Medical treatment predicts mortality after hip fracture.
BACKGROUND
The mortality after hip fracture has remained high and stable the past 50 years despite improved surgical treatment. The aim of this study was to identify medications and medical factors associated with mortality after hip fracture.


METHODS
This is a prospective observational study with median observation time of 21 months. Three hundred and sixty-four patients, mean age 83.4 years and 75.8% women, were enrolled. Information on comorbidity, medications, surgery, and clinical findings were collected at the time of fracture. Information on cause and time of death was obtained from the Norwegian Cause of Death Register.


RESULTS
Six risk factors and one protective factor were identified by Cox proportional hazards model adjusted for propensity score: the use of diuretics (adjusted hazard ratio [HR] = 4.03, 95% confidence interval [CI] = 2.13-7.64), history of coronary heart disease (CHD) (HR = 2.61, CI = 1.37-4.98), male sex (HR = 2.32, CI = 1.27-4.24), Barthel Index < or = 18/20 (HR = 2.48, CI = 1.23-5.01), heart rate > 100 on admission (HR = 2.47, CI = 1.18-5.14), body mass index < or = 20 (HR = 1.94, CI = 1.13-3.34), and the use of statins (HR = 0.23, CI = 0.08-0.68). Patients using diuretics had increased risk of death from all causes, including death from CHD, chronic obstructive pulmonary disease, and falls or other accidents.


CONCLUSIONS
The use of diuretics is the strongest predictor of mortality, followed by CHD at the time of fracture, whereas the use of statins is associated with improved survival. Future research is needed to evaluate whether improved diagnosis and management of CHD and congestive heart failure among hip fracture patients would improve survival.
Juliebø
Vibeke
V
Department of Geriatric Medicine, Oslo University Hospital, Ullevaal, N-0407 Oslo, Norway. vibeke.juliebo@medisin.uio.no
Krogseth
Maria
M
Skovlund
Eva
E
Engedal
Knut
K
Wyller
Torgeir B
TB
D000369:Aged, 80 and over; D002423:Cause of Death; D003327:Coronary Disease / Q000150:complications; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D006620:Hip Fractures / Q000150:complications / Q000401:mortality*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D011446:Prospective Studies
D004232:Diuretics; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors