Provision of critical care for the elderly in Europe: a retrospective comparison of national healthcare frameworks in intensive care units
Objectives In Europe, there is a distinction between two different healthcare organisation systems, the tax-based healthcare system (THS) and the social health insurance system (SHI). Our aim was to investigate whether the characteristics, treatment and mortality of older, critically ill patients in...
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2021-06-01
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| author | Antonio Artigas Nuno Catorze Bernhard Wernly Wojciech Szczeklik Raimund Helbok Pål Klepstad Emmanuel Guerot Tim Rahmel Kelly Tiercelet Louise Bell Clare Bolger Helder Filipe Michael Reay Jean-Pierre Quenot Saad Nseir Didier Thévenin Maurizio Cecconi Susan Dowling Jason Cupitt Willem Dieperink Henning Ebelt Philipp Eller Patrick Meybohm Rene Schmutz Michael Joannidis Sally Humphreys Filippo Boroli Gerardo Aguilar Jørund Langørgen Malte Kelm Marcus Franz Hans Flaatten Christian Jung Michael Beil Susannah Leaver Bertrand Guidet Tom Dormans Jonathan Ball Patrick Morgan Nick Spittle Tom Lawton Diederik Gommers Antoine Romen Camilla Brorsson Ana Rita Santos JANE EVANS Ala Khaled Hazem Ahmed Madhu Balasubramaniam Simon Dubler Jean-Philippe Rigaud Michael Schuster Julien Maizel Christophe Vinsonneau Carole Boulanger Jeremy Henning Catia Cillóniz Michael Spivey Kiran Salaunkey Raphael Romano Bruno Stephan Binnebössel Sviri Sigal Peter Vernon van Heerden Ariane Boumendil Brian Marsh Rui Moreno Sandra Oeyen Bernardo Bollen Pinto Sten Mikael Walther Joerg C Schefold Jesper Fjølner Tilemachos Zafeiridis Dylan de Lange Joke Nollet Nikolaas de Neve Pieter De Buysscher Walter Swinnen Marijana Mikačić Anders Bastiansen Andreas Husted Bård E S Dahle Christine Cramer Christoffer Sølling Dorthe Ørsnes Jakob Edelberg Thomsen Jonas Juul Pedersen Mathilde Hummelmose Enevoldsen Thomas Elkmann Agnieszka Kubisz-Pudelko Alan Pope Amy Collins Ashok S Raj Christian Frey Ciaran Hart Dominic Spray Georgina Randell Ingeborg D Welters Irina Grecu Jenny Lord Joanne Jones Julie North Laura Ortiz-Ruiz De Gordoa Marcela Vizcaychipi Maria Faulkner McDonald Mupudzi Megan Lea-Hagerty Nicholas Love Nigel White Patricia Williams Phillipa Wakefield Rachel Savine Reni Jacob Richard Innes Ritoo Kapoor Steve Rose Tarkeshwari Mane Vongayi Ogbeide Waqas Khaliq Yolanda Baird Arnaud Galbois Cyril Charron Guillaume Besch Guillaume Savary Hervé Mentec Jean-Luc Chagnon Jeremy Castaneray Jérémy Rosman Lucie Vettoretti Maud Mousset Hovaere Messika Messika Michel Djibré Nathalie Rolin Philippe Burtin Pierre Garcon Xavier Valette Christian Rabe Eberhard Barth Kristina Fuest Michael Horacek Raphael Romano Bruno Sebastian Allgäuer Stefan J Schaller Stefan Schering Stephan Steiner Thorben Dieck Tobias Graf Anastasia Koutsikou Aristeidis Vakalos Bogdan Raitsiou Elli Niki Flioni Evangelia Neou Fotios Tsimpoukas Georgios Papathanakos Giorgos Marinakis Ioannis Koutsodimitropoulos Kounougeri Aikaterini Nikoletta Rovina Stylliani Kourelea Tasioudis Polychronis Vasiiios Zidianakis Vryza Konstantinia Zoi Aidoni Catherine Motherway Chris Read Ignacio Martin-Loeches Andrea Neville Cracchiolo Aristide Morigi Italo Calamai Stefania Brusa Ahmed Elhadi Ahmed Tarek Wesal Ali Belkhair Alexander D Cornet Evavan Boven Jasper Haringman Lenneke Haas Lettie van den Berg Oscar Hoiting Peter de Jager Rik T Gerritsen Alena Breidablik Anita Slapgard Anne-Karin Rime Bente Jannestad Britt Sjøbøe Eva Rice Finn H Andersen Hans Frank Strietzel Jan Peter Jensen Kirsti Tøien Kristian Strand Michael Hahn Aleksandra Biernacka Anna Kluzik Bartosz Kudlinski Dariusz Maciejewski Dorota Studzińska Hubert Hymczak Jan Stefaniak Joanna Solek-Pastuszka Joanna Zorska Katarzyna Cwyl Lukasz J Krzych Maciej Zukowski Małgorzata Lipińska-Gediga Marek Pietruszko Mariusz Piechota Marta Serwa Miroslaw Czuczwar Mirosław Ziętkiewicz Natalia Kozera Paweł Nasiłowski Paweł Sendur Paweł Zatorski Piotr Galkin Ryszard Gawda Urszula Kościuczuk Waldemar