51
|
Moreira JI. Beta-blocker therapy after myocardial infarction or acute coronary syndrome: What we don't know. Rev Port Cardiol 2021; 40:291-292. [PMID: 33637361 DOI: 10.1016/j.repc.2021.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- José Ilídio Moreira
- Serviço de Cardiologia, Centro Hospitalar de Trás-os-Montes e Alto Douro (Hospitais de Vila Real, Chaves e Lamego), Vila Real, Portugal.
| |
Collapse
|
52
|
Kobashigawa J, Shah P, Joseph S, Olymbios M, Bhat G, Dhital K, Eisen H, Kransdorf E, Patel J, Skorka R, Pinney S, Wilson ME, Hall S. Frailty in heart transplantation: Report from the heart workgroup of a consensus conference on frailty. Am J Transplant 2021; 21:636-644. [PMID: 32659872 DOI: 10.1111/ajt.16207] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 07/05/2020] [Accepted: 07/06/2020] [Indexed: 01/25/2023]
Abstract
A consensus conference on frailty in solid organ transplantation took place on February 11, 2018, to discuss the latest developments in frailty, adopt a standardized approach to assessment, and generate ideas for future research. The findings and consensus of the Frailty Heart Workgroup (American Society of Transplantation's Thoracic and Critical Care Community of Practice) are presented here. Frailty is defined as a clinically recognizable state of increased vulnerability resulting from aging-associated decline in reserve and function across multiple physiologic systems such that the ability to cope with every day or acute stressors is compromised. Frailty is increasingly recognized as a distinct biologic entity that can adversely affect outcomes before and after heart transplantation. A greater proportion of patients referred for heart transplantation are older and have more complex comorbidities. However, outcomes data in the pretransplant setting, particularly for younger patients, are limited. Therefore, there is a need to develop objective frailty assessment tools for risk stratification in patients with advanced heart disease. These tools will help to determine appropriate recipient selection for advanced heart disease therapies including heart transplantation and mechanical circulatory support, improve overall outcomes, and help distinguish frailty phenotypes amenable to intervention.
Collapse
Affiliation(s)
- Jon Kobashigawa
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Palak Shah
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Susan Joseph
- Baylor University Medical Center, Dallas, Texas, USA
| | - Michael Olymbios
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Geetha Bhat
- Advocate Christ Medical Center, Oak Lawn, Illinois, USA
| | | | - Howard Eisen
- Drexel University, Philadelphia, Pennsylvania, USA
| | - Evan Kransdorf
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Jignesh Patel
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Rafael Skorka
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Sean Pinney
- Mount Sinai Hospital, New York, New York, USA
| | | | - Shelley Hall
- Baylor University Medical Center, Dallas, Texas, USA
| | | |
Collapse
|
53
|
Shoji S, Kohsaka S, Shiraishi Y, Oishi S, Kato M, Shiota S, Takada Y, Mizuno A, Yumino D, Yokoyama H, Watanabe N, Isobe M. Appropriateness rating for the application of optimal medical therapy and multidisciplinary care among heart failure patients. ESC Heart Fail 2021; 8:300-308. [PMID: 33201597 PMCID: PMC7835502 DOI: 10.1002/ehf2.13062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/04/2020] [Accepted: 09/25/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS Clinical guidelines for improving the patients' quality of care vary in clinical practice, particularly in super-aging societies, like in Japan. We aimed to develop a set of appropriate-use criteria (AUC) for contemporary heart failure (HF) management to assist physicians in decision making. METHODS AND RESULTS With the use of the RAND methodology, a multidisciplinary writing group developed patient-based clinical scenarios in 10 selected key topics, stratified mainly by HF stage, age, and renal function. Nine nationally recognized expert panellists independently rated the clinical scenario appropriateness twice on a scale of 1-9, as 'appropriate' (7-9), 'may be appropriate' (4-6), or 'rarely appropriate' (1-3). Decisions were based on clinical evidence and professional opinions in the context of available resource use and costs. An interactive round-table discussion was held between the first and second ratings; the median score of the nine experts was then assigned to an appropriate-use category. Most clinical scenarios without strong evidence were evaluated as 'may be appropriate'. Frailty assessments in elderly patients (age ≥ 75 years), regardless of the HF stage, and advanced care planning in patients with stage C/D HF, regardless of age, were considered 'appropriate'. For HF with reduced ejection fraction, beta-blocker administration in elderly patients (age ≥ 75 years) with heart rate < 50 b.p.m. and mineral corticosteroid receptor antagonist use in elderly patients (age ≥ 75 years) with an estimated glomerular filtration rate < 30 mL/min/1.73 m2 were considered 'rarely appropriate'. CONCLUSIONS The HF management AUC provide a practical guide for physicians regarding scenarios commonly encountered in daily practice.
Collapse
Affiliation(s)
- Satoshi Shoji
- Department of CardiologyKeio University School of Medicine35 Shinanomachi Shinjuku‐kuTokyo160‐8582Japan
| | - Shun Kohsaka
- Department of CardiologyKeio University School of Medicine35 Shinanomachi Shinjuku‐kuTokyo160‐8582Japan
| | - Yasuyuki Shiraishi
- Department of CardiologyKeio University School of Medicine35 Shinanomachi Shinjuku‐kuTokyo160‐8582Japan
| | - Shogo Oishi
- Department of CardiologyHimeji Cardiovascular CenterHimejiJapan
| | | | - Shigehito Shiota
- Department of RehabilitationHiroshima University HospitalHiroshimaJapan
| | - Yasuko Takada
- Department of NursingNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Atsushi Mizuno
- Department of CardiologySt Luke's International HospitalTokyoJapan
| | | | | | - Noboru Watanabe
- Department of CardiologyHokushin General HospitalNaganoJapan
| | | |
Collapse
|
54
|
Lowenstern A, Alexander KP, Hill CL, Alhanti B, Pellikka PA, Nanna MG, Mehta RH, Cooper LS, Bullock-Palmer RP, Hoffmann U, Douglas PS. Age-Related Differences in the Noninvasive Evaluation for Possible Coronary Artery Disease: Insights From the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) Trial. JAMA Cardiol 2021; 5:193-201. [PMID: 31738382 DOI: 10.1001/jamacardio.2019.4973] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Importance Although cardiovascular (CV) disease represents the leading cause of morbidity and mortality that increases with age, the best noninvasive test to identify older patients at risk for CV events remains unknown. Objective To determine whether the prognostic utility of anatomic vs functional testing varies based on patient age. Design, Setting, and Participants Prespecified analysis of the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) study, which used a pragmatic comparative effectiveness design. Participants were enrolled from 193 sites across North America and comprised outpatients without known coronary artery disease (CAD) but with symptoms suggestive of CAD. Data were analyzed between October 2018 and April 2019. Interventions Randomization to noninvasive testing with coronary computed tomographic angiography or functional testing. Main Outcomes and Measures The composite of CV death/myocardial infarction (MI) over a median follow-up of 25 months. Results Among 10 003 PROMISE patients, we included the 8966 who received the noninvasive test to which they were randomized and had interpretable results; 6378 (71.1%) were younger than 65 years, 2062 (23.0%) were between ages 65 and 74 years, and 526 (5.9%) were 75 years and older. More than half of participants were women (4720 of 8966 [52.6%]). Only a minority of patients were of nonwhite race/ethnicity, a proportion that was lower among the older age groups (1071 of 6378 [16.8%] for <65 years; 258 of 2062 [12.5%] for age 65-74 years; 41 of 526 [7.8%] for ≥75 years). Compared with patients younger than 65 years, older patients were more likely to have a positive test result (age 65-74 years: odds ratio, 1.65; 95% CI, 1.42-1.91; age ≥75 years: odds ratio, 2.32; 95% CI, 1.83-2.95), regardless of noninvasive test completed. A positive functional test result was not associated with CV death/MI in patients younger than 65 years (hazard ratio [HR], 1.09; 95% CI, 0.43-2.82) but it was among older patients (age 65-74 years: HR, 3.18; 95% CI, 1.44-7.01; age ≥75 years: HR, 6.55; 95% CI, 1.46-29.35). Conversely, a positive anatomic test result was associated with CV death/MI among patients younger than 65 years (HR, 3.04; 95% CI, 1.46-6.34) but not among older patients (age, 65-74 years: HR, 0.67; 95% CI, 0.15-2.94; age ≥75 years: HR, 1.07; 95% CI, 0.22-5.34; P for interaction = .01). An elevated coronary artery calcium score was predictive of events in patients younger than 65 years (HR, 2.73; 95% CI, 1.31-5.69) but not for older patients (age 65-74 years: HR, 0.44; 95% CI, 0.14-1.42; age ≥75 years: HR, 1.31; 95% CI, 0.25-6.88). Conclusions and Relevance Older patients with stable symptoms suggestive of CAD are more likely to have a positive noninvasive test result and more coronary artery calcium. However, only a positive functional test result was associated with risk of CV death/MI. Age-specific approaches to noninvasive evaluation of CAD should be further examined. Trial Registration ClinicalTrials.gov identifier: NCT01174550.
Collapse
Affiliation(s)
- Angela Lowenstern
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Karen P Alexander
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - C Larry Hill
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Brooke Alhanti
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | | | - Michael G Nanna
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Rajendra H Mehta
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Lawton S Cooper
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | | | - Udo Hoffmann
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| |
Collapse
|
55
|
Kitakata H, Kohno T, Kohsaka S, Fujisawa D, Nakano N, Shiraishi Y, Katsumata Y, Yuasa S, Fukuda K. Prognostic Understanding and Preference for the Communication Process with Physicians in Hospitalized Heart Failure Patients. J Card Fail 2020; 27:318-326. [PMID: 33171293 DOI: 10.1016/j.cardfail.2020.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/23/2020] [Accepted: 10/18/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Heart failure (HF) is a highly prevalent, heterogeneous, and life-threatening condition. Precise prognostic understanding is essential for effective decision making, but little is known about patients' attitudes toward prognostic communication with their physicians. METHODS AND RESULTS We conducted a questionnaire survey, consisting of patients' prognostic understanding, preferences for information disclosure, and depressive symptoms, among hospitalized patients with HF (92 items in total). Individual 2-year survival rates were calculated using the Seattle Heart Failure Model, and its agreement level with patient self-expectations of 2-year survival were assessed. A total of 113 patients completed the survey (male 65.5%, median age 75.0 years, interquartile range 66.0-81.0 years). Compared with the Seattle Heart Failure Model prediction, patient expectation of 2-year survival was matched only in 27.8% of patients; their agreement level was low (weighted kappa = 0.11). Notably, 50.9% wished to know "more," although 27.7% felt that they did not have an adequate prognostic discussion. Compared with the known prognostic variables (eg, age and HF severity), logistic regression analysis demonstrated that female and less depressive patients were associated with patients' preference for "more" prognostic discussion. CONCLUSIONS Patients' overall prognostic understanding was suboptimal. The communication process requires further improvement for patients to accurately understand their HF prognosis and be involved in making a better informed decision.
Collapse
Affiliation(s)
- Hiroki Kitakata
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Takashi Kohno
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan; Department of Cardiovascular Medicine, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka, Tokyo, Japan.
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Daisuke Fujisawa
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Naomi Nakano
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Yoshinori Katsumata
- Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shinsuke Yuasa
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| |
Collapse
|
56
|
Okumura K, Akao M, Yoshida T, Kawata M, Okazaki O, Akashi S, Eshima K, Tanizawa K, Fukuzawa M, Hayashi T, Akishita M, Lip GYH, Yamashita T. Low-Dose Edoxaban in Very Elderly Patients with Atrial Fibrillation. N Engl J Med 2020; 383:1735-1745. [PMID: 32865374 DOI: 10.1056/nejmoa2012883] [Citation(s) in RCA: 175] [Impact Index Per Article: 43.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Implementation of appropriate oral anticoagulant treatment for the prevention of stroke in very elderly patients with atrial fibrillation is challenging because of concerns regarding bleeding. METHODS We conducted a phase 3, multicenter, randomized, double-blind, placebo-controlled, event-driven trial to compare a once-daily 15-mg dose of edoxaban with placebo in elderly Japanese patients (≥80 years of age) with nonvalvular atrial fibrillation who were not considered to be appropriate candidates for oral anticoagulant therapy at doses approved for stroke prevention. The primary efficacy end point was the composite of stroke or systemic embolism, and the primary safety end point was major bleeding according to the definition of the International Society on Thrombosis and Haemostasis. RESULTS A total of 984 patients were randomly assigned in a 1:1 ratio to receive a daily dose of 15 mg of edoxaban (492 patients) or placebo (492 patients). A total of 681 patients completed the trial, and 303 discontinued (158 withdrew, 135 died, and 10 had other reasons); the numbers of patients who discontinued the trial were similar in the two groups. The annualized rate of stroke or systemic embolism was 2.3% in the edoxaban group and 6.7% in the placebo group (hazard ratio, 0.34; 95% confidence interval [CI], 0.19 to 0.61; P<0.001), and the annualized rate of major bleeding was 3.3% in the edoxaban group and 1.8% in the placebo group (hazard ratio, 1.87; 95% CI, 0.90 to 3.89; P = 0.09). There were substantially more events of gastrointestinal bleeding in the edoxaban group than in the placebo group. There was no substantial between-group difference in death from any cause (9.9% in the edoxaban group and 10.2% in the placebo group; hazard ratio, 0.97; 95% CI, 0.69 to 1.36). CONCLUSIONS In very elderly Japanese patients with nonvalvular atrial fibrillation who were not appropriate candidates for standard doses of oral anticoagulants, a once-daily 15-mg dose of edoxaban was superior to placebo in preventing stroke or systemic embolism and did not result in a significantly higher incidence of major bleeding than placebo. (Funded by Daiichi Sankyo; ELDERCARE-AF ClinicalTrials.gov number, NCT02801669.).
