Key predictors of mortality in comorbid patients under remote follow-up

Abstract

Objective. To determine predictors of the risk of developing adverse outcomes in patients with comorbid pathology, including broncho-obstructive and cardiovascular diseases, during remote follow-up. Materials and methods. The study included 79 patients (aged 40 to 88 years, 73.4 % men), predominantly urban residents, with combined respiratory and cardiovascular diseases. As predictors of adverse outcomes during dynamic observation, the frequency of outpatient visits, emergency medical service calls, and recurrent hospitalizations within one year after discharge from the pulmonology department were identified based on the electronic medical records from the Unified Healthcare Information System of the Perm Region. Results. During the one-year observation period, the mean number of outpatient visits was 9 [4; 13], emergency medical service calls 1 [0; 3], hospitalizations 1 [1; 2], and the Charlson comorbidity index was 6 [4; 7]. The mortality rate was 40.5 %. A Charlson index ³ 6 and ³ 2 repeated hospitalizations reflected the severity of patients’ condition and significantly increased the risk of death by 4.2 (95 % CI: 1.56–11.21) and 2.8 (95 % CI: 1.02–9.38) times, respectively. A score of ³ 14 points on the integral scale of dynamic monitoring effectiveness increased the risk of death by 3.6 times (95 % CI: 1.16–11.2). The highest risk of adverse prognosis was having ³ 2 emergency medical service calls, corresponding to an over 4.4-fold increase in mortality risk (95 % CI: 1.34–14.78). Conclusions. The key predictors of mortality are the Charlson comorbidity index, frequency of emergency medical service calls, recurrent hospitalizations, and the integrated scale for assessing the effectiveness of remote follow-up.