Cyrankiewicz Wojciech Gola Alexandre Fernandes Pinto Ana Margarida Fernandes Cristina Sousa Inês Barros Isabel Amorim Ferreira Jacobo Bacariza Blanco João Teles Carvalho Jose Maia Nuno Candeias Vladislav Belskiy Africa Lores Angela Prado Mira David Perez-Torres Emilio Maseda Enver Rodriguez Estefania Prol-Silva Gaspar Eixarch Gemma Gomà Gonzalo Navarro Velasco MariánIrazábal Jaimes Mercedes Ibarz Villamayor Noemí Llamas Fernández Patricia Jimeno Cubero Sonia López-Cuenca Teresa Tomasa Anders Sjöqvist Fredrik Schiöler Henrik Westberg Jessica Nauska Joakim Sivik Johan Berkius Karin Kleiven Thiringer Lina DeGeer Sten Walther Joerg C Schefold Leila Hergafi Philippe Eckert Ismail Yıldız Ihor Yovenko Yuriy Nalapko Richard Pugh |
| author_facet | Antonio Artigas Nuno Catorze Bernhard Wernly Wojciech Szczeklik Raimund Helbok Pål Klepstad Emmanuel Guerot Tim Rahmel Kelly Tiercelet Louise Bell Clare Bolger Helder Filipe Michael Reay Jean-Pierre Quenot Saad Nseir Didier Thévenin Maurizio Cecconi Susan Dowling Jason Cupitt Willem Dieperink Henning Ebelt Philipp Eller Patrick Meybohm Rene Schmutz Michael Joannidis Sally Humphreys Filippo Boroli Gerardo Aguilar Jørund Langørgen Malte Kelm Marcus Franz Hans Flaatten Christian Jung Michael Beil Susannah Leaver Bertrand Guidet Tom Dormans Jonathan Ball Patrick Morgan Nick Spittle Tom Lawton Diederik Gommers Antoine Romen Camilla Brorsson Ana Rita Santos JANE EVANS Ala Khaled Hazem Ahmed Madhu Balasubramaniam Simon Dubler Jean-Philippe Rigaud Michael Schuster Julien Maizel Christophe Vinsonneau Carole Boulanger Jeremy Henning Catia Cillóniz Michael Spivey Kiran Salaunkey Raphael Romano Bruno Stephan Binnebössel Sviri Sigal Peter Vernon van Heerden Ariane Boumendil Brian Marsh Rui Moreno Sandra Oeyen Bernardo Bollen Pinto Sten Mikael Walther Joerg C Schefold Jesper Fjølner Tilemachos Zafeiridis Dylan de Lange Joke Nollet Nikolaas de Neve Pieter De Buysscher Walter Swinnen Marijana Mikačić Anders Bastiansen Andreas Husted Bård E S Dahle Christine Cramer Christoffer Sølling Dorthe Ørsnes Jakob Edelberg Thomsen Jonas Juul Pedersen Mathilde Hummelmose Enevoldsen Thomas Elkmann Agnieszka Kubisz-Pudelko Alan Pope Amy Collins Ashok S Raj Christian Frey Ciaran Hart Dominic Spray Georgina Randell Ingeborg D Welters Irina Grecu Jenny Lord Joanne Jones Julie North Laura Ortiz-Ruiz De Gordoa Marcela Vizcaychipi Maria Faulkner McDonald Mupudzi Megan Lea-Hagerty Nicholas Love Nigel White Patricia Williams Phillipa Wakefield Rachel Savine Reni Jacob Richard Innes Ritoo Kapoor Steve Rose Tarkeshwari Mane Vongayi Ogbeide Waqas Khaliq Yolanda Baird Arnaud Galbois Cyril Charron Guillaume Besch Guillaume Savary Hervé Mentec Jean-Luc Chagnon Jeremy Castaneray Jérémy Rosman Lucie Vettoretti Maud Mousset Hovaere Messika Messika Michel Djibré Nathalie Rolin Philippe Burtin Pierre Garcon Xavier Valette Christian Rabe Eberhard Barth Kristina Fuest Michael Horacek Raphael Romano Bruno Sebastian Allgäuer Stefan J Schaller Stefan Schering Stephan Steiner Thorben Dieck Tobias Graf Anastasia Koutsikou Aristeidis Vakalos Bogdan Raitsiou Elli Niki Flioni Evangelia Neou Fotios Tsimpoukas Georgios Papathanakos Giorgos Marinakis Ioannis Koutsodimitropoulos Kounougeri Aikaterini Nikoletta Rovina Stylliani Kourelea Tasioudis Polychronis Vasiiios Zidianakis Vryza Konstantinia Zoi Aidoni Catherine Motherway Chris Read Ignacio Martin-Loeches Andrea Neville Cracchiolo Aristide Morigi Italo Calamai Stefania Brusa Ahmed Elhadi Ahmed Tarek Wesal Ali Belkhair Alexander D Cornet Evavan Boven Jasper Haringman Lenneke Haas Lettie van den Berg Oscar Hoiting Peter de Jager Rik T Gerritsen Alena Breidablik Anita Slapgard Anne-Karin Rime Bente Jannestad Britt Sjøbøe Eva Rice Finn H Andersen Hans Frank Strietzel Jan Peter Jensen Kirsti Tøien Kristian Strand Michael Hahn Aleksandra Biernacka Anna Kluzik Bartosz Kudlinski Dariusz Maciejewski Dorota Studzińska Hubert Hymczak Jan Stefaniak Joanna Solek-Pastuszka Joanna Zorska Katarzyna Cwyl Lukasz J Krzych Maciej Zukowski Małgorzata Lipińska-Gediga Marek Pietruszko