Collapse
Affiliation(s)
- Ken Okumura
- From the Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto (K.O.), the Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto (M. Akao), Onga Nakama Medical Association Onga Hospital, Onga (T. Yoshida), the Department of Cardiology, Akashi Medical Center, Akashi (M.K.), the Department of Cardiology, National Center for Global Health and Medicine (O.O.), Clinical Development Department III, Development Function, Research and Development Division (K.T., M.F.), and the Data Intelligence Group, Data Intelligence Department, Digital Transformation Management Division (T.H.), Daiichi Sankyo, the Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo (M. Akishita), and the Cardiovascular Institute (T. Yamashita), Tokyo, the Division of Cardiology, Hamada Medical Center, Hamada (S.A.), and the Department of Cardiology, Saga-Ken Medical Center Koseikan, Saga (K.E.) - all in Japan; the Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (G.Y.H.L.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.)
| | - Masaharu Akao
- From the Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto (K.O.), the Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto (M. Akao), Onga Nakama Medical Association Onga Hospital, Onga (T. Yoshida), the Department of Cardiology, Akashi Medical Center, Akashi (M.K.), the Department of Cardiology, National Center for Global Health and Medicine (O.O.), Clinical Development Department III, Development Function, Research and Development Division (K.T., M.F.), and the Data Intelligence Group, Data Intelligence Department, Digital Transformation Management Division (T.H.), Daiichi Sankyo, the Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo (M. Akishita), and the Cardiovascular Institute (T. Yamashita), Tokyo, the Division of Cardiology, Hamada Medical Center, Hamada (S.A.), and the Department of Cardiology, Saga-Ken Medical Center Koseikan, Saga (K.E.) - all in Japan; the Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (G.Y.H.L.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.)
| | - Tetsuro Yoshida
- From the Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto (K.O.), the Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto (M. Akao), Onga Nakama Medical Association Onga Hospital, Onga (T. Yoshida), the Department of Cardiology, Akashi Medical Center, Akashi (M.K.), the Department of Cardiology, National Center for Global Health and Medicine (O.O.), Clinical Development Department III, Development Function, Research and Development Division (K.T., M.F.), and the Data Intelligence Group, Data Intelligence Department, Digital Transformation Management Division (T.H.), Daiichi Sankyo, the Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo (M. Akishita), and the Cardiovascular Institute (T. Yamashita), Tokyo, the Division of Cardiology, Hamada Medical Center, Hamada (S.A.), and the Department of Cardiology, Saga-Ken Medical Center Koseikan, Saga (K.E.) - all in Japan; the Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (G.Y.H.L.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.)
| | - Masahito Kawata
- From the Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto (K.O.), the Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto (M. Akao), Onga Nakama Medical Association Onga Hospital, Onga (T. Yoshida), the Department of Cardiology, Akashi Medical Center, Akashi (M.K.), the Department of Cardiology, National Center for Global Health and Medicine (O.O.), Clinical Development Department III, Development Function, Research and Development Division (K.T., M.F.), and the Data Intelligence Group, Data Intelligence Department, Digital Transformation Management Division (T.H.), Daiichi Sankyo, the Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo (M. Akishita), and the Cardiovascular Institute (T. Yamashita), Tokyo, the Division of Cardiology, Hamada Medical Center, Hamada (S.A.), and the Department of Cardiology, Saga-Ken Medical Center Koseikan, Saga (K.E.) - all in Japan; the Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (G.Y.H.L.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.)
| | - Osamu Okazaki
- From the Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto (K.O.), the Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto (M. Akao), Onga Nakama Medical Association Onga Hospital, Onga (T. Yoshida), the Department of Cardiology, Akashi Medical Center, Akashi (M.K.), the Department of Cardiology, National Center for Global Health and Medicine (O.O.), Clinical Development Department III, Development Function, Research and Development Division (K.T., M.F.), and the Data Intelligence Group, Data Intelligence Department, Digital Transformation Management Division (T.H.), Daiichi Sankyo, the Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo (M. Akishita), and the Cardiovascular Institute (T. Yamashita), Tokyo, the Division of Cardiology, Hamada Medical Center, Hamada (S.A.), and the Department of Cardiology, Saga-Ken Medical Center Koseikan, Saga (K.E.) - all in Japan; the Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (G.Y.H.L.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.)
| | - Shintaro Akashi
- From the Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto (K.O.), the Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto (M. Akao), Onga Nakama Medical Association Onga Hospital, Onga (T. Yoshida), the Department of Cardiology, Akashi Medical Center, Akashi (M.K.), the Department of Cardiology, National Center for Global Health and Medicine (O.O.), Clinical Development Department III, Development Function, Research and Development Division (K.T., M.F.), and the Data Intelligence Group, Data Intelligence Department, Digital Transformation Management Division (T.H.), Daiichi Sankyo, the Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo (M. Akishita), and the Cardiovascular Institute (T. Yamashita), Tokyo, the Division of Cardiology, Hamada Medical Center, Hamada (S.A.), and the Department of Cardiology, Saga-Ken Medical Center Koseikan, Saga (K.E.) - all in Japan; the Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (G.Y.H.L.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.)
| | - Kenichi Eshima
- From the Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto (K.O.), the Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto (M. Akao), Onga Nakama Medical Association Onga Hospital, Onga (T. Yoshida), the Department of Cardiology, Akashi Medical Center, Akashi (M.K.), the Department of Cardiology, National Center for Global Health and Medicine (O.O.), Clinical Development Department III, Development Function, Research and Development Division (K.T., M.F.), and the Data Intelligence Group, Data Intelligence Department, Digital Transformation Management Division (T.H.), Daiichi Sankyo, the Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo (M. Akishita), and the Cardiovascular Institute (T. Yamashita), Tokyo, the Division of Cardiology, Hamada Medical Center, Hamada (S.A.), and the Department of Cardiology, Saga-Ken Medical Center Koseikan, Saga (K.E.) - all in Japan; the Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (G.Y.H.L.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.)
| | - Kimihiko Tanizawa
- From the Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto (K.O.), the Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto (M. Akao), Onga Nakama Medical Association Onga Hospital, Onga (T. Yoshida), the Department of Cardiology, Akashi Medical Center, Akashi (M.K.), the Department of Cardiology, National Center for Global Health and Medicine (O.O.), Clinical Development Department III, Development Function, Research and Development Division (K.T., M.F.), and the Data Intelligence Group, Data Intelligence Department, Digital Transformation Management Division (T.H.), Daiichi Sankyo, the Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo (M. Akishita), and the Cardiovascular Institute (T. Yamashita), Tokyo, the Division of Cardiology, Hamada Medical Center, Hamada (S.A.), and the Department of Cardiology, Saga-Ken Medical Center Koseikan, Saga (K.E.) - all in Japan; the Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (G.Y.H.L.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.)
| | - Masayuki Fukuzawa
- From the Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto (K.O.), the Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto (M. Akao), Onga Nakama Medical Association Onga Hospital, Onga (T. Yoshida), the Department of Cardiology, Akashi Medical Center, Akashi (M.K.), the Department of Cardiology, National Center for Global Health and Medicine (O.O.), Clinical Development Department III, Development Function, Research and Development Division (K.T., M.F.), and the Data Intelligence Group, Data Intelligence Department, Digital Transformation Management Division (T.H.), Daiichi Sankyo, the Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo (M. Akishita), and the Cardiovascular Institute (T. Yamashita), Tokyo, the Division of Cardiology, Hamada Medical Center, Hamada (S.A.), and the Department of Cardiology, Saga-Ken Medical Center Koseikan, Saga (K.E.) - all in Japan; the Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (G.Y.H.L.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.)
| | - Takuya Hayashi
- From the Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto (K.O.), the Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto (M. Akao), Onga Nakama Medical Association Onga Hospital, Onga (T. Yoshida), the Department of Cardiology, Akashi Medical Center, Akashi (M.K.), the Department of Cardiology, National Center for Global Health and Medicine (O.O.), Clinical Development Department III, Development Function, Research and Development Division (K.T., M.F.), and the Data Intelligence Group, Data Intelligence Department, Digital Transformation Management Division (T.H.), Daiichi Sankyo, the Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo (M. Akishita), and the Cardiovascular Institute (T. Yamashita), Tokyo, the Division of Cardiology, Hamada Medical Center, Hamada (S.A.), and the Department of Cardiology, Saga-Ken Medical Center Koseikan, Saga (K.E.) - all in Japan; the Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (G.Y.H.L.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.)
| | - Masahiro Akishita
- From the Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto (K.O.), the Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto (M. Akao), Onga Nakama Medical Association Onga Hospital, Onga (T. Yoshida), the Department of Cardiology, Akashi Medical Center, Akashi (M.K.), the Department of Cardiology, National Center for Global Health and Medicine (O.O.), Clinical Development Department III, Development Function, Research and Development Division (K.T., M.F.), and the Data Intelligence Group, Data Intelligence Department, Digital Transformation Management Division (T.H.), Daiichi Sankyo, the Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo (M. Akishita), and the Cardiovascular Institute (T. Yamashita), Tokyo, the Division of Cardiology, Hamada Medical Center, Hamada (S.A.), and the Department of Cardiology, Saga-Ken Medical Center Koseikan, Saga (K.E.) - all in Japan; the Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (G.Y.H.L.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.)
| | - Gregory Y H Lip
- From the Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto (K.O.), the Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto (M. Akao), Onga Nakama Medical Association Onga Hospital, Onga (T. Yoshida), the Department of Cardiology, Akashi Medical Center, Akashi (M.K.), the Department of Cardiology, National Center for Global Health and Medicine (O.O.), Clinical Development Department III, Development Function, Research and Development Division (K.T., M.F.), and the Data Intelligence Group, Data Intelligence Department, Digital Transformation Management Division (T.H.), Daiichi Sankyo, the Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo (M. Akishita), and the Cardiovascular Institute (T. Yamashita), Tokyo, the Division of Cardiology, Hamada Medical Center, Hamada (S.A.), and the Department of Cardiology, Saga-Ken Medical Center Koseikan, Saga (K.E.) - all in Japan; the Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (G.Y.H.L.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.)
| | - Takeshi Yamashita
- From the Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto (K.O.), the Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto (M. Akao), Onga Nakama Medical Association Onga Hospital, Onga (T. Yoshida), the Department of Cardiology, Akashi Medical Center, Akashi (M.K.), the Department of Cardiology, National Center for Global Health and Medicine (O.O.), Clinical Development Department III, Development Function, Research and Development Division (K.T., M.F.), and the Data Intelligence Group, Data Intelligence Department, Digital Transformation Management Division (T.H.), Daiichi Sankyo, the Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo (M. Akishita), and the Cardiovascular Institute (T. Yamashita), Tokyo, the Division of Cardiology, Hamada Medical Center, Hamada (S.A.), and the Department of Cardiology, Saga-Ken Medical Center Koseikan, Saga (K.E.) - all in Japan; the Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (G.Y.H.L.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.)
| |
Collapse
|
57
|
Hajduk AM, Dodson JA, Murphy TE, Tsang S, Geda M, Ouellet GM, Gill TM, Brush JE, Chaudhry SI. Risk Model for Decline in Activities of Daily Living Among Older Adults Hospitalized With Acute Myocardial Infarction: The SILVER-AMI Study. J Am Heart Assoc 2020; 9:e015555. [PMID: 33000681 PMCID: PMC7792390 DOI: 10.1161/jaha.119.015555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background Functional decline (ie, a decrement in ability to perform everyday activities necessary to live independently) is common after acute myocardial infarction (AMI) and associated with poor long-term outcomes; yet, we do not have a tool to identify older AMI survivors at risk for this important patient-centered outcome. Methods and Results We used data from the prospective SILVER-AMI (Comprehensive Evaluation of Risk Factors in Older Patients With Acute Myocardial Infarction) study of 3041 patients with AMI, aged ≥75 years, recruited from 94 US hospitals. Participants were assessed during hospitalization and at 6 months to collect data on demographics, geriatric impairments, psychosocial factors, and activities of daily living. Clinical variables were abstracted from the medical record. Functional decline was defined as a decrement in ability to independently perform essential activities of daily living (ie, bathing, dressing, transferring, and ambulation) from baseline to 6 months postdischarge. The mean age of the sample was 82±5 years; 57% were men, 90% were White, and 13% reported activity of daily living decline at 6 months postdischarge. The model identified older age, longer hospital stay, mobility impairment during hospitalization, preadmission physical activity, and depression as risk factors for decline. Revascularization during AMI hospitalization and ability to walk a quarter mile before AMI were associated with decreased risk. Model discrimination (c=0.78) and calibration were good. Conclusions We identified a parsimonious model that predicts risk of activity of daily living decline among older patients with AMI. This tool may aid in identifying older patients with AMI who may benefit from restorative therapies to optimize function after AMI.
Collapse
Affiliation(s)
| | - John A. Dodson
- Leon H. Charney Division of CardiologyDepartment of MedicineNew York University School of MedicineNew YorkNY
- Division of Healthcare Delivery ScienceDepartment of Population HealthNew York University School of MedicineNew YorkNY
| | | | - Sui Tsang
- Department of Internal MedicineYale School of MedicineNew HavenCT
| | - Mary Geda
- Department of Internal MedicineYale School of MedicineNew HavenCT
| | | | - Thomas M. Gill
- Department of Internal MedicineYale School of MedicineNew HavenCT
| | - John E. Brush
- Sentara Healthcare and Eastern Virginia Medical SchoolNorfolkVA
| | | |
Collapse
|
58
|
Dai H, Much AA, Maor E, Asher E, Younis A, Xu Y, Lu Y, Liu X, Shu J, Bragazzi NL. Global, regional, and national burden of ischemic heart disease and its attributable risk factors, 1990-2017: results from the global Burden of Disease Study 2017. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2020; 8:50-60. [PMID: 33017008 PMCID: PMC8728029 DOI: 10.1093/ehjqcco/qcaa076] [Citation(s) in RCA: 145] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/16/2020] [Accepted: 09/19/2020] [Indexed: 01/24/2023]
Abstract
Aims The aim of this study was to estimate the burden and risk factors for ischaemic heart disease (IHD) in 195 countries and territories from 1990 to 2017. Methods and results Data from the Global Burden of Disease Study 2017 were used. Prevalence, incidence, deaths, years lived with disability (YLDs), and years of life lost (YLLs) were metrics used to measure IHD burden. Population attributable fraction was used to estimate the proportion of IHD deaths attributable to potentially modifiable risk factors. Globally, in 2017, 126.5 million [95% uncertainty interval (UI) 118.6 to 134.7] people lived with IHD and 10.6 million (95% UI 9.6 to 11.8) new IHD cases occurred, resulting in 8.9 million (95% UI 8.8 to 9.1) deaths, 5.3 million (95% UI 3.7 to 7.2) YLDs, and 165.0 million (95% UI 162.2 to 168.6) YLLs. Between 1990 and 2017, despite the decrease in age-standardized rates, the global numbers of these burden metrics of IHD have significantly increased. The burden of IHD in 2017 and its temporal trends from 1990 to 2017 varied widely by geographic location. Among all potentially modifiable risk factors, age-standardized IHD deaths worldwide were primarily attributable to dietary risks, high systolic blood pressure, high LDL cholesterol, high fasting plasma glucose, tobacco use, and high body mass index in 2017. Conclusion Our results suggested that IHD remains a major public health challenge worldwide. More effective and targeted strategies aimed at implementing cost-effective interventions and addressing modifiable risk factors are urgently needed, particularly in geographies with high or increasing burden.
