Provision of critical care for the elderly in Europe: a retrospective comparison of national healthcare frameworks in intensive care units

Bernhard Wernly , Michael Beil , Raphael Romano Bruno , Stephan Binnebössel , Malte Kelm , Sviri Sigal , Peter Vernon van Heerden , Ariane Boumendil , Antonio Artigas , Maurizio Cecconi , Brian Marsh , Rui Moreno , Sandra Oeyen , Bernardo Bollen Pinto , Wojciech Szczeklik , Susannah Leaver , Sten Mikael Walther , Joerg Schefold , Michael Joannidis , Jesper Fjølner , Tilemachos Zafeiridis , Dylan de Lange , Bertrand Guidet , Hans Flaatten , Christian Jung , Joannidis Michael , Eller Philipp , Helbok Raimund , Schmutz René , Nollet Joke , Neve Nikolaas De , Buysscher Pieter De , Oeyen Sandra , Swinnen Walter , Mikačić Marijana , Bastiansen Anders , Husted Andreas , Dahle Bård E S , Cramer Christine , Sølling Christoffer , Ørsnes Dorthe , Thomsen Jakob Edelberg , Pedersen Jonas Juul , Enevoldsen Mathilde Hummelmose , Elkmann Thomas , Kubisz-Pudelko Agnieszka , Pope Alan , Collins Amy , Raj Ashok S , Boulanger Carole , Frey Christian , Hart Ciaran , Bolger Clare , Spray Dominic , Randell Georgina , Filipe Helder , Welters Ingeborg D , Grecu Irina , Evans Jane , Cupitt Jason , Lord Jenny , Henning Jeremy , Jones Joanne , Ball Jonathan , North Julie , Salaunkey Kiran , Gordoa Laura Ortiz-Ruiz De , Bell Louise , Balasubramaniam Madhu , Vizcaychipi Marcela , Faulkner Maria , Mupudzi Mcdonald , Lea-Hagerty Megan , Reay Michael , Spivey Michael , Love Nicholas , Spittle Nick , White Nigel , Williams Patricia , Morgan Patrick , Wakefield Phillipa , Savine Rachel , Jacob Reni , Innes Richard , Kapoor Ritoo , Humphreys Sally , Rose Steve , Dowling Susan , Leaver Susannah , Mane Tarkeshwari , Lawton Tom , Ogbeide Vongayi , Khaliq Waqas , Baird Yolanda , Romen Antoine , Galbois Arnaud , Guidet Bertrand , Vinsonneau Christophe , Charron Cyril , Thevenin Didier , Guerot Emmanuel , Besch Guillaume , Savary Guillaume , Mentec Hervé , Chagnon Jean-Luc , Rigaud Jean-Philippe , Quenot Jean-Pierre , Castaneray Jeremy , Rosman Jérémy , Maizel Julien (1) , Tiercelet Kelly , Vettoretti Lucie , Hovaere Maud Mousset , Messika Messika , Djibré Michel , Rolin Nathalie , Burtin Philippe , Garcon Pierre , Nseir Saad , Valette Xavier , Rabe Christian , Barth Eberhard , Ebelt Henning , Fuest Kristina , Franz Marcus , Horacek Michael , Schuster Michael , Meybohm Patrick , Bruno Raphael Romano , Allgäuer Sebastian , Dubler Simon , Schaller Stefan J , Schering Stefan , Steiner Stephan , Dieck Thorben , Rahmel Tim , Graf Tobias , Koutsikou Anastasia , Vakalos Aristeidis , Raitsiou Bogdan , Flioni Elli Niki , Neou Evangelia , Tsimpoukas Fotios , Papathanakos Georgios , Marinakis Giorgos , Koutsodimitropoulos Ioannis , Aikaterini Kounougeri , Rovina Nikoletta , Kourelea Stylliani , Polychronis Tasioudis , Zidianakis Vasiiios , Konstantinia Vryza , Aidoni Zoi , Marsh Brian , Motherway Catherine , Read Chris , Martin-Loeches Ignacio , Cracchiolo Andrea Neville , Morigi Aristide , Calamai Italo , Brusa Stefania , Elhadi Ahmed , Tarek Ahmed , Khaled Ala , Ahmed Hazem , Belkhair Wesal Ali , Cornet Alexander D , Gommers Diederik , Lange Dylan De , Boven Evavan , Haringman Jasper , Haas Lenneke , Berg Lettie van Den , Hoiting Oscar , Jager Peter De , Gerritsen Rik T , Dormans Tom , Dieperink Willem , Breidablik Alena , Slapgard Anita , Rime Anne-Karin , Jannestad Bente , Sjøbøe Britt , Rice Eva , Andersen Finn H , Strietzel Hans Frank , Jensen Jan Peter , Langørgen Jørund , Tøien Kirsti , Strand Kristian , Hahn Michael , Klepstad Pål , Biernacka Aleksandra , Kluzik Anna , Kudlinski Bartosz , Maciejewski Dariusz , Studzińska Dorota , Hymczak Hubert , Stefaniak Jan , Solek-Pastuszka Joanna , Zorska Joanna , Cwyl Katarzyna , Krzych Lukasz J , Zukowski Maciej , Lipińska-Gediga Małgorzata , Pietruszko Marek , Piechota Mariusz , Serwa Marta , Czuczwar Miroslaw , Ziętkiewicz Mirosław , Kozera Natalia , Nasiłowski Paweł , Sendur Paweł , Zatorski Paweł , Galkin Piotr , Gawda Ryszard , Kościuczuk Urszula , Cyrankiewicz Waldemar , Gola Wojciech , Pinto Alexandre Fernandes , Fernandes Ana Margarida , Santos Ana Rita , Sousa Cristina , Barros Inês , Ferreira Isabel Amorim , Blanco Jacobo Bacariza , Carvalho João Teles , Maia Jose , Candeias Nuno , Catorze Nuno , Belskiy Vladislav , Lores Africa , Mira Angela Prado , Cilloniz Catia , Perez-Torres David , Maseda Emilio , Rodriguez Enver , Prol-Silva Estefania , Eixarch Gaspar , Gomà Gemma , Aguilar Gerardo , Velasco Gonzalo Navarro , Jaimes Mariánirazábal , Villamayor Mercedes Ibarz , Fernández Noemí Llamas , Cubero Patricia Jimeno , López-Cuenca Sonia , Tomasa Teresa , Sjöqvist Anders , Brorsson Camilla , Schiöler Fredrik , Westberg Henrik , Nauska Jessica , Sivik Joakim , Berkius Johan , Thiringer Karin Kleiven , Degeer Lina , Walther Sten , Boroli Filippo , Schefold Joerg C , Hergafi Leila , Eckert Philippe , Yıldız Ismail , Yovenko Ihor , Nalapko Yuriy , Nalapko Yuriy , Pugh Richard

1 MP3CV - Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517

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 .

Mots clés: adult intensive & critical care; geriatric medicine; public health

Domaines: Sciences du Vivant [q-bio]

Bernhard Wernly, Michael Beil, Raphael Romano Bruno, Stephan Binnebössel, Malte Kelm, et al.. Provision of critical care for the elderly in Europe: a retrospective comparison of national healthcare frameworks in intensive care units. BMJ Open, 2021, 11 (6), pp.e046909. ⟨10.1136/bmjopen-2020-046909⟩. ⟨hal-03921877⟩