Geriatric risk screening in older cardiovascular patients at admission: a population approach to prevent hospital-acquired complications

Background Older adults have a higher risk of hospital-acquired complications. Early identification of vulnerable patients may help prevent complications and improve long-term outcomes. This study examined whether a very short, structured screening tool, such as the Acutely Presenting Older Patient (APOP) screener, can identify elderly cardiovascular patients at increased risk at admission, and thus support integration of systematic geriatric risk assessment into routine cardiology practice. Purpose To investigate whether systematic risk screening of cardiovascular patients at admission identifies those aged 75 years and older who are more likely to experience complications during hospitalization. Methods We conducted a prospective observational single-center study that included 127 consecutively admitted adults aged 75 years or older on a cardiovascular ward. Each participant completed the standardized APOP risk screening questionnaire at admission and was classified into low-or high-risk groups. Additional variables included mode of admission (emergency/elective), use of psychotropic medication before admission, and the Clinical Frailty Scale (CFS). During hospitalization, we recorded complications including delirium, falls, pressure ulcers, incontinence, hospital-acquired infections, functional decline, discharge to long-term care, deterioration of cardiac or renal function, bleeding, and death. Associations were analyzed using Spearman’s rho, and predictive ability was assessed with receiver operating characteristic (ROC) analysis. Results The mean age was 82.6 ± 5.1 years. Forty-three patients (33.9%) were categorized as high risk. Thirty of them (69.8%) experienced at least one complication, compared with 32.5% in the low-risk group, confirming the discriminatory value of the APOP screening tool. Higher risk scores were moderately correlated with a greater number of complications (rho = 0.357; p<0.01). In a multivariate analysis including APOP result, CFS score, mode of admission, and preadmission psychotropic medication use, ROC analysis demonstrated an area under the curve of 0.743 (95% CI 0.651–0.836) for predicting hospital-acquired complications. Conclusions A structured screening tool administered at admission identifies older cardiovascular patients at increased risk of hospital-acquired complications, independent of mode of admission. Routine use may facilitate earlier preventive measures, reduce complication rates, shorten hospital stay, and improve overall quality of life. Further multicenter research is required to evaluate its impact when integrated into standard care pathways.For image description, please refer to the figure legend and surrounding text. For image description, please refer to the figure legend and surrounding text.