Collapse
Affiliation(s)
- Haijiang Dai
- Centre for Disease Modelling, York University, Toronto, ON, Canada.,Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Arsalan Abu Much
- Leviev Heart Center, Sheba Medical Center, Tel HaShomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Elad Maor
- Leviev Heart Center, Sheba Medical Center, Tel HaShomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Elad Asher
- Leviev Heart Center, Sheba Medical Center, Tel HaShomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Arwa Younis
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York
| | - Yawen Xu
- Centre for Disease Modelling, York University, Toronto, ON, Canada
| | - Yao Lu
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xinyao Liu
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jingxian Shu
- The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | | |
Collapse
|
59
|
Kamiya K, Sato Y, Takahashi T, Tsuchihashi-Makaya M, Kotooka N, Ikegame T, Takura T, Yamamoto T, Nagayama M, Goto Y, Makita S, Isobe M. Multidisciplinary Cardiac Rehabilitation and Long-Term Prognosis in Patients With Heart Failure. Circ Heart Fail 2020; 13:e006798. [DOI: 10.1161/circheartfailure.119.006798] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background:
Exercise-based cardiac rehabilitation (CR) improves health-related quality of life and exercise capacity in patients with heart failure (HF). However, CR efficacy in patients with HF who are elderly, frail, or have HF with preserved ejection fraction remains unclear. We examined whether participation in multidisciplinary outpatient CR is associated with long-term survival and rehospitalization in patients with HF, with subgroup analysis by age, sex, comorbidities, frailty, and HF with preserved ejection fraction.
Methods:
This multicenter retrospective cohort study was performed in patients hospitalized for acute HF at 15 hospitals in Japan, 2007 to 2016. The primary outcome (composite of all-cause mortality and HF rehospitalization after discharge) and secondary outcomes (all-cause mortality and HF rehospitalization) were analyzed in outpatient CR program participants versus nonparticipants.
Results:
Of the 3277 patients, 26% (862) participated in outpatient CR. After propensity matching for potential confounders, 1592 patients were included (n=796 pairs), of which 511 had composite outcomes (223 [14%] all-cause deaths and 392 [25%] HF rehospitalizations, median 2.4-year follow-up). Hazard ratios associated with CR participation were 0.77 (95% CI, 0.65–0.92) for composite outcome, 0.67 (95% CI, 0.51–0.87) for all-cause mortality, and 0.82 (95% CI, 0.67–0.99) for HF-related rehospitalization. CR participation was also associated with numerically lower rates of composite outcome in patients with HF with preserved ejection fraction or frail patients.
Conclusions:
Outpatient CR participation was associated with substantial prognostic benefit in a large HF cohort regardless of age, sex, comorbidities, frailty, and HF with preserved ejection fraction.
Collapse
Affiliation(s)
- Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences (K.K.), Kitasato University, Kanagawa, Japan
| | - Yukihito Sato
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Japan (Y.S.)
| | - Tetsuya Takahashi
- Department of Physical Therapy, Juntendo University, Tokyo, Japan (T. Takahashi)
| | | | - Norihiko Kotooka
- Department of Cardiovascular Medicine, Saga University, Japan (N.K.)
| | - Toshimi Ikegame
- Department of Nursing (T.I.), Sakakibara Heart Institute, Tokyo, Japan
| | - Tomoyuki Takura
- Department of Healthcare Economics and Health Policy, Graduate School of Medicine, The University of Tokyo, Japan (T. Takura)
| | - Takanobu Yamamoto
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (T.Y.)
| | - Masatoshi Nagayama
- Department of Cardiovascular Medicine (M.N.), Sakakibara Heart Institute, Tokyo, Japan
| | - Yoichi Goto
- Yoka Municipal Hospital, Hyogo, Japan (Y.G.)
| | - Shigeru Makita
- Department of Cardiac Rehabilitation, Saitama Medical University International Medical Center, Japan (S.M.)
| | | |
Collapse
|
60
|
Segev A, Itelman E, Avaky C, Negru L, Shenhav-Saltzman G, Grupper A, Wasserstrum Y, Segal G. Low ALT Levels Associated with Poor Outcomes in 8700 Hospitalized Heart Failure Patients. J Clin Med 2020; 9:E3185. [PMID: 33008125 PMCID: PMC7600048 DOI: 10.3390/jcm9103185] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/23/2020] [Accepted: 09/28/2020] [Indexed: 12/12/2022] Open
Abstract
Sarcopenia and frailty are causes for morbidity and mortality amongst heart failure (HF) patients. Low alanine transaminase (ALT) is a marker for these syndromes and, therefore, could serve as a biomarker for the prognostication of HF patients. We performed a retrospective analysis of all consecutive hospitalized HF patients in our institute in order to find out whether low ALT values would be a biomarker for poor outcomes. Our cohort included 11,102 patients, 35.6% categorized as heart failure with reduced ejection fraction. We excluded patients with ALT > 40 IU/L and cirrhosis. 8700 patients were followed for a median duration of 22 months and included in a univariate analysis. Patients with ALT < 10 IU/L were older (mean age 78.6 vs. 81.8, p < 0.001), had past stroke (24.6% vs. 19.6%, p < 0.001), dementia (7.7% vs. 4.6%, p < 0.001), and malignancy (13.4% vs. 10.2%, p = 0.003). Hospitalization length was longer in the low-ALT group (4 vs. 3 days, p < 0.001), and the rate of acute kidney injury during hospitalization was higher (19.1% vs. 15.6%; p = 0.006). The in-hospital mortality rate was higher in the low-ALT group (6.5% vs. 3.9%; p < 0.001). Long-term mortality was also higher (73.3% vs. 61.5%; p < 0.001). In a multivariate regression analysis, ALT < 10 IU/L had a 1.22 hazard ratio for mortality throughout the follow-up period (CI = 1.09-1.36; p < 0.001). Low ALT plasma level, a biomarker for sarcopenia and frailty, can assist clinicians in prognostic stratification of heart failure patients.
Collapse
Affiliation(s)
- Amitai Segev
- Internal Medicine “T”, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5266202, Israel; (A.S.); (E.I.); (C.A.); (L.N.); (G.S.-S.); (Y.W.)
| | - Edward Itelman
- Internal Medicine “T”, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5266202, Israel; (A.S.); (E.I.); (C.A.); (L.N.); (G.S.-S.); (Y.W.)
| | - Chen Avaky
- Internal Medicine “T”, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5266202, Israel; (A.S.); (E.I.); (C.A.); (L.N.); (G.S.-S.); (Y.W.)
| | - Liat Negru
- Internal Medicine “T”, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5266202, Israel; (A.S.); (E.I.); (C.A.); (L.N.); (G.S.-S.); (Y.W.)
| | - Gilat Shenhav-Saltzman
- Internal Medicine “T”, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5266202, Israel; (A.S.); (E.I.); (C.A.); (L.N.); (G.S.-S.); (Y.W.)
| | - Avishay Grupper
- Cardiovascular Division, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5266202, Israel;
| | - Yishay Wasserstrum
- Internal Medicine “T”, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5266202, Israel; (A.S.); (E.I.); (C.A.); (L.N.); (G.S.-S.); (Y.W.)
| | - Gad Segal
- Internal Medicine “T”, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5266202, Israel; (A.S.); (E.I.); (C.A.); (L.N.); (G.S.-S.); (Y.W.)
| |
Collapse
|
61
|
Beverung S, Wu J, Steward R. Lab-on-a-Chip for Cardiovascular Physiology and Pathology. MICROMACHINES 2020; 11:E898. [PMID: 32998305 PMCID: PMC7600691 DOI: 10.3390/mi11100898] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/09/2020] [Accepted: 09/24/2020] [Indexed: 02/08/2023]
Abstract
Lab-on-a-chip technologies have allowed researchers to acquire a flexible, yet relatively inexpensive testbed to study one of the leading causes of death worldwide, cardiovascular disease. Cardiovascular diseases, such as peripheral artery disease, arteriosclerosis, and aortic stenosis, for example, have all been studied by lab-on-a-chip technologies. These technologies allow for the integration of mammalian cells into functional structures that mimic vital organs with geometries comparable to those found in vivo. For this review, we focus on microdevices that have been developed to study cardiovascular physiology and pathology. With these technologies, researchers can better understand the electrical-biomechanical properties unique to cardiomyocytes and better stimulate and understand the influence of blood flow on the human vasculature. Such studies have helped increase our understanding of many cardiovascular diseases in general; as such, we present here a review of the current state of the field and potential for the future.
Collapse
Affiliation(s)
| | | | - Robert Steward
- Department of Mechanical and Aerospace Engineering, Burnett School of Biomedical Sciences, University of Central Florida, Orlando, FL 32816, USA; (S.B.); (J.W.)
| |
Collapse
|
62
|
Abstract
IMPORTANCE Perioperative cardiovascular complications occur in 3% of hospitalizations for noncardiac surgery in the US. This review summarizes evidence regarding cardiovascular risk assessment prior to noncardiac surgery. OBSERVATIONS Preoperative cardiovascular risk assessment requires a focused history and physical examination to identify signs and symptoms of ischemic heart disease, heart failure, and severe valvular disease. Risk calculators, such as the Revised Cardiac Risk Index, identify individuals with low risk (<1%) and higher risk (≥1%) for perioperative major adverse cardiovascular events during the surgical hospital admission or within 30 days of surgery. Cardiovascular testing is rarely indicated in patients at low risk for major adverse cardiovascular events. Stress testing may be considered in patients at higher risk (determined by the inability to climb ≥2 flights of stairs, which is <4 metabolic equivalent tasks) if the results from the testing would change the perioperative medical, anesthesia, or surgical approaches. Routine coronary revascularization does not reduce perioperative risk and should not be performed without specific indications independent of planned surgery. Routine perioperative use of low-dose aspirin (100 mg/d) does not decrease cardiovascular events but does increase surgical bleeding. Statins are associated with fewer postoperative cardiovascular complications and lower mortality (1.8% vs 2.3% without statin use; P < .001) in observational studies, and should be considered preoperatively in patients with atherosclerotic cardiovascular disease undergoing vascular surgery. High-dose β-blockers (eg, 100 mg of metoprolol succinate) administered 2 to 4 hours prior to surgery are associated with a higher risk of stroke (1.0% vs 0.5% without β-blocker use; P = .005) and mortality (3.1% vs 2.3% without β-blocker use; P = .03) and should not be routinely used. There is a greater risk of perioperative myocardial infarction and major adverse cardiovascular events in adults aged 75 years or older (9.5% vs 4.8% for younger adults; P < .001) and in patients with coronary stents (8.9% vs 1.5% for those without stents; P < .001) and these patients warrant careful preoperative consideration. CONCLUSIONS AND RELEVANCE Comprehensive history, physical examination, and assessment of functional capacity during daily life should be performed prior to noncardiac surgery to assess cardiovascular risk. Cardiovascular testing is rarely indicated in patients with a low risk of major adverse cardiovascular events, but may be useful in patients with poor functional capacity (<4 metabolic equivalent tasks) undergoing high-risk surgery if test results would change therapy independent of the planned surgery. Perioperative medical therapy should be prescribed based on patient-specific risk.