Mariusz Piechota Marta Serwa Miroslaw Czuczwar Mirosław Ziętkiewicz Natalia Kozera Paweł Nasiłowski Paweł Sendur Paweł Zatorski Piotr Galkin Ryszard Gawda Urszula Kościuczuk Waldemar Cyrankiewicz Wojciech Gola Alexandre Fernandes Pinto Ana Margarida Fernandes Cristina Sousa Inês Barros Isabel Amorim Ferreira Jacobo Bacariza Blanco João Teles Carvalho Jose Maia Nuno Candeias Vladislav Belskiy Africa Lores Angela Prado Mira David Perez-Torres Emilio Maseda Enver Rodriguez Estefania Prol-Silva Gaspar Eixarch Gemma Gomà Gonzalo Navarro Velasco MariánIrazábal Jaimes Mercedes Ibarz Villamayor Noemí Llamas Fernández Patricia Jimeno Cubero Sonia López-Cuenca Teresa Tomasa Anders Sjöqvist Fredrik Schiöler Henrik Westberg Jessica Nauska Joakim Sivik Johan Berkius Karin Kleiven Thiringer Lina DeGeer Sten Walther Joerg C Schefold Leila Hergafi Philippe Eckert Ismail Yıldız Ihor Yovenko Yuriy Nalapko Richard Pugh |
| author_sort | Antonio Artigas |
| collection | DOAJ |
| description | Objectives In Europe, there is a distinction between two different healthcare organisation systems, the tax-based healthcare system (THS) and the social health insurance system (SHI). Our aim was to investigate whether the characteristics, treatment and mortality of older, critically ill patients in the intensive care unit (ICU) differed between THS and SHI.Setting ICUs in 16 European countries.Participants In total, 7817 critically ill older (≥80 years) patients were included in this study, 4941 in THS and 2876 in the SHI systems.Primary and secondary outcomes measures We chose generalised estimation equations with robust standard errors to produce population average adjusted OR (aOR). We adjusted for patient-specific variables, health economic data, including gross domestic product (GDP) and human development index (HDI), and treatment strategies.Results In SHI systems, there were higher rates of frail patients (Clinical Frailty Scale>4; 46% vs 41%; p<0.001), longer length of ICU stays (90±162 vs 72±134 hours; p<0.001) and increased levels of organ support. The ICU mortality (aOR 1.50, 95% CI 1.09 to 2.06; p=0.01) was consistently higher in the SHI; however, the 30-day mortality (aOR 0.89, 95% CI 0.66 to 1.21; p=0.47) was similar between THS and SHI. In a sensitivity analysis stratifying for the health economic data, the 30-day mortality was higher in SHI, in low GDP per capita (aOR 2.17, 95% CI 1.42 to 3.58) and low HDI (aOR 1.22, 95% CI 1.64 to 2.20) settings.Conclusions The 30-day mortality was similar in both systems. Patients in SHI were older, sicker and frailer at baseline, which could be interpreted as a sign for a more liberal admission policy in SHI. We believe that the observed trend towards ICU excess mortality in SHI results mainly from a more liberal admission policy and an increase in treatment limitations.Trial registration numbers NCT03134807 and NCT03370692. |
| format | Article |
| id | doaj-art-c3bc50ef6f4f4fb19749b3909d2e0727 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2021-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-c3bc50ef6f4f4fb19749b3909d2e07272024-11-19T22:10:12ZengBMJ Publishing GroupBMJ Open2044-60552021-06-0111610.1136/bmjopen-2020-046909Provision of critical care for the elderly in Europe: a retrospective comparison of national healthcare frameworks in intensive care unitsAntonio Artigas0Nuno CatorzeBernhard Wernly1Wojciech Szczeklik2Raimund HelbokPål KlepstadEmmanuel GuerotTim Rahmel3Kelly TierceletLouise BellClare BolgerHelder FilipeMichael Reay4Jean-Pierre Quenot5Saad NseirDidier ThéveninMaurizio Cecconi6Susan DowlingJason CupittWillem DieperinkHenning Ebelt7Philipp EllerPatrick Meybohm8Rene SchmutzMichael Joannidis9Sally HumphreysFilippo BoroliGerardo AguilarJørund Langørgen10Malte Kelm11Marcus FranzHans Flaatten12Christian Jung13Michael Beil14Susannah Leaver15Bertrand Guidet16Tom Dormans17Jonathan Ball18Patrick MorganNick SpittleTom Lawton19Diederik Gommers20Antoine Romen21Camilla BrorssonAna Rita Santos22JANE EVANSAla KhaledHazem AhmedMadhu BalasubramaniamSimon