiovascular Medicine, Epidemiology, Geriatrics and Gerontology
View Paper: https://www.semanticscholar.org/paper/b7762209639d94bed01b75f183b5d0d1f45e0bf8
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In Cardiology and Cardiovascular Medicine
In Epidemiology
Citations in the corpus
- Cancer screening in the United States, 2018: A review of current American Cancer Society guidelines and current issues in cancer screening (2018, methodology): “In applying clinical judgement about longevity, clinicians should use mortality indices that incorporate age, comorbidities, and functional status.(25,26) In addition, women should be provided opportunities for individualized decision making to consider the potential benefits and harms and incorpora”
- 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. (2014, methodology): “Bivalirudin is useful as an anticoagulant with or without prior treatment with UFH in patients with NSTE-ACS undergoing PCI (154, 213-217).”
- Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. (2012, background): “Prognostic indices of life expectancy may play a central role in moving beyond arbitrary age-based cut-offs [14].”
- Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. (2012, neutral): “Prognostic indices of life expectancy may play a central role in moving beyond arbitrary age-based cut-offs [14].”