Collapse
Affiliation(s)
- Nathaniel R Smilowitz
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York
- Division of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Health Care System, New York, New York
| | - Jeffrey S Berger
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York
- Division of Vascular Surgery, Department of Surgery, New York University School of Medicine, New York, New York
| |
Collapse
|
63
|
Eijsvogels TMH, Maessen MFH, Bakker EA, Meindersma EP, van Gorp N, Pijnenburg N, Thompson PD, Hopman MTE. Association of Cardiac Rehabilitation With All-Cause Mortality Among Patients With Cardiovascular Disease in the Netherlands. JAMA Netw Open 2020; 3:e2011686. [PMID: 32716516 DOI: 10.1001/jamanetworkopen.2020.11686] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE Cardiac rehabilitation (CR) is an effective strategy to improve clinical outcomes, but it remains underused in some subgroups of patients with cardiovascular disease (CVD). OBJECTIVE To investigate the implications of sex, age, socioeconomic status, CVD diagnosis, cardiothoracic surgery, and comorbidity for the association between CR participation and all-cause mortality. DESIGN, SETTING, AND PARTICIPANTS Observational cohort study with patient enrollment between July 1, 2012, and December 31, 2017, and a follow-up to March 19, 2020. The dates of analysis were March to May 2020. This study was performed among Dutch patients with CVD with a multidisciplinary outpatient CR program indication and who were insured at Coöperatie Volksgezondheidszorg, one of the largest health insurance companies in the Netherlands. Among 4.1 million beneficiaries, patients with CVD with an acute coronary event (myocardial infarction or unstable angina pectoris), stable angina pectoris, chronic heart failure, or cardiothoracic surgery (coronary artery bypass grafting, valve replacement, or percutaneous coronary intervention) were identified by inpatient diagnosis codes and included in the study. MAIN OUTCOMES AND MEASURES Cox proportional hazards models were used to evaluate the association between CR participation and all-cause mortality. Stabilized inverse propensity score weighting was used to account for patient and disease characteristics associated with CR participation. RESULTS Among 83 687 eligible patients with CVD (mean [SD] age, 67 [12] years; 60.4% [n = 50 512] men), only 31.3% (n = 26 171) participated in CR, with large variation across different subgroups (range, 5.1%-73.0%). During a mean (SD) of 4.7 (1.8) years of follow-up, 1966 CR participants (7.5%) and 13 443 CR nonparticipants (23.4%) died. After multivariable adjustment, CR participation was associated with a 32% lower risk of all-cause mortality (adjusted hazard ratio, 0.68; 95% CI, 0.65-0.71) compared with nonparticipation. Sex, age, socioeconomic status, and comorbidity did not alter risk reduction after CR participation, but a statistically significant interaction association was found across categories of CVD diagnosis and cardiothoracic surgery. Larger reductions in risk estimates for all-cause mortality were found after CR participation for STEMI (adjusted HR, 0.59; 95% CI, 0.52-0.68 vs 0.72; 95% CI, 0.65-0.79; P < .001), NSTEMI (adjusted HR, 0.64; 95% CI, 0.58-0.70 vs 0.72; 95% CI, 0.65-0.79; P < .001), and stable AP (adjusted HR, 0.69; 95% CI, 0.63-0.76 vs 0.72; 95% CI, 0.65-0.79; P < .001) compared with patients with chronic heart failure, whereas unstable AP had a smaller risk reduction (adjusted HR, 0.75; 95% CI, 0.67-0.85 vs 0.72; 95% CI, 0.65-0.79; P < .001). CONCLUSIONS AND RELEVANCE In this cohort study, CR participation was associated with a 32% risk reduction in all-cause mortality, and this benefit was independent of sex, age, socioeconomic status, and comorbidity. These findings reinforce the importance of CR participation in secondary prevention and highlight the possibility that CR should be prescribed more widely to vulnerable patients with CVD, such as older adults with chronic diseases or multimorbidity.
Collapse
Affiliation(s)
- Thijs M H Eijsvogels
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Martijn F H Maessen
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
- Coöperatie Volksgezondheidszorg, Business Intelligence Services, Arnhem, the Netherlands
| | - Esmée A Bakker
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
- Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Esther P Meindersma
- Department of Cardiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Niels van Gorp
- Coöperatie Volksgezondheidszorg, Business Intelligence Services, Arnhem, the Netherlands
| | - Nicole Pijnenburg
- Coöperatie Volksgezondheidszorg, Business Intelligence Services, Arnhem, the Netherlands
| | - Paul D Thompson
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut
| | - Maria T E Hopman
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| |
Collapse
|
64
|
Putot A, Chagué F, Manckoundia P, Brunel P, Beer JC, Cottin Y, Zeller M. Post-Infectious Myocardial Infarction: Does Percutaneous Coronary Intervention Improve Outcomes? A Propensity Score-Matched Analysis. J Clin Med 2020; 9:E1608. [PMID: 32466424 PMCID: PMC7355802 DOI: 10.3390/jcm9061608] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/23/2020] [Accepted: 05/25/2020] [Indexed: 02/06/2023] Open
Abstract
Acute infection is a frequent trigger of myocardial infarction (MI). However, whether percutaneous coronary intervention (PCI) improves post-infectious MI prognosis is a major but unsolved issue. In this prospective multicenter study from coronary care units, we performed propensity score-matched analysis to compare outcomes in patients with and without PCI for post-infectious MI with angiography-proven significant coronary stenosis (>50%). Among 4573 consecutive MI patients, 476 patients (10%) had a concurrent diagnosis of acute infection at admission, of whom 375 underwent coronary angiography and 321 patients had significant stenosis. Among the 321 patients, 195 underwent PCI. Before the matching procedure, patients without PCI had a similar age and sex ratio but a higher rate of risk factors (hypertension, diabetes, chronic renal failure, and prior coronary artery disease), pneumonia, and SYNTAX score than patients without PCI. After propensity score matching, neither in-hospital mortality (13% with PCI vs. 8% without PCI; p = 0.4) nor one-year mortality (24% with PCI vs. 19% without PCI, p = 0.5) significantly differed between the two groups. In this first prospective cohort of post-infectious MI in coronary care units, PCI might not improve short- and long-term prognosis in patients with angiography-proven significant coronary stenosis. If confirmed, these results do not argue for systematic invasive procedures after post-infectious MI.
Collapse
Affiliation(s)
- Alain Putot
- Geriatrics Internal Medicine Department, University Hospital of Dijon Bourgogne, 21079 Dijon CEDEX, France;
- Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2), EA 7460, University of Burgundy and Franche Comté, 21079 Dijon CEDEX, France; (F.C.); (Y.C.); (M.Z.)
| | - Frédéric Chagué
- Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2), EA 7460, University of Burgundy and Franche Comté, 21079 Dijon CEDEX, France; (F.C.); (Y.C.); (M.Z.)
- Cardiology Department, University Hospital of Dijon Bourgogne, 21079 Dijon CEDEX, France;
| | - Patrick Manckoundia
- Geriatrics Internal Medicine Department, University Hospital of Dijon Bourgogne, 21079 Dijon CEDEX, France;
| | - Philippe Brunel
- Cardiology Department, Hopital privé Dijon Bourgogne, 21000 Dijon, France;
| | - Jean-Claude Beer
- Cardiology Department, University Hospital of Dijon Bourgogne, 21079 Dijon CEDEX, France;
| | - Yves Cottin
- Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2), EA 7460, University of Burgundy and Franche Comté, 21079 Dijon CEDEX, France; (F.C.); (Y.C.); (M.Z.)
- Cardiology Department, University Hospital of Dijon Bourgogne, 21079 Dijon CEDEX, France;
| | - Marianne Zeller
- Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2), EA 7460, University of Burgundy and Franche Comté, 21079 Dijon CEDEX, France; (F.C.); (Y.C.); (M.Z.)
| |
Collapse
|
65
|
Testa G, Curcio F, Liguori I, Basile C, Papillo M, Tocchetti CG, Galizia G, Della-Morte D, Gargiulo G, Cacciatore F, Bonaduce D, Abete P. Physical vs. multidimensional frailty in older adults with and without heart failure. ESC Heart Fail 2020; 7:1371-1380. [PMID: 32243099 PMCID: PMC7261566 DOI: 10.1002/ehf2.12688] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 03/08/2020] [Indexed: 12/27/2022] Open
Abstract
Aims The assessment of frailty in older adults with heart failure (HF) is still debated. Here, we compare the predictive role and the diagnostic accuracy of physical vs. multidimensional frailty assessment on mortality, disability, and hospitalization in older adults with and without HF. Methods and results A total of 1077 elderly (≥65 years) outpatients were evaluated with the physical (phy‐Fi) and multidimensional (m‐Fi) frailty scores and according to the presence or the absence of HF. Mortality, disability, and hospitalizations were assessed at baseline and after a 24 month follow‐up. Cox regression analysis demonstrated that, compared with phy‐Fi score, m‐Fi score was more predictive of mortality [hazard ratio (HR) = 1.05 vs. 0.66], disability (HR = 1.02 vs. 0.89), and hospitalization (HR = 1.03 vs. 0.96) in the absence and even more in the presence of HF (HR = 1.11 vs. 0.63, 1.06 vs. 0.98, and 1.14 vs. 1.03, respectively). The area under the curve indicated a better diagnostic accuracy with m‐Fi score than with phy‐Fi score for mortality, disability, and hospitalizations, both in absence (0.782 vs. 0.649, 0.763 vs. 0.695, and 0.732 vs. 0.666, respectively) and in presence of HF (0.824 vs. 0.625, 0.886 vs. 0.793, and 0.812 vs. 0.688, respectively). Conclusions The m‐Fi score is able to predict mortality, disability, and hospitalizations better than the phy‐Fi score, not only in absence but also in presence of HF. Our data also demonstrate that the m‐Fi score has better diagnostic accuracy than the phy‐Fi score. Thus, the use of the m‐FI score should be considered for the assessment of frailty in older HF adults.
Collapse
Affiliation(s)
- Gianluca Testa
- Department of Translational Medical Sciences, University of Naples "Federico II", Via S. Pansini, 80131, Naples, Italy.,Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Francesco Curcio
- Department of Translational Medical Sciences, University of Naples "Federico II", Via S. Pansini, 80131, Naples, Italy
| | - Ilaria Liguori
- Department of Translational Medical Sciences, University of Naples "Federico II", Via S. Pansini, 80131, Naples, Italy
| | - Claudia Basile
- Department of Translational Medical Sciences, University of Naples "Federico II", Via S. Pansini, 80131, Naples, Italy
| | - Martina Papillo
- Department of Translational Medical Sciences, University of Naples "Federico II", Via S. Pansini, 80131, Naples, Italy
| | - Carlo Gabriele Tocchetti
- Department of Translational Medical Sciences, University of Naples "Federico II", Via S. Pansini, 80131, Naples, Italy
| | - Gianlugi Galizia
- Department of Translational Medical Sciences, University of Naples "Federico II", Via S. Pansini, 80131, Naples, Italy.,IRCCS Salvatore Maugeri Foundation, Scientific Institute of Veruno, Novara, Italy
| | - David Della-Morte
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Department of Human Sciences and Quality of Life Promotion, San Raffaele Roma Open University, Rome, Italy
| | - Gaetano Gargiulo
- Division of Internal Medicine, AOU San Giovanni di Dio e Ruggi di Aragona, Salerno, Italy
| | - Francesco Cacciatore
- Department of Translational Medical Sciences, University of Naples "Federico II", Via S. Pansini, 80131, Naples, Italy
| | - Domenico Bonaduce
- Department of Translational Medical Sciences, University of Naples "Federico II", Via S. Pansini, 80131, Naples, Italy
| | - Pasquale Abete
- Department of Translational Medical Sciences, University of Naples "Federico II", Via S. Pansini, 80131, Naples, Italy
| |
Collapse
|
66
|
Jepma P, Jorstad HT, Snaterse M, Ter Riet G, Kragten H, Lachman S, Minneboo M, Boekholdt SM, Peters RJ, Scholte Op Reimer W. Lifestyle modification in older versus younger patients with coronary artery disease. Heart 2020; 106:1066-1072. [PMID: 32179587 PMCID: PMC7361002 DOI: 10.1136/heartjnl-2019-316056] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/10/2020] [Accepted: 02/10/2020] [Indexed: 01/14/2023] Open
Abstract
Objective To compare the treatment effect on lifestyle-related risk factors (LRFs) in older (≥65 years) versus younger (<65 years) patients with coronary artery disease (CAD) in The Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists 2 (RESPONSE-2) trial. Methods The RESPONSE-2 trial was a community-based lifestyle intervention trial (n=824) comparing nurse-coordinated referral with a comprehensive set of three lifestyle interventions (physical activity, weight reduction and/or smoking cessation) to usual care. In the current analysis, our primary outcome was the proportion of patients with improvement at 12 months follow-up (n=711) in ≥1 LRF stratified by age. Results At baseline, older patients (n=245, mean age 69.2±3.9 years) had more adverse cardiovascular risk profiles and comorbidities than younger patients (n=579, mean age 53.7±6.6 years). There was no significant variation on the treatment effect according to age (p value treatment by age=0.45, OR 1.67, 95% CI 1.22 to 2.31). However, older patients were more likely to achieve ≥5% weight loss (OR old 5.58, 95% CI 2.77 to 11.26 vs OR young 1.57, 95% CI 0.98 to 2.49, p=0.003) and younger patients were more likely to show non-improved LRFs (OR old 0.38, 95% CI 0.22 to 0.67 vs OR young 0.88, 95% CI 0.61 to 1.26, p=0.01). Conclusion Despite more adverse cardiovascular risk profiles and comorbidities among older patients, nurse-coordinated referral to a community-based lifestyle intervention was at least as successful in improving LRFs in older as in younger patients. Higher age alone should not be a reason to withhold lifestyle interventions in patients with CAD.
Collapse
Affiliation(s)
- Patricia Jepma
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands .,Achieve Centre for Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Harald T Jorstad
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marjolein Snaterse
- Achieve Centre for Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Gerben Ter Riet
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Achieve Centre for Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Hans Kragten
- Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Sangeeta Lachman
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Madelon Minneboo
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - S Matthijs Boekholdt
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ron J Peters
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Wilma Scholte Op Reimer
- Achieve Centre for Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands
| |
Collapse
|
67
|
Damluji AA, Bandeen-Roche K, Berkower C, Boyd CM, Al-Damluji MS, Cohen MG, Forman DE, Chaudhary R, Gerstenblith G, Walston JD, Resar JR, Moscucci M. Percutaneous Coronary Intervention in Older Patients With ST-Segment Elevation Myocardial Infarction and Cardiogenic Shock. J Am Coll Cardiol 2020; 73:1890-1900. [PMID: 30999991 DOI: 10.1016/j.jacc.2019.01.055] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 01/24/2019] [Accepted: 01/28/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND Older adults ≥75 years of age carry an increased risk of mortality after ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock. OBJECTIVES The purpose of this study was to examine the use of percutaneous coronary intervention (PCI) in older adults with STEMI and shock and its influence on in-hospital mortality. METHODS We used a large publicly available all-payer inpatient health care database sponsored by the Agency for Healthcare Research and Quality between 1999 and 2013. The primary outcome was in-hospital mortality. The influence of PCI on in-hospital mortality was assessed by quintiles of propensity score (PS). RESULTS Of the 317,728 encounters with STEMI and shock in the United States, 111,901 (35%) were adults age ≥75 years. Of these, 53% were women and 83% were Caucasians. The median number of chronic conditions was 8 (interquartile range: 6 to 10). The diagnosis of STEMI and cardiogenic shock in older patients decreased significantly over time (proportion of older adults with STEMI and shock: 1999: 42% vs. 2013: 29%). Concomitantly, the rate of PCI utilization in older adults increased (1999: 27% vs. 2013: 56%, p < 0.001), with declining in-hospital mortality rates (1999: 64% vs. 2013: 46%; p < 0.001). Utilizing PS matching methods, PCI was associated with a lower risk of in-hospital mortality across quintiles of propensity score (Mantel-Haenszel odds ratio: 0.48; 95% confidence interval [CI]: 0.45 to 0.51). This reduction in hospital mortality risk was seen across the 4 different U.S. census bureau regions (adjusted odds ratio: Northeast: 0.41; 95% CI: 0.36 to 0.47; Midwest: 0.49; 95% CI: 0.42 to 0.57; South: 0.51; 95% CI: 0.46 to 0.56; West: 0.46; 95% CI: 0.41 to 0.53). CONCLUSIONS This large and contemporary analysis shows that utilization of PCI in older adults with STEMI and cardiogenic shock is increasing and paralleled by a substantial reduction in mortality. Although clinical judgment is critical, older adults should not be excluded from early revascularization based on age in the absence of absolute contraindications.
Collapse
Affiliation(s)
- Abdulla A Damluji
- Sinai Hospital of Baltimore, LifeBridge Health Cardiovascular Institute, Baltimore, Maryland; Division of Cardiology, Johns Hopkins University, Baltimore, Maryland.
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Carol Berkower
- Sinai Hospital of Baltimore, LifeBridge Health Cardiovascular Institute, Baltimore, Maryland
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Maryland
| | - Mohammed S Al-Damluji
- Department of Internal Medicine, University of Connecticut Health Center, Farmington, Connecticut
| | | | - Daniel E Forman
- Geriatric Cardiology Section, University of Pittsburgh, Pittsburgh, Pennsylvania; Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Rahul Chaudhary
- Sinai Hospital of Baltimore, LifeBridge Health Cardiovascular Institute, Baltimore, Maryland
| | - Gary Gerstenblith
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Jeremy D Walston
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Maryland
| | - Jon R Resar
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Mauro Moscucci
- Sinai Hospital of Baltimore, LifeBridge Health Cardiovascular Institute, Baltimore, Maryland; University of Michigan Health System, Ann Arbor, Michigan.
| |
Collapse
|
68
|
Hiasa KI, Kaku H, Inoue H, Yamashita T, Akao M, Atarashi H, Koretsune Y, Okumura K, Shimizu W, Ikeda T, Toyoda K, Hirayama A, Yasaka M, Yamaguchi T, Teramukai S, Kimura T, Kaburagi J, Takita A, Tsutsui H. Age-Related Differences in the Clinical Characteristics and Treatment of Elderly Patients With Atrial Fibrillation in Japan - Insight From the ANAFIE (All Nippon AF In Elderly) Registry. Circ J 2020; 84:388-396. [PMID: 31969518 DOI: 10.1253/circj.cj-19-0898] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is increasing as the global population ages. Elderly AF patients (≥75 years) have a worse prognosis than younger patients, and effective management is often difficult due to multiple comorbidities. This analysis examined the age-related differences in clinical characteristics and treatment in real-world elderly Japanese AF patients.Methods and Results:The ANAFIE Registry is a multicenter, prospective, observational registry of 32,726 non-valvular AF patients aged ≥75 years. The present study assessed the age-related differences in baseline clinical status and anticoagulant therapy between age groups 75-<80, 80-<85, 85-<90, and ≥90 years. The prevalence of persistent or permanent AF increased, and that of paroxysmal AF decreased, with increasing age (trend P<0.0001). The risk of stroke, based on CHADS2and CHA2DS2-VASc scores, and bleeding, based on HAS-BLED score, increased with age. Both warfarin and apixaban were used more often as age increased (trend P<0.0001, for each), while other anticoagulants were used less. Anticoagulant doses were significantly lower in older patients. CONCLUSIONS Permanent/persistent AF, comorbidities, and cardiovascular and bleeding risk all increased significantly with age. Furthermore, use of warfarin and apixaban increased with age, accompanied by a decrease in other oral anticoagulant usage.
Collapse
Affiliation(s)
- Ken-Ichi Hiasa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Hidetaka Kaku
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | | | | | | | | | | | | | | | | | - Kazunori Toyoda
- National Cerebral and Cardiovascular Research Center Hospital
| | | | | | | | | | | | | | - Atsushi Takita
- Biostatistics and Data Management Department, Daiichi Sankyo Co., Ltd
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| |
Collapse
|
69
|
Kyosaka Y, Owatari T, Inokoshi M, Kubota K, Inoue M, Minakuchi S. Cardiovascular Comparison of 2 Types of Local Anesthesia With Vasoconstrictor in Older Adults: A Crossover Study. Anesth Prog 2020; 66:133-140. [PMID: 31545671 DOI: 10.2344/anpr-66-02-04] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
We assessed the effect of 2% lidocaine with 1:80,000 adrenaline (L + AD) and 3% prilocaine with 0.03 IU/mL felypressin (P + FP) on blood pressure and heart rate in older adults with systemic diseases undergoing dental extraction. This double-blind, randomized crossover study included 22 elderly participants, aged over 65 years. The participants were administered L + AD for one dental extraction and P + FP for the other. Blood pressure and heart rate were recorded immediately, 5, and 10 minutes after local anesthetic administration and the data were analyzed. The systolic and diastolic blood pressures in the P + FP group increased at all measurement points (p < .001). In the L + AD group, the diastolic blood pressure decreased at 5 and 10 minutes after local anesthetic administration (p < .05), whereas the heart rate increased at all measured time points (p < .001). There were statistically significant differences in systolic blood pressure at 5 and 10 minutes after local anesthetic administration and in diastolic blood pressure and heart rate at all time points between the 2 groups. In older adults, P + FP administration increased the systolic and diastolic blood pressures. L + AD administration increased the heart rate and decreased the diastolic blood pressure.
Collapse
Affiliation(s)
- Yuka Kyosaka
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsuneto Owatari
- Dental Center of the Medically Compromised Patient (DEMCOP), Kyushu Dental University, Fukuoka, Japan
| | - Masanao Inokoshi
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazumasa Kubota
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Minoru Inoue
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shunsuke Minakuchi
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
70
|
Hamada S, Kojima T, Maruoka H, Ishii S, Hattori Y, Okochi J, Akishita M. Utilization of drugs for the management of cardiovascular diseases at intermediate care facilities for older adults in Japan. Arch Gerontol Geriatr 2020; 88:104016. [PMID: 32045709 DOI: 10.1016/j.archger.2020.104016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES No established approaches exist for the pharmacological management of cardiovascular diseases (CVDs) in residents of long-term care facilities (LTCFs). This study aimed to evaluate the use of drugs for CVD prevention and treatment (CVD-related drugs) in a major type of LTCF in Japan. METHODS This study included 1318 randomly selected residents at 349 intermediate care facilities for older adults (called Roken). Prescriptions were investigated at admission and two months after admission according to therapeutic categories. Logistic regression was used to identify residents' characteristics that were associated with prescriptions of CVD-related drugs. RESULTS Prescriptions of all types of drugs and CVD-related drugs decreased in 36 % and 16 % of residents, respectively. Half of the residents received antihypertensives, a quarter received antiplatelets and diuretics, whereas one-tenth received antidiabetics, oral anticoagulants, and lipid-modifying drugs. The prevalence of most of individual drug categories were similar among residents with different physical or cognitive function, except for fewer antihypertensive and lipid-modifying drugs in those with severe cognitive disability. Adjusted analyses for prescriptions at two months after admission revealed that bedridden residents were more likely to be prescribed diuretics but less likely to be prescribed antihypertensives, antiplatelets, or lipid-modifying drugs. Residents with severe cognitive disability were less likely to be prescribed antihypertensives or lipid-modifying drugs. A known history of cardiovascular events was associated with greater use of CVD-related drugs. CONCLUSION CVD-related drugs were commonly prescribed for Roken residents, including those with low physical and cognitive functions. Deprescribing may contribute to the optimization of pharmacotherapy in LTCF residents.
Collapse
Affiliation(s)
- Shota Hamada
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan; Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Taro Kojima
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Maruoka
- Yokohama Aobanosato Geriatric Health Services Facility, Yokohama, Japan
| | - Shinya Ishii
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukari Hattori
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Jiro Okochi
- Tatsumanosato Geriatric Health Services Facility, Daito, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
71
|
Disdier Moulder MPA, Hendricks AK, Ou NN. Towards appropriate polypharmacy in older cardiovascular patients: How many medications do I have to take? Clin Cardiol 2020; 43:137-144. [PMID: 31825133 PMCID: PMC7021656 DOI: 10.1002/clc.23304] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/31/2019] [Accepted: 11/08/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Polypharmacy in older adults leads to increased risks of side effects and drug-drug interactions, affecting their health outcomes and quality of life. Deprescribing, the act of simplifying medication regimens, is challenging due to the lack of consensus guidelines. HYPOTHESIS To offer some guidance on managing medication regimens for older cardiovascular patients. METHODS We reviewed the most recent pertinent guidelines and literature. RESULTS This review provides practical considerations for appropriate prescribing in the older population with cardiovascular disease in order to strike a balance between unnecessary or harmful medications and therapies with proven long-term benefits. CONCLUSION On-going dialogue between healthcare providers and patients allows close monitoring of medication effectiveness and prevention of side effects. Medication regimens require individualization, as patients' goals of care change with advancing age.
Collapse
Affiliation(s)
| | | | - Narith N. Ou
- Department of PharmacyMayo ClinicRochesterMinnesota
| |
Collapse
|
72
|
Damluji AA, Forman DE, van Diepen S, Alexander KP, Page RL, Hummel SL, Menon V, Katz JN, Albert NM, Afilalo J, Cohen MG. Older Adults in the Cardiac Intensive Care Unit: Factoring Geriatric Syndromes in the Management, Prognosis, and Process of Care: A Scientific Statement From the American Heart Association. Circulation 2020; 141:e6-e32. [DOI: 10.1161/cir.0000000000000741] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Longevity is increasing, and more adults are living to the stage of life when age-related biological factors determine a higher likelihood of cardiovascular disease in a distinctive context of concurrent geriatric conditions. Older adults with cardiovascular disease are frequently admitted to cardiac intensive care units (CICUs), where care is commensurate with high age-related cardiovascular disease risks but where the associated geriatric conditions (including multimorbidity, polypharmacy, cognitive decline and delirium, and frailty) may be inadvertently exacerbated and destabilized. The CICU environment of procedures, new medications, sensory overload, sleep deprivation, prolonged bed rest, malnourishment, and sleep is usually inherently disruptive to older patients regardless of the excellence of cardiovascular disease care. Given these fundamental and broad challenges of patient aging, CICU management priorities and associated decision-making are particularly complex and in need of enhancements. In this American Heart Association statement, we examine age-related risks and describe some of the distinctive dynamics pertinent to older adults and emerging opportunities to enhance CICU care. Relevant assessment tools are discussed, as well as the need for additional clinical research to best advance CICU care for the already dominating and still expanding population of older adults.
Collapse
|
73
|
Dodson JA, Hajduk AM, Geda M, Krumholz HM, Murphy TE, Tsang S, Tinetti ME, Nanna MG, McNamara R, Gill TM, Chaudhry SI. Predicting 6-Month Mortality for Older Adults Hospitalized With Acute Myocardial Infarction: A Cohort Study. Ann Intern Med 2020; 172:12-21. [PMID: 31816630 PMCID: PMC7695040 DOI: 10.7326/m19-0974] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Older adults with acute myocardial infarction (AMI) have higher prevalence of functional impairments, including deficits in cognition, strength, and sensory domains, than their younger counterparts. Objective To develop and evaluate the prognostic utility of a risk model for 6-month post-AMI mortality in older adults that incorporates information about functional impairments. Design Prospective cohort study. (ClinicalTrials.gov: NCT01755052). Setting 94 hospitals throughout the United States. Participants 3006 persons aged 75 years or older who were hospitalized with AMI and discharged alive. Measurements Functional impairments were assessed during hospitalization via direct measurement (cognition, mobility, muscle strength) or self-report (vision, hearing). Clinical variables associated with mortality in prior risk models were ascertained by chart review. Seventy-two candidate variables were selected for inclusion, and backward selection and Bayesian model averaging were used to derive (n = 2004 participants) and validate (n = 1002 participants) a model for 6-month mortality. Results Participants' mean age was 81.5 years, 44.4% were women, and 10.5% were nonwhite. There were 266 deaths (8.8%) within 6 months. The final risk model included 15 variables, 4 of which were not included in prior risk models: hearing impairment, mobility impairment, weight loss, and lower patient-reported health status. The model was well calibrated (Hosmer-Lemeshow P > 0.05) and showed good discrimination (area under the curve for the validation cohort = 0.84). Adding functional impairments significantly improved model performance, as evidenced by category-free net reclassification improvement indices of 0.21 (P = 0.008) for hearing impairment and 0.26 (P < 0.001) for mobility impairment. Limitation The model was not externally validated. Conclusion A newly developed model for 6-month post-AMI mortality in older adults was well calibrated and had good discriminatory ability. This model may be useful in decision making at hospital discharge. Primary Funding Source National Heart, Lung, and Blood Institute of the National Institutes of Health.