DublerJean-Philippe Rigaud23Michael SchusterJulien Maizel24Christophe Vinsonneau25Carole BoulangerJeremy HenningCatia CillónizMichael SpiveyKiran Salaunkey26Raphael Romano Bruno27Stephan Binnebössel28Sviri Sigal29Peter Vernon van Heerden30Ariane Boumendil31Brian Marsh32Rui Moreno33Sandra Oeyen34Bernardo Bollen Pinto35Sten Mikael Walther36Joerg C Schefold37Jesper Fjølner38Tilemachos Zafeiridis39Dylan de Lange40Joke NolletNikolaas de NevePieter De BuysscherWalter SwinnenMarijana MikačićAnders BastiansenAndreas Husted41Bård E S DahleChristine Cramer42Christoffer Sølling43Dorthe ØrsnesJakob Edelberg ThomsenJonas Juul PedersenMathilde Hummelmose EnevoldsenThomas ElkmannAgnieszka Kubisz-PudelkoAlan PopeAmy Collins44Ashok S RajChristian FreyCiaran HartDominic SprayGeorgina RandellIngeborg D Welters45Irina GrecuJenny LordJoanne JonesJulie NorthLaura Ortiz-Ruiz De GordoaMarcela VizcaychipiMaria FaulknerMcDonald MupudziMegan Lea-HagertyNicholas LoveNigel WhitePatricia WilliamsPhillipa WakefieldRachel SavineReni JacobRichard InnesRitoo KapoorSteve Rose46Tarkeshwari ManeVongayi OgbeideWaqas KhaliqYolanda BairdArnaud Galbois47Cyril CharronGuillaume Besch48Guillaume SavaryHervé MentecJean-Luc ChagnonJeremy CastanerayJérémy RosmanLucie Vettoretti49Maud Mousset HovaereMessika MessikaMichel Djibré50Nathalie RolinPhilippe BurtinPierre GarconXavier ValetteChristian RabeEberhard Barth51Kristina FuestMichael HoracekRaphael Romano BrunoSebastian AllgäuerStefan J SchallerStefan ScheringStephan SteinerThorben DieckTobias GrafAnastasia KoutsikouAristeidis VakalosBogdan RaitsiouElli Niki FlioniEvangelia NeouFotios TsimpoukasGeorgios PapathanakosGiorgos MarinakisIoannis KoutsodimitropoulosKounougeri AikateriniNikoletta RovinaStylliani KoureleaTasioudis PolychronisVasiiios ZidianakisVryza KonstantiniaZoi AidoniCatherine MotherwayChris ReadIgnacio Martin-LoechesAndrea Neville CracchioloAristide MorigiItalo CalamaiStefania BrusaAhmed ElhadiAhmed TarekWesal Ali BelkhairAlexander D CornetEvavan BovenJasper HaringmanLenneke HaasLettie van den BergOscar Hoiting52Peter de JagerRik T GerritsenAlena BreidablikAnita SlapgardAnne-Karin RimeBente JannestadBritt SjøbøeEva RiceFinn H AndersenHans Frank StrietzelJan Peter JensenKirsti TøienKristian StrandMichael Hahn53Aleksandra BiernackaAnna KluzikBartosz KudlinskiDariusz MaciejewskiDorota StudzińskaHubert HymczakJan StefaniakJoanna Solek-PastuszkaJoanna ZorskaKatarzyna CwylLukasz J KrzychMaciej ZukowskiMałgorzata Lipińska-GedigaMarek PietruszkoMariusz PiechotaMarta SerwaMiroslaw CzuczwarMirosław ZiętkiewiczNatalia KozeraPaweł NasiłowskiPaweł SendurPaweł ZatorskiPiotr GalkinRyszard GawdaUrszula KościuczukWaldemar CyrankiewiczWojciech GolaAlexandre Fernandes PintoAna Margarida FernandesCristina Sousa54Inês BarrosIsabel Amorim FerreiraJacobo Bacariza Blanco55João Teles CarvalhoJose MaiaNuno CandeiasVladislav BelskiyAfrica LoresAngela Prado MiraDavid Perez-TorresEmilio MasedaEnver RodriguezEstefania Prol-SilvaGaspar EixarchGemma GomàGonzalo Navarro VelascoMariánIrazábal JaimesMercedes Ibarz VillamayorNoemí Llamas FernándezPatricia Jimeno CuberoSonia López-CuencaTeresa TomasaAnders SjöqvistFredrik SchiölerHenrik WestbergJessica NauskaJoakim SivikJohan BerkiusKarin Kleiven ThiringerLina DeGeerSten WaltherJoerg C SchefoldLeila HergafiPhilippe Eckert56Ismail YıldızIhor YovenkoYuriy NalapkoRichard PughCritical Care Centre, Corporació Sanitària I Universitaria Parc Taulí-Hospital De Sabadell-Ciber Enfermedades Respiratorias, Sabadell, Barcelona, Spain1 Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria13 Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland5 Clinic for Anesthesiology, Intensive Care and Pain Therapy, University Medical Center Knappschaftskrankenhaus Bochum, Bochum, GermanyRussells Hall Hospital, Dudley, UKRéanimation médicale, Centre Hospitalier Universitaire de Dijon, Dijon, Francecritical care physicianDepartment of Medicine II, Sankt Johann Nepomuk, Catholic Hospital Erfurt, Erfurt, Thüringen, Germany6 Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, GermanyDivision of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria1 Department of Heart Disease, Haukeland University Hospital, Bergen, Norway6 Division of Cardiology, Pulmonology, and Vascular Medicine, Department of Internal Medicine, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany23 Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, NorwayDepartment of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany3 Department of Medical Intensive Care, Hadassah University Medical Center, Jerusalem, Israel14 General Intensive Care, Research Lead Critical Care Directorate St George’s Hospital, London, UKDepartment of Intensive Care, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, FranceVascular Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlandsconsultant in intensive careBradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UKDepartment of Adult Intensive Care, Erasmus MC University Medical Center, Rotterdam, The NetherlandsRéanimation polyvalente, CH de Pau, Pau, France3 Faculdade de Medicina da Universidade do Algarve, Universidade do Algarve, Faro, PortugalService de Médecine Intensive-Réanimation, Hospital Centre Dieppe, Dieppe, FranceService de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, Hauts-de-France, FranceService de Médecine Intensive Réanimation, Centre Hospitalier de Béthune, Bethune, Nord-Pas de Calais, FranceRoyal Papworth Hospital NHS Foundation Trust Theatres Critical Care and Anaesthetics Directorate, Cambridge, UK4 Division of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Dusseldorf, Dusseldorf, Germany4 Division of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Dusseldorf, Dusseldorf, Germany3 Department of Medical Intensive Care, Hadassah University Medical Center, Jerusalem, Israel5 General Intensive Care, Hadassah Medical Center, Jerusalem, Israel6 service de réanimation médicale, Hôpital Saint-Antoine, Paris, France9 Critical Care Medicine, Mater Misericordiae University Hospital, Dublin, Ireland10 Department of Intensive Care, UCINC, Hospital de São José, Centro Hospitalar de Lisboa Central, EPE, Lisbon, Portugal11 Department of Intensive Care, University of Ghent, Ghent, Belgium12 Department of Acute Medicine, Geneva University Hospitals, Geneve, Switzerland15 Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Division of Cardiovascular Medicine, Linköping, SwedenIntensive Care Medicine, Inselspital, Bern University Hospital, Bern University, Bern, Switzerland19 Department of Intensive Care, Aarhus Universitet, Aarhus, Denmark20 Department of Critical Care, General University Hospital of Larissa, Larissa, Thessaly, Greece21 Department of Intensive Care Medicine, Utrecht University, Utrecht, The NetherlandsDepartment of Cardiology, Aarhus University Hospital Skejby, Aarhus N, Denmark5Department of Public Health, Research Unit for Work, Environment and Health, Danish Ramazzini Centre, Aarhus University, DK-8000 Aarhus C, Denmark11 Department of Anaesthesiology and Intensive Care, Viborg Regional Hospital, Viborg, Midtjylland, DenmarkHealthcare Without Harm, Vancouver, British Columbia, CanadaLiverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UKGreat Ormond Street Hospital for Children NHS Foundation Trust, UKIntensive Care Unit, Claude Galien Private Hospital, Quincy-sous-Senart, Île-de-France, France1 Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, Bourgogne Franche-Comte University, Besancon, France1 Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, Bourgogne Franche-Comte University, Besancon, France8 Médecine Intensive Réanimation, APHP, Hôpital Tenon, Paris, FranceDepartment of Anaesthesiology, University Hospital Ulm, Ulm, GermanyDepartment of Intensive Care Medicine, Canisius Wilhelmina Hospital, Nijmegen, The NetherlandsDepartment of Radiology, University of California San Diego, La Jolla, California, USA1Vila Real, PortugalIntensive Care Department, Hospital Garcia de Orta EPE, Almada, PortugalGeneral Directorate, Lausanne University Hospital, Lausanne, SwitzerlandObjectives In Europe, there is a distinction