Collapse
Affiliation(s)
- John A Dodson
- New York University School of Medicine, New York, New York (J.A.D.)
| | - Alexandra M Hajduk
- Yale School of Medicine, New Haven, Connecticut (A.M.H., M.G., T.E.M., S.T., M.E.T., T.M.G., S.I.C.)
| | - Mary Geda
- Yale School of Medicine, New Haven, Connecticut (A.M.H., M.G., T.E.M., S.T., M.E.T., T.M.G., S.I.C.)
| | - Harlan M Krumholz
- Yale New Haven Hospital, Yale School of Medicine, and Yale School of Public Health, New Haven, Connecticut (H.M.K.)
| | - Terrence E Murphy
- Yale School of Medicine, New Haven, Connecticut (A.M.H., M.G., T.E.M., S.T., M.E.T., T.M.G., S.I.C.)
| | - Sui Tsang
- Yale School of Medicine, New Haven, Connecticut (A.M.H., M.G., T.E.M., S.T., M.E.T., T.M.G., S.I.C.)
| | - Mary E Tinetti
- Yale School of Medicine, New Haven, Connecticut (A.M.H., M.G., T.E.M., S.T., M.E.T., T.M.G., S.I.C.)
| | - Michael G Nanna
- Duke University School of Medicine, Durham, North Carolina (M.G.N.)
| | | | - Thomas M Gill
- Yale School of Medicine, New Haven, Connecticut (A.M.H., M.G., T.E.M., S.T., M.E.T., T.M.G., S.I.C.)
| | - Sarwat I Chaudhry
- Yale School of Medicine, New Haven, Connecticut (A.M.H., M.G., T.E.M., S.T., M.E.T., T.M.G., S.I.C.)
| |
Collapse
|
74
|
Green AR. How Can We Optimize Care and Outcomes for Patients with Mild Cognitive Impairment and Acute Myocardial Infarction? J Gen Intern Med 2020; 35:5-7. [PMID: 31659666 PMCID: PMC6957667 DOI: 10.1007/s11606-019-05484-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Ariel R Green
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
75
|
Pandey A, Kitzman D, Reeves G. Frailty Is Intertwined With Heart Failure: Mechanisms, Prevalence, Prognosis, Assessment, and Management. JACC. HEART FAILURE 2019; 7:1001-1011. [PMID: 31779921 PMCID: PMC7098068 DOI: 10.1016/j.jchf.2019.10.005] [Citation(s) in RCA: 156] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/15/2019] [Accepted: 10/15/2019] [Indexed: 02/06/2023]
Abstract
Frailty, a syndrome characterized by an exaggerated decline in function and reserve of multiple physiological systems, is common in older patients with heart failure (HF) and is associated with worse clinical and patient-reported outcomes. Although several detailed assessment tools have been developed and validated in the geriatric population, they are cumbersome, not validated in patients with HF, and not commonly used in routine management of patients with HF. More recently, there has been an increasing interest in developing simple frailty screening tools that could efficiently and quickly identify frail patients with HF in routine clinical settings. As the burden and recognition of frailty in older patients with HF increase, a more comprehensive approach to management is needed that targets deficits across multiple domains, including physical function and medical, cognitive, and social domains. Such a multidomain approach is critical to address the unique, multidimensional challenges to the care of these high-risk patients and to improve their functional status, quality of life, and long-term clinical outcomes. This review discusses the burden of frailty, the conceptual underpinnings of frailty in older patients with HF, and potential strategies for the assessment, screening, and management of frailty in this vulnerable patient population.
Collapse
Affiliation(s)
- Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Dalane Kitzman
- Sections on Cardiovascular Medicine and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Gordon Reeves
- Novant Health Heart & Vascular Institute, Charlotte, North Carolina.
| |
Collapse
|
76
|
Vardeny O, Claggett B, Vaduganathan M, Beldhuis I, Rouleau J, O'Meara E, Anand IS, Shah SJ, Sweitzer NK, Fang JC, Desai AS, Lewis EF, Pitt B, Pfeffer MA, Solomon SD. Influence of Age on Efficacy and Safety of Spironolactone in Heart Failure. JACC-HEART FAILURE 2019; 7:1022-1028. [PMID: 31779923 DOI: 10.1016/j.jchf.2019.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/26/2019] [Accepted: 08/26/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVES The authors examined efficacy and safety of spironolactone by age in the Americas region (N = 1,767) of the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) trial. BACKGROUND Heart failure with preserved ejection fraction disproportionately affects older adults who may exhibit changes in physiology and variable pharmacokinetics. METHODS TOPCAT enrolled patients with heart failure and a left ventricular ejection fraction ≥45% who were age 50 or older with an estimated glomerular filtration rate ≥30 mL/min/1.73 m2 and prior heart failure hospitalization or elevated natriuretic peptide levels. Participants were randomized to spironolactone or placebo with a mean follow-up duration of 3.3 years. We assessed treatment effect and safety by protocol-defined age categories (<65, 65 to 74, and ≥75 years). RESULTS The mean age was 72 ± 10 years (range 50 to 97 years) with 41% over the age of 75 years. Participants ≥75 years were more commonly women and white and had a lower body mass index and estimated glomerular filtration rate compared with the younger age categories. Spironolactone reduced the primary composite outcome compared with placebo across all age categories (p interaction = 0.42). However, spironolactone was associated with an increased risk of the safety endpoint (hazard ratio: 2.54; 95% confidence interval: 1.91 to 3.37; p < 0.001), particularly in older age groups (p interaction = 0.02). Findings in the whole TOPCAT cohort were consistent with results from the Americas region. CONCLUSIONS In this post hoc, exploratory analysis of the TOPCAT trial data from the Americas region, although there was no effect of age on efficacy, there were considerable effects of age on increased rates of adverse safety outcomes. These results should be weighed when considering spironolactone for older heart failure with preserved ejection fraction patients. (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist [TOPCAT]; NCT00094302).
Collapse
Affiliation(s)
- Orly Vardeny
- Minneapolis VA Medical Center, Minneapolis, Minnesota; University of Minnesota, Minneapolis, Minnesota.
| | | | | | | | - Jean Rouleau
- Institut de Cardiologie de Montreal, Montreal, Quebec, Canada; Université de Montreal, Montreal, Quebec
| | - Eileen O'Meara
- Institut de Cardiologie de Montreal, Montreal, Quebec, Canada; Université de Montreal, Montreal, Quebec
| | - Inder S Anand
- Minneapolis VA Medical Center, Minneapolis, Minnesota; University of Minnesota, Minneapolis, Minnesota
| | - Sanjiv J Shah
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | | | | | | | | | | |
Collapse
|
77
|
Yang X, Lupón J, Vidán MT, Ferguson C, Gastelurrutia P, Newton PJ, Macdonald PS, Bueno H, Bayés-Genís A, Woo J, Fung E. Impact of Frailty on Mortality and Hospitalization in Chronic Heart Failure: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2019; 7:e008251. [PMID: 30571603 PMCID: PMC6405567 DOI: 10.1161/jaha.117.008251] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Although frailty has been associated with increased risks for hospitalization and mortality in chronic heart failure, the precise average effect remains uncertain. We performed a systematic review and meta‐analysis to summarize the hazards for mortality and incident hospitalization in patients with heart failure and frailty compared with those without frailty and explored the heterogeneity underlying the effect size estimates. Methods and Results MEDLINE, EMBASE, and Cochrane databases were queried for articles published between January 1966 and March 2018. Predefined selection criteria were used. Hazard ratios (HRs) were pooled for meta‐analyses, and where odds ratios were used previously, original data were recalculated for HR. Overlapping data were consolidated, and only unique data points were used. Study quality and bias were assessed. Eight studies were included for mortality (2645 patients), and 6 studies were included for incident hospitalization (2541 patients) during a median follow‐up of 1.82 and 1.12 years, respectively. Frailty was significantly associated with an increased hazard for mortality (HR, 1.54; 95% confidence interval, 1.34–1.75; P<0.001) and incident hospitalization (HR, 1.56; 95% confidence interval, 1.36–1.78; P<0.001) in chronic heart failure. The Fried phenotype estimated a 16.9% larger effect size than the combined Fried/non‐Fried frailty assessment for the end point of mortality (HR, 1.80; 95% confidence interval, 1.41–2.28; P<0.001), but not for hospitalization (HR, 1.57; 95% confidence interval, 1.30–1.89; P<0.001). Study heterogeneity was found to be low (I2=0%), and high quality of studies was verified by the Newcastle‐Ottawa scale. Conclusions Overall, the presence of frailty in chronic heart failure is associated with an increased hazard for death and hospitalization by ≈1.5‐fold.
Collapse
Affiliation(s)
- Xiaobo Yang
- 1 Department of Medicine and Therapeutics Faculty of Medicine The Chinese University of Hong Kong Hong Kong, SAR.,2 Laboratory for Heart Failure and Circulation Research Li Ka Shing Institute of Health Sciences Prince of Wales Hospital Hong Kong, SAR
| | - Josep Lupón
- 3 Cardiology Department Hospital Universitari Germans Trias i Pujol Badalona Spain.,4 Department of Medicine Universitat Autonòma de Barcelona Spain.,5 CIBERCV Instituto de Salud Carlos III Madrid Spain
| | - Maria T Vidán
- 6 Department of Geriatrics Instituto de Investigación IiSGM and CIBERFES Hospital General Universitario Gregorio Marañón Madrid Spain.,7 Universidad Complutense de Madrid Spain
| | - Caleb Ferguson
- 8 Western Sydney Nursing and Midwifery Research Centre Western Sydney University and Western Sydney Local Health District Sydney Australia
| | - Paloma Gastelurrutia
- 5 CIBERCV Instituto de Salud Carlos III Madrid Spain.,9 Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol Badalona Spain
| | - Phillip J Newton
- 8 Western Sydney Nursing and Midwifery Research Centre Western Sydney University and Western Sydney Local Health District Sydney Australia
| | - Peter S Macdonald
- 10 Heart and Lung Transplant Unit St Vincent's Hospital University of New South Wales Sydney Australia.,11 Transplantation Research Laboratory Victor Chang Cardiac Research Institute Sydney Australia
| | - Héctor Bueno
- 7 Universidad Complutense de Madrid Spain.,12 Centro Nacional de Investigaciones Cardiovasculares Madrid Spain.,13 Instituto de Investigación i+12 and Cardiology Department Hospital Universitario 12 de Octubre Madrid Spain
| | - Antoni Bayés-Genís
- 3 Cardiology Department Hospital Universitari Germans Trias i Pujol Badalona Spain.,4 Department of Medicine Universitat Autonòma de Barcelona Spain.,5 CIBERCV Instituto de Salud Carlos III Madrid Spain
| | - Jean Woo
- 1 Department of Medicine and Therapeutics Faculty of Medicine The Chinese University of Hong Kong Hong Kong, SAR.,14 CUHK Jockey Club Institute of Ageing The Chinese University of Hong Kong Hong Kong, SAR
| | - Erik Fung
- 1 Department of Medicine and Therapeutics Faculty of Medicine The Chinese University of Hong Kong Hong Kong, SAR.,2 Laboratory for Heart Failure and Circulation Research Li Ka Shing Institute of Health Sciences Prince of Wales Hospital Hong Kong, SAR.,15 School of Public Health Imperial College London London United Kingdom.,16 CARE Programme Lui Che Woo Institute of Innovative Medicine Faculty of Medicine The Chinese University of Hong Kong Hong Kong, SAR.,17 Gerald Choa Cardiac Research Centre Faculty of Medicine The Chinese University of Hong Kong Hong Kong, SAR
| |
Collapse
|
78
|
Iboaya A, Harris JL, Arickx AN, Nudo RJ. Models of Traumatic Brain Injury in Aged Animals: A Clinical Perspective. Neurorehabil Neural Repair 2019; 33:975-988. [PMID: 31722616 PMCID: PMC6920554 DOI: 10.1177/1545968319883879] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Traumatic brain injury (TBI) is a major cause of morbidity and mortality in the United States, with advanced age being one of the major predictors of poor prognosis. To replicate the mechanisms and multifaceted complexities of human TBI and develop prospective therapeutic treatments, various TBI animal models have been developed. These models have been essential in furthering our understanding of the pathophysiology and biochemical effects on brain mechanisms following TBI. Despite these advances, translating preclinical results to clinical application, particularly in elderly individuals, continues to be challenging. This review aims to provide a clinical perspective, identifying relevant variables currently not replicated in TBI animal models, to potentially improve translation to clinical practice, especially as it applies to elderly populations. As background for this clinical perspective, we reviewed articles indexed on PubMed from 1970 to 2019 that used aged animal models for studying TBI. These studies examined end points relevant for clinical translation, such as neurocognitive effects, sensorimotor behavior, physiological mechanisms, and efficacy of neuroprotective therapies. However, compared with the higher incidence of TBI in older individuals, animal studies on the basic science of aging and TBI remain remarkably scarce. Moreover, a fundamental disconnect remains between experiments in animal models of TBI and successful translation of findings for treating the older TBI population. In this article, we aim to provide a clinical perspective on the unique attributes of TBI in older individuals and a critical appraisal of the research to date on TBI in aged animal models as well as recommendations for future studies.
Collapse
Affiliation(s)
- Aiwane Iboaya
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Janna L Harris
- University of Kansas Medical Center, Kansas City, KS, USA
| | | | | |
Collapse
|
79
|
|
80
|
Lim BG, Lee IO. Anesthetic management of geriatric patients. Korean J Anesthesiol 2019; 73:8-29. [PMID: 31636241 PMCID: PMC7000283 DOI: 10.4097/kja.19391] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 10/20/2019] [Indexed: 12/15/2022] Open
Abstract
The number of elderly patients who frequently access health care services is increasing worldwide. While anesthesiologists are developing the expertise to care for these elderly patients, areas of concern remain. We conducted a comprehensive search of major international databases (PubMed, Embase, and Cochrane) and a Korean database (KoreaMed) to review preoperative considerations, intraoperative management, and postoperative problems when anesthetizing elderly patients. Preoperative preparation of elderly patients included functional assessment to identify preexisting cognitive impairment or cardiopulmonary reserve, depression, frailty, nutrition, polypharmacy, and anticoagulation issues. Intraoperative management included anesthetic mode and pharmacology, monitoring, intravenous fluid or transfusion management, lung-protective ventilation, and prevention of hypothermia. Postoperative checklists included perioperative analgesia, postoperative delirium and cognitive dysfunction, and other complications. A higher level of perioperative care was required for older surgical patients, as multiple chronic diseases often makes them prone to developing postoperative complications, including functional decline and loss of independence. Although the guiding evidence remains poor so far, elderly patients have to be provided optimal perioperative care through close interdisciplinary, interprofessional, and cross-sectional collaboration to minimize unwanted postoperative outcomes. Furthermore, along with adequate anesthetic care, well-planned postoperative care should begin immediately after surgery and extend until discharge.