between two different healthcare organisation systems, the tax-based healthcare system (THS) and the social health insurance system (SHI). Our aim was to investigate whether the characteristics, treatment and mortality of older, critically ill patients in the intensive care unit (ICU) differed between THS and SHI.Setting ICUs in 16 European countries.Participants In total, 7817 critically ill older (≥80 years) patients were included in this study, 4941 in THS and 2876 in the SHI systems.Primary and secondary outcomes measures We chose generalised estimation equations with robust standard errors to produce population average adjusted OR (aOR). We adjusted for patient-specific variables, health economic data, including gross domestic product (GDP) and human development index (HDI), and treatment strategies.Results In SHI systems, there were higher rates of frail patients (Clinical Frailty Scale>4; 46% vs 41%; p<0.001), longer length of ICU stays (90±162 vs 72±134 hours; p<0.001) and increased levels of organ support. The ICU mortality (aOR 1.50, 95% CI 1.09 to 2.06; p=0.01) was consistently higher in the SHI; however, the 30-day mortality (aOR 0.89, 95% CI 0.66 to 1.21; p=0.47) was similar between THS and SHI. In a sensitivity analysis stratifying for the health economic data, the 30-day mortality was higher in SHI, in low GDP per capita (aOR 2.17, 95% CI 1.42 to 3.58) and low HDI (aOR 1.22, 95% CI 1.64 to 2.20) settings.Conclusions The 30-day mortality was similar in both systems. Patients in SHI were older, sicker and frailer at baseline, which could be interpreted as a sign for a more liberal admission policy in SHI. We believe that the observed trend towards ICU excess mortality in SHI results mainly from a more liberal admission policy and an increase in treatment limitations.Trial registration numbers NCT03134807 and NCT03370692.https://bmjopen.bmj.com/content/11/6/e046909.full |
| spellingShingle | Antonio Artigas Nuno Catorze Bernhard Wernly Wojciech Szczeklik Raimund Helbok Pål Klepstad Emmanuel Guerot Tim Rahmel Kelly Tiercelet Louise Bell Clare Bolger Helder Filipe Michael Reay Jean-Pierre Quenot Saad Nseir Didier Thévenin Maurizio Cecconi Susan Dowling Jason Cupitt Willem Dieperink Henning Ebelt Philipp Eller Patrick Meybohm Rene Schmutz Michael Joannidis Sally Humphreys Filippo Boroli Gerardo Aguilar Jørund Langørgen Malte Kelm Marcus Franz Hans Flaatten Christian Jung Michael Beil Susannah Leaver Bertrand Guidet Tom Dormans Jonathan Ball Patrick Morgan Nick Spittle Tom Lawton Diederik Gommers Antoine Romen Camilla Brorsson Ana Rita Santos JANE EVANS Ala Khaled Hazem Ahmed Madhu Balasubramaniam Simon Dubler Jean-Philippe Rigaud Michael Schuster Julien Maizel Christophe Vinsonneau Carole Boulanger Jeremy Henning Catia Cillóniz Michael Spivey Kiran Salaunkey Raphael Romano Bruno Stephan Binnebössel Sviri Sigal Peter Vernon van Heerden Ariane Boumendil Brian Marsh Rui Moreno Sandra Oeyen Bernardo Bollen Pinto Sten Mikael Walther Joerg C Schefold Jesper Fjølner Tilemachos Zafeiridis Dylan de Lange Joke Nollet Nikolaas de Neve Pieter De Buysscher Walter Swinnen Marijana Mikačić Anders Bastiansen Andreas Husted Bård E S Dahle Christine Cramer Christoffer Sølling Dorthe Ørsnes Jakob Edelberg Thomsen Jonas Juul Pedersen Mathilde Hummelmose Enevoldsen Thomas Elkmann Agnieszka Kubisz-Pudelko Alan Pope Amy Collins Ashok S Raj Christian Frey Ciaran Hart Dominic Spray Georgina Randell Ingeborg D Welters Irina Grecu Jenny Lord Joanne Jones Julie North Laura Ortiz-Ruiz De Gordoa Marcela Vizcaychipi Maria Faulkner McDonald Mupudzi Megan Lea-Hagerty Nicholas Love Nigel White Patricia Williams Phillipa Wakefield Rachel Savine Reni Jacob Richard Innes Ritoo Kapoor Steve Rose Tarkeshwari Mane Vongayi Ogbeide Waqas Khaliq Yolanda Baird Arnaud Galbois Cyril Charron Guillaume Besch Guillaume Savary Hervé Mentec Jean-Luc Chagnon Jeremy Castaneray Jérémy Rosman Lucie Vettoretti Maud Mousset Hovaere Messika Messika Michel Djibré Nathalie Rolin Philippe Burtin Pierre Garcon Xavier Valette Christian Rabe Eberhard Barth Kristina Fuest Michael Horacek Raphael Romano Bruno Sebastian Allgäuer Stefan J Schaller Stefan Schering Stephan Steiner Thorben Dieck Tobias Graf Anastasia Koutsikou Aristeidis Vakalos Bogdan Raitsiou Elli Niki Flioni Evangelia Neou Fotios Tsimpoukas Georgios Papathanakos Giorgos Marinakis Ioannis Koutsodimitropoulos Kounougeri Aikaterini Nikoletta Rovina Stylliani Kourelea Tasioudis Polychronis Vasiiios Zidianakis Vryza Konstantinia Zoi Aidoni Catherine Motherway Chris Read Ignacio Martin-Loeches Andrea Neville Cracchiolo Aristide Morigi Italo Calamai Stefania Brusa Ahmed Elhadi Ahmed Tarek Wesal Ali Belkhair Alexander D Cornet Evavan Boven Jasper Haringman Lenneke Haas Lettie van den Berg Oscar Hoiting Peter de Jager Rik T Gerritsen Alena Breidablik Anita Slapgard Anne-Karin Rime Bente Jannestad Britt Sjøbøe Eva Rice Finn H Andersen Hans Frank Strietzel Jan Peter Jensen Kirsti Tøien Kristian Strand Michael Hahn Aleksandra Biernacka Anna Kluzik Bartosz Kudlinski Dariusz Maciejewski Dorota Studzińska Hubert Hymczak Jan Stefaniak Joanna Solek-Pastuszka Joanna Zorska Katarzyna Cwyl Lukasz J Krzych Maciej Zukowski Małgorzata Lipińska-Gediga Marek Pietruszko Mariusz Piechota Marta Serwa Miroslaw Czuczwar Mirosław Ziętkiewicz Natalia Kozera Paweł Nasiłowski Paweł Sendur Paweł Zatorski Piotr Galkin Ryszard Gawda Urszula Kościuczuk Waldemar Cyrankiewicz Wojciech Gola Alexandre Fernandes Pinto Ana Margarida Fernandes Cristina Sousa Inês Barros Isabel Amorim Ferreira Jacobo Bacariza Blanco João Teles Carvalho Jose Maia Nuno Candeias Vladislav Belskiy Africa Lores Angela Prado Mira David Perez-Torres Emilio Maseda Enver Rodriguez Estefania Prol-Silva Gaspar Eixarch Gemma Gomà Gonzalo Navarro Velasco MariánIrazábal Jaimes Mercedes Ibarz Villamayor Noemí Llamas Fernández Patricia Jimeno Cubero Sonia López-Cuenca Teresa Tomasa Anders Sjöqvist Fredrik Schiöler Henrik Westberg Jessica Nauska Joakim Sivik Johan Berkius Karin Kleiven Thiringer Lina DeGeer Sten Walther Joerg C Schefold Leila Hergafi Philippe Eckert Ismail Yıldız Ihor Yovenko Yuriy Nalapko Richard Pugh Provision of critical care for the elderly in Europe: a retrospective comparison of national healthcare frameworks in intensive care units BMJ Open |
| title | Provision of critical care for the elderly in Europe: a retrospective comparison of national healthcare frameworks in intensive care units |
| title_full | Provision of critical care for the elderly in Europe: a retrospective comparison of national healthcare frameworks in intensive care units |
| title_fullStr | Provision of critical care for the elderly in Europe: a retrospective comparison of national healthcare frameworks in intensive care units |
| title_full_unstemmed | Provision of critical care for the elderly in Europe: a retrospective comparison of national healthcare frameworks in intensive care units |
| title_short | Provision of critical care for the elderly in Europe: a retrospective comparison of national healthcare frameworks in intensive care units |
| title_sort | provision of critical care for the elderly in europe a retrospective comparison of national healthcare frameworks in intensive care units |
| url | https://bmjopen.bmj.com/content/11/6/e046909.full |
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provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT huberthymczak provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT janstefaniak provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT joannasolekpastuszka provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT joannazorska provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT katarzynacwyl provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT lukaszjkrzych provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT maciejzukowski provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT małgorzatalipinskagediga provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT marekpietruszko provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT mariuszpiechota provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT martaserwa provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT miroslawczuczwar provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT mirosławzietkiewicz provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT nataliakozera provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT pawełnasiłowski provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT pawełsendur provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT pawełzatorski provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT piotrgalkin provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT ryszardgawda provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT urszulakosciuczuk provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT waldemarcyrankiewicz provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT wojciechgola provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT alexandrefernandespinto provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT anamargaridafernandes provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT cristinasousa provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT inesbarros provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT isabelamorimferreira provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT jacobobacarizablanco provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT joaotelescarvalho provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT josemaia provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT nunocandeias provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT vladislavbelskiy provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT africalores provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT angelapradomira provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT davidpereztorres provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT emiliomaseda provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT enverrodriguez provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT estefaniaprolsilva provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT gaspareixarch provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT gemmagoma provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT gonzalonavarrovelasco provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT marianirazabaljaimes provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT mercedesibarzvillamayor provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT noemillamasfernandez provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT patriciajimenocubero provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT sonialopezcuenca provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT teresatomasa provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT anderssjoqvist provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT fredrikschioler provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT henrikwestberg provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT jessicanauska provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT joakimsivik provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT johanberkius provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT karinkleiventhiringer provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT linadegeer provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT stenwalther provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT joergcschefold provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT leilahergafi provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT philippeeckert provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT ismailyıldız provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT ihoryovenko provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT yuriynalapko provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits AT richardpugh provisionofcriticalcarefortheelderlyineuropearetrospectivecomparisonofnationalhealthcareframeworksinintensivecareunits |