Collapse
Affiliation(s)
- Byung-Gun Lim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Il-Ok Lee
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| |
Collapse
|
81
|
Campitelli MA, Maxwell CJ, Maclagan LC, Ko DT, Bell CM, Jeffs L, Morris AM, Lapane KL, Daneman N, Bronskill SE. One-year survival and admission to hospital for cardiovascular events among older residents of long-term care facilities who were prescribed intensive- and moderate-dose statins. CMAJ 2019; 191:E32-E39. [PMID: 30642823 DOI: 10.1503/cmaj.180853] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Guidance from randomized clinical trials about the ongoing benefits of statin therapies in residents of long-term care facilities is lacking. We sought to examine the effect of statin dose on 1-year survival and admission to hospital for cardiovascular events in this setting. METHODS We conducted a retrospective cohort study using population-based administrative data from Ontario, Canada. We identified 21 808 residents in long-term care facilities who were 76 years of age and older and were prevalent statin users on the date of a full clinical assessment between April 2013 and March 2014, and categorized residents as intensive- or moderate-dose users. Treatment groups were matched on age, sex, admission to hospital for atherosclerotic cardiovascular disease, resident frailty and propensity score. Differences in 1-year survival and admission to hospital for cardiovascular events were measured using Cox proportional and subdistribution hazard models, respectively. RESULTS Using propensity-score matching, we included 4577 well-balanced pairs of residents who were taking intensive- and moderate-dose statins. After 1 year, there were 1210 (26.4%) deaths and 524 (11.5%) admissions to hospital for cardiovascular events among residents using moderate-dose statins compared with 1173 (25.6%) deaths and 522 (11.4%) admissions to hospital for cardiovascular events among those taking intensive-dose statins. We found no significant association between prevalent use of intensive-dose statins and 1-year survival (hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.90 to 1.05) or 1-year admission to hospital for cardiovascular events (HR 0.99, 95% CI 0.88 to 1.12) compared with use of moderate-dose statins. INTERPRETATION The rates of mortality and admission to hospital for cardiovascular events at 1 year were similar between residents in long-term care taking intensive-dose statins compared with those taking moderate-dose statins. This lack of benefit should be considered when prescribing statins to vulnerable residents of long-term care facilities who are at potentially increased risk of statin-related adverse events.
Collapse
Affiliation(s)
- Michael A Campitelli
- ICES (Campitelli, Maxwell, Maclagan, Ko, Bell, Daneman, Bronskill); Sunnybrook Research Institute (Ko, Daneman, Bronskill), Department of Cardiology (Ko) and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Ko, Bell, Morris, Daneman) and Institute of Health Policy, Management and Evaluation (Ko, Jeffs, Daneman, Bronskill), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Jeffs), University of Toronto; Division of General Internal Medicine (Bell), Mount Sinai Health System; Women's College Research Institute (Bronskill), Women's College Hospital; Keenan Research Centre at the Li Ka Shing Knowledge Institute (Jeffs), St. Michael's Hospital, Toronto, Ont.; Schools of Pharmacy (Maxwell) and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Quantitative Health Sciences (Lapane), University of Massachusetts Medical School, Worchester, Mass
| | - Colleen J Maxwell
- ICES (Campitelli, Maxwell, Maclagan, Ko, Bell, Daneman, Bronskill); Sunnybrook Research Institute (Ko, Daneman, Bronskill), Department of Cardiology (Ko) and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Ko, Bell, Morris, Daneman) and Institute of Health Policy, Management and Evaluation (Ko, Jeffs, Daneman, Bronskill), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Jeffs), University of Toronto; Division of General Internal Medicine (Bell), Mount Sinai Health System; Women's College Research Institute (Bronskill), Women's College Hospital; Keenan Research Centre at the Li Ka Shing Knowledge Institute (Jeffs), St. Michael's Hospital, Toronto, Ont.; Schools of Pharmacy (Maxwell) and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Quantitative Health Sciences (Lapane), University of Massachusetts Medical School, Worchester, Mass
| | - Laura C Maclagan
- ICES (Campitelli, Maxwell, Maclagan, Ko, Bell, Daneman, Bronskill); Sunnybrook Research Institute (Ko, Daneman, Bronskill), Department of Cardiology (Ko) and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Ko, Bell, Morris, Daneman) and Institute of Health Policy, Management and Evaluation (Ko, Jeffs, Daneman, Bronskill), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Jeffs), University of Toronto; Division of General Internal Medicine (Bell), Mount Sinai Health System; Women's College Research Institute (Bronskill), Women's College Hospital; Keenan Research Centre at the Li Ka Shing Knowledge Institute (Jeffs), St. Michael's Hospital, Toronto, Ont.; Schools of Pharmacy (Maxwell) and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Quantitative Health Sciences (Lapane), University of Massachusetts Medical School, Worchester, Mass
| | - Dennis T Ko
- ICES (Campitelli, Maxwell, Maclagan, Ko, Bell, Daneman, Bronskill); Sunnybrook Research Institute (Ko, Daneman, Bronskill), Department of Cardiology (Ko) and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Ko, Bell, Morris, Daneman) and Institute of Health Policy, Management and Evaluation (Ko, Jeffs, Daneman, Bronskill), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Jeffs), University of Toronto; Division of General Internal Medicine (Bell), Mount Sinai Health System; Women's College Research Institute (Bronskill), Women's College Hospital; Keenan Research Centre at the Li Ka Shing Knowledge Institute (Jeffs), St. Michael's Hospital, Toronto, Ont.; Schools of Pharmacy (Maxwell) and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Quantitative Health Sciences (Lapane), University of Massachusetts Medical School, Worchester, Mass
| | - Chaim M Bell
- ICES (Campitelli, Maxwell, Maclagan, Ko, Bell, Daneman, Bronskill); Sunnybrook Research Institute (Ko, Daneman, Bronskill), Department of Cardiology (Ko) and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Ko, Bell, Morris, Daneman) and Institute of Health Policy, Management and Evaluation (Ko, Jeffs, Daneman, Bronskill), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Jeffs), University of Toronto; Division of General Internal Medicine (Bell), Mount Sinai Health System; Women's College Research Institute (Bronskill), Women's College Hospital; Keenan Research Centre at the Li Ka Shing Knowledge Institute (Jeffs), St. Michael's Hospital, Toronto, Ont.; Schools of Pharmacy (Maxwell) and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Quantitative Health Sciences (Lapane), University of Massachusetts Medical School, Worchester, Mass
| | - Lianne Jeffs
- ICES (Campitelli, Maxwell, Maclagan, Ko, Bell, Daneman, Bronskill); Sunnybrook Research Institute (Ko, Daneman, Bronskill), Department of Cardiology (Ko) and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Ko, Bell, Morris, Daneman) and Institute of Health Policy, Management and Evaluation (Ko, Jeffs, Daneman, Bronskill), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Jeffs), University of Toronto; Division of General Internal Medicine (Bell), Mount Sinai Health System; Women's College Research Institute (Bronskill), Women's College Hospital; Keenan Research Centre at the Li Ka Shing Knowledge Institute (Jeffs), St. Michael's Hospital, Toronto, Ont.; Schools of Pharmacy (Maxwell) and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Quantitative Health Sciences (Lapane), University of Massachusetts Medical School, Worchester, Mass
| | - Andrew M Morris
- ICES (Campitelli, Maxwell, Maclagan, Ko, Bell, Daneman, Bronskill); Sunnybrook Research Institute (Ko, Daneman, Bronskill), Department of Cardiology (Ko) and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Ko, Bell, Morris, Daneman) and Institute of Health Policy, Management and Evaluation (Ko, Jeffs, Daneman, Bronskill), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Jeffs), University of Toronto; Division of General Internal Medicine (Bell), Mount Sinai Health System; Women's College Research Institute (Bronskill), Women's College Hospital; Keenan Research Centre at the Li Ka Shing Knowledge Institute (Jeffs), St. Michael's Hospital, Toronto, Ont.; Schools of Pharmacy (Maxwell) and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Quantitative Health Sciences (Lapane), University of Massachusetts Medical School, Worchester, Mass
| | - Kate L Lapane
- ICES (Campitelli, Maxwell, Maclagan, Ko, Bell, Daneman, Bronskill); Sunnybrook Research Institute (Ko, Daneman, Bronskill), Department of Cardiology (Ko) and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Ko, Bell, Morris, Daneman) and Institute of Health Policy, Management and Evaluation (Ko, Jeffs, Daneman, Bronskill), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Jeffs), University of Toronto; Division of General Internal Medicine (Bell), Mount Sinai Health System; Women's College Research Institute (Bronskill), Women's College Hospital; Keenan Research Centre at the Li Ka Shing Knowledge Institute (Jeffs), St. Michael's Hospital, Toronto, Ont.; Schools of Pharmacy (Maxwell) and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Quantitative Health Sciences (Lapane), University of Massachusetts Medical School, Worchester, Mass
| | - Nick Daneman
- ICES (Campitelli, Maxwell, Maclagan, Ko, Bell, Daneman, Bronskill); Sunnybrook Research Institute (Ko, Daneman, Bronskill), Department of Cardiology (Ko) and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Ko, Bell, Morris, Daneman) and Institute of Health Policy, Management and Evaluation (Ko, Jeffs, Daneman, Bronskill), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Jeffs), University of Toronto; Division of General Internal Medicine (Bell), Mount Sinai Health System; Women's College Research Institute (Bronskill), Women's College Hospital; Keenan Research Centre at the Li Ka Shing Knowledge Institute (Jeffs), St. Michael's Hospital, Toronto, Ont.; Schools of Pharmacy (Maxwell) and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Quantitative Health Sciences (Lapane), University of Massachusetts Medical School, Worchester, Mass
| | - Susan E Bronskill
- ICES (Campitelli, Maxwell, Maclagan, Ko, Bell, Daneman, Bronskill); Sunnybrook Research Institute (Ko, Daneman, Bronskill), Department of Cardiology (Ko) and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Ko, Bell, Morris, Daneman) and Institute of Health Policy, Management and Evaluation (Ko, Jeffs, Daneman, Bronskill), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Jeffs), University of Toronto; Division of General Internal Medicine (Bell), Mount Sinai Health System; Women's College Research Institute (Bronskill), Women's College Hospital; Keenan Research Centre at the Li Ka Shing Knowledge Institute (Jeffs), St. Michael's Hospital, Toronto, Ont.; Schools of Pharmacy (Maxwell) and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Quantitative Health Sciences (Lapane), University of Massachusetts Medical School, Worchester, Mass.
| |
Collapse
|
82
|
Manemann SM, Chamberlain AM, Boyd CM, Miller DM, Poe KL, Cheville A, Weston SA, Koepsell EE, Jiang R, Roger VL. Fall Risk and Outcomes Among Patients Hospitalized With Cardiovascular Disease in the Community. Circ Cardiovasc Qual Outcomes 2019; 11:e004199. [PMID: 30354374 DOI: 10.1161/circoutcomes.117.004199] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background As the population with cardiovascular disease ages, geriatric conditions are of increasing relevance. A possible geriatric prognostic indicator may be a fall risk score, which is mandated by The Joint Commission to be measured on all hospitalized patients. The prognostic value of a fall risk score on outcomes after dismissal is not well known. Thus, we aimed to determine whether a fall risk score is associated with death and hospital readmissions in patients with a recent incident cardiovascular disease event. Methods and Results In this retrospective cohort study, Olmsted County, MN patients with incident heart failure, myocardial infarction, or atrial fibrillation between August 1, 2005, and December 31, 2011, who were hospitalized within 180 days after the event were studied. Fall risk was measured by the Hendrich II fall risk model. Patients were followed for death or readmission within 30 days or 1 year. Among 2456 hospitalized patients with recent incident cardiovascular disease (549 heart failure, 784 myocardial infarction, 1123 atrial fibrillation; mean [SD] age, 71 [15] years; 55% men), the fall risk score was high in 22% of patients and moderate in 38%. The risk of death was increased if the fall risk score was increased, independent of age and comorbidities (moderate hazard ratio, 1.51; 95% CI, 1.09-2.08; high hazard ratio, 3.49; 95% CI, 2.52-4.85). Similarly, the risk of 30-day readmissions was substantially increased with a greater fall risk score (moderate hazard ratio, 1.29; 95% CI, 1.03-1.62; high hazard ratio, 1.63; 95% CI, 1.23-2.15). Results were similar for readmissions within 1 year. Conclusions More than half of hospitalized patients with recent incident cardiovascular disease have an elevated fall risk score, which is associated with an increased risk in readmissions and death. These results delineate an approach for risk stratification and management that may prevent readmissions and improve survival.
Collapse
Affiliation(s)
- Sheila M Manemann
- Department of Health Sciences Research (S.M.M., A.M.C., S.A.W., R.J., V.L.R.)
| | | | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, MD (C.M.B.)
| | | | - Kimberly L Poe
- Division of Cardiovascular Diseases (K.L.P., A.C., E.E.K., V.L.R.).,Division of Physical Medicine and Rehabilitation (K.L.P., A.C., E.E.K., V.L.R.), Mayo Clinic, Rochester, MN
| | - Andrea Cheville
- Division of Cardiovascular Diseases (K.L.P., A.C., E.E.K., V.L.R.).,Division of Physical Medicine and Rehabilitation (K.L.P., A.C., E.E.K., V.L.R.), Mayo Clinic, Rochester, MN
| | - Susan A Weston
- Department of Health Sciences Research (S.M.M., A.M.C., S.A.W., R.J., V.L.R.)
| | - Ellen E Koepsell
- Division of Cardiovascular Diseases (K.L.P., A.C., E.E.K., V.L.R.).,Division of Physical Medicine and Rehabilitation (K.L.P., A.C., E.E.K., V.L.R.), Mayo Clinic, Rochester, MN
| | - Ruoxiang Jiang
- Department of Health Sciences Research (S.M.M., A.M.C., S.A.W., R.J., V.L.R.)
| | - Véronique L Roger
- Department of Health Sciences Research (S.M.M., A.M.C., S.A.W., R.J., V.L.R.).,Division of Cardiovascular Diseases (K.L.P., A.C., E.E.K., V.L.R.).,Division of Physical Medicine and Rehabilitation (K.L.P., A.C., E.E.K., V.L.R.), Mayo Clinic, Rochester, MN
| |
Collapse
|
83
|
Brennan MJ, Coylewright M, Ayo-Vaughan M, Ganesan N. Bridging gaps in heart valve disease care: Opportunities for quality improvement. Catheter Cardiovasc Interv 2019; 94:289-293. [PMID: 31237112 DOI: 10.1002/ccd.28371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 06/10/2019] [Indexed: 11/07/2022]
Abstract
In January 2018, the Society of Cardiovascular and Angiography Interventions (SCAI) and Avalere Health ("Avalere") launched the development of the Heart Valve Initiative to advance the identification and management of patients with heart valve disease. To define the priority gap areas in identification and management of valve disease, a formal environmental scan was conducted to uncover current and planned initiatives that might inform the development of the initiative and bring to light stakeholder activities that seek to address the target patient population. This document summarizes the methodology and key findings from the scan, which will inform the development of interventions, research questions, and quality measure concepts to consider. Understanding that quality improvement initiatives and evidence in cardiovascular care may evolve rapidly, this synopsis represents a snapshot of information gathered from February 2018 to May 2019.
Collapse
Affiliation(s)
- Matthew J Brennan
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Megan Coylewright
- Structural Heart Disease Program, Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire
| | - Morenike Ayo-Vaughan
- Center for Healthcare Transformation, Avalere Health, Washington, District of Columbia
| | - Nelly Ganesan
- Center for Healthcare Transformation, Avalere Health, Washington, District of Columbia
| |
Collapse
|
84
|
Hawley CE, Roefaro J, Forman DE, Orkaby AR. Statins for Primary Prevention in Those Aged 70 Years and Older: A Critical Review of Recent Cholesterol Guidelines. Drugs Aging 2019; 36:687-699. [PMID: 31049807 PMCID: PMC7245614 DOI: 10.1007/s40266-019-00673-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The risk of atherosclerotic cardiovascular disease rises with age and remains the leading cause of death in older adults. Evidence for the use of statins for primary prevention in older adults is limited, despite the possibility that this population may derive significant clinical benefit given its increased cardiovascular risk. Until publication of the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the Management of Blood Cholesterol, and the 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease, guidelines for statin prescription in older adults remained unchanged despite new evidence of possible benefit in older adults. In this review, we present key updates in the 2018 and 2019 guidelines and the evidence informing these updates. We compare the discordant recommendations of the seven major North American and European guidelines on cholesterol management released in the past 5 years and highlight gaps in the literature regarding primary prevention of cardiovascular disease in older adults. As most cardiovascular events in older adults are nonfatal, we ask how clinicians should weigh the risks and benefits of continuing a statin for primary prevention in older adults. We also reframe the concept of deprescribing of statins in the older population, using the Geriatrics 5Ms framework: Mind, Mobility, Medications, Multi-complexity, and what Matters Most to older adults. A recent call from the National Institute on Aging for a statin trial focusing on older adults extends from similar concerns.
Collapse
Affiliation(s)
- Chelsea E. Hawley
- New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, USA
- Pharmacy Department, VA Boston Healthcare System, Boston, MA, USA
| | - John Roefaro
- Pharmacy Department, VA Boston Healthcare System, Boston, MA, USA
| | - Daniel E. Forman
- Section of Geriatric Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Ariela R. Orkaby
- New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, USA
- Division of Aging, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
85
|
Pratesi A, Baldasseroni S, Burgisser C, Orso F, Barucci R, Silverii MV, Venturini S, Ungar A, Marchionni N, Fattirolli F. Long-term functional outcomes after cardiac rehabilitation in older patients. Data from the Cardiac Rehabilitation in Advanced aGE: EXercise TRaining and Active follow-up (CR-AGE EXTRA) randomised study. Eur J Prev Cardiol 2019; 26:1470-1478. [DOI: 10.1177/2047487319854141] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Aim Cardiac rehabilitation promotes functional recovery after cardiac events. Our study aimed at evaluating whether, compared to usual care, a home-based exercise programme with monthly reinforcement sessions adds long-term functional benefits to those obtained with cardiac rehabilitation in the elderly. Methods After a 4-week outpatient cardiac rehabilitation, 160 of 197 patients aged 75 years and older screened for eligibility with different indications for cardiac rehabilitation, were randomly assigned to a control (C) or an active treatment (T) group. During a 12-month follow-up, C patients received usual care, while T patients were prescribed a standardised set of home-based exercises with centre-based monthly reinforcements for the first 6 months. The main (peak oxygen consumption) and three secondary outcome measures (distance walked in 6 minutes, inferior limbs peak 90° Torque strength, health-related quality of life) were assessed at baseline, at random assignment and at 6 and 12-month follow-ups with the cardiopulmonary exercise test, 6-minute walking test, isokinetic dynamometer and the Short Form-36 questionnaire, respectively. Results Both C and T groups obtained a significant and similar improvement from baseline to the end of the 4-week cardiac rehabilitation programme in the three functional outcome measures. However, at univariable and age and gender-adjusted analysis of variance for repeated measures, changes from random assignment to 6 or 12-month follow-up in any outcome measure were similar in the C and T groups. Conclusion Results from this randomised study suggest that a home-based exercise programme with monthly reinforcements does not add any long-term functional benefit beyond those offered by a conventional, 4-week outpatient cardiac rehabilitation programme. Trial registration ClinicalTrial.gov Identifier: NCT00641134.
Collapse
Affiliation(s)
- Alessandra Pratesi
- Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Italy
| | - Samuele Baldasseroni
- Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Italy
| | - Costanza Burgisser
- Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Italy
| | - Francesco Orso
- Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Italy
| | - Riccardo Barucci
- Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Italy
| | - Maria Vittoria Silverii
- Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Italy
| | - Simone Venturini
- Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Italy
| | - Andrea Ungar
- Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Italy
| | - Niccolò Marchionni
- Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Italy
| | - Francesco Fattirolli
- Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Italy
| |
Collapse
|
86
|
Azad N. Opportunities for Care Optimization and Hospitalization Reduction for Older Persons With Heart Failure. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2019; 13:1179546819841597. [PMID: 31105431 PMCID: PMC6503604 DOI: 10.1177/1179546819841597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 02/27/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Nahid Azad
- The Ottawa Hospital, University of Ottawa,
Ottawa, ON, Canada
| |
Collapse
|
87
|
Rich MW. Predicting 30-Day Readmissions in Older Adults With Acute Myocardial Infarction. Circ Cardiovasc Qual Outcomes 2019; 12:e005627. [DOI: 10.1161/circoutcomes.119.005627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michael W. Rich
- Department of Medicine, Division of Cardiology, Washington University School of Medicine, St Louis, MO
| |
Collapse
|
88
|
Dagres N, Chao TF, Fenelon G, Aguinaga L, Benhayon D, Benjamin EJ, Bunch TJ, Chen LY, Chen SA, Darrieux F, de Paola A, Fauchier L, Goette A, Kalman J, Kalra L, Kim YH, Lane DA, Lip GYH, Lubitz SA, Márquez MF, Potpara T, Pozzer DL, Ruskin JN, Savelieva I, Teo WS, Tse HF, Verma A, Zhang S, Chung MK. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on arrhythmias and cognitive function: what is the best practice? Europace 2019; 20:1399-1421. [PMID: 29562326 DOI: 10.1093/europace/euy046] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 02/22/2018] [Indexed: 01/24/2023] Open
Abstract
Abstract
Collapse
Affiliation(s)
- Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig, Strümpellstr. 39, Leipzig, Germany
| | - Tze-Fan Chao
- Taipei Veterans General Hospital, Taipei, Taiwan
| | | | | | - Daniel Benhayon
- Cardiac and Vascular Institute, Memorial Health, Hollywood, FL, USA
| | - Emelia J Benjamin
- Boston University Schools of Medicine and Public Health, Framingham Heart Study, Boston, MA, USA
| | | | - Lin Yee Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | | | | | - Angelo de Paola
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Université François Rabelais, Tours, France
| | - Andreas Goette
- Department of Cardiology and Intensive Care Medicine, St. Vincenz-Hospital Paderborn, Working Group: Molecular Electrophysiology, University Hospital Magdeburg, Germany
| | - Jonathan Kalman
- University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | | | - Young-Hoon Kim
- Korea University Medical Center, Seoul, Republic of Korea
| | - Deirdre A Lane
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Manlio F Márquez
- Departmen of Electrocardiography, Instituto Nacional De Cardiologia, Mexico City, Mexico
| | - Tatjana Potpara
- School of Medicine, Belgrade University, Belgrade, Serbia.,Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | | | | | - Irina Savelieva
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's University of London, London, UK
| | | | - Hung-Fat Tse
- Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Atul Verma
- Southlake Regional Health Centre, Ontario, Canada
| | - Shu Zhang
- Beijing Fuwai Hospital, Beijing, People's Republic of China
| | | | | |
Collapse
|
89
|
Gleason KT, Dennison Himmelfarb CR, Ford DE, Lehmann H, Samuel L, Han HR, Jain SK, Naccarelli GV, Aggarwal V, Nazarian S. Association of sex, age and education level with patient reported outcomes in atrial fibrillation. BMC Cardiovasc Disord 2019; 19:85. [PMID: 30953478 PMCID: PMC6451250 DOI: 10.1186/s12872-019-1059-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 03/21/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In atrial fibrillation (AF), there are known sex and sociodemographic disparities in clinical outcomes such as stroke. We investigate whether disparities also exist with respect to patient-reported outcomes. We explored the association of sex, age, and education level with patient-reported outcomes (AF-related quality of life, symptom severity, and emotional and functional status). METHODS The PaTH AF cohort study recruited participants (N = 953) with an AF diagnosis and age ≥ 18 years across 4 academic medical centers. We performed longitudinal multiple regression with random effects to determine if individual characteristics were associated with patient-reported outcomes. RESULTS Women reported poorer functional status (β - 2.23, 95% CI: -3.52, - 0.94) and AF-related quality of life (β - 4.12, 95% CI: -8.10, - 0.14), and higher symptoms of anxiety (β 2.08, 95% CI: 0.76, 3.40), depression (β 1.44, 95% CI: 0.25, 2.63), and AF (β 0.29, 95% CI: 0.08, 0.50). Individuals < 60 years were significantly (p < 0.05) more likely to report higher symptoms of depression, anxiety, and AF, and poorer AF-related quality of life. Lack of college education was associated with reporting higher symptoms of AF (β 0.42, 95% CI: 0.17, 0.68), anxiety (β 1.86, 95% CI: 0.26, 3.45), and depression (β 1.11, 95% CI: 0.15, 2.38), and lower AF-related quality of life (β - 4.41, 95% CI: -8.25, - 0.57) and functional status. CONCLUSION Women, younger adults, and individuals with lower levels of education reported comparatively poor patient-reported outcomes. These findings highlight the importance of understanding why individuals experience AF differently based on certain characteristics.
Collapse
Affiliation(s)
- Kelly T. Gleason
- School of Nursing, Johns Hopkins University, 525 N Wolfe Street, Baltimore, MD 21205 USA
| | | | - Daniel E. Ford
- School of Medicine, Johns Hopkins University, Baltimore, MD USA
| | - Harold Lehmann
- School of Medicine, Johns Hopkins University, Baltimore, MD USA
| | - Laura Samuel
- School of Nursing, Johns Hopkins University, 525 N Wolfe Street, Baltimore, MD 21205 USA
| | - Hae Ra Han
- School of Nursing, Johns Hopkins University, 525 N Wolfe Street, Baltimore, MD 21205 USA
| | - Sandeep K. Jain
- School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | | | - Vikas Aggarwal
- University of Michigan Health System/Frankel Cardiovascular Center, Ann Harbor, MI USA
| | - Saman Nazarian
- School of Medicine, Johns Hopkins University, Baltimore, MD USA
- School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| |
Collapse
|
90
|
Affiliation(s)
- Athanase Benetos
- From the Department of Geriatrics and FHU CARTAGE, CHU de Nancy and INSERM 1116, Université de Lorraine, France (A.B.)
| | - Mirko Petrovic
- Department of Geriatrics, Ghent University Hospital, and Ghent University, Belgium (M.P.)
| | - Timo Strandberg
- University of Helsinki, Clinicum, and Helsinki University Hospital, Finland (T.S.)
- Center for Life Course Health Research, University of Oulu, Finland (T.S.)
| |
Collapse
|
91
|
Zhao M, Graham I, Cooney MT, Grobbee DE, Vaartjes I, Klipstein-Grobusch K. Determinants of coronary artery disease risk factor management across three world regions. HEART ASIA 2019; 11:e011112. [PMID: 31031827 PMCID: PMC6454324 DOI: 10.1136/heartasia-2018-011112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 12/14/2022]
Abstract
Background The SUrvey of Risk Factors (SURF) indicated poor control of risk factors in subjects with established coronary heart disease (CHD). The present study aimed to investigate determinants of risk factor management in patients with CHD. Methods and results SURF recruited 9987 consecutive patients with CHD from Europe, Asia and the Middle East between 2012 and 2013. Risk factor management was summarised as a Cardiovascular Health Index Score (CHIS) based on six risk factor targets (non-smoker/ex-smoker, body mass index <30, adequate exercise, controlled blood pressure, controlled low-density lipoprotein and controlled glucose). Logistic regression models assessed the associations between determinants (age, sex, family history, cardiac rehabilitation, previous hospital admission and diabetes) and achievement of moderate CHIS (≥3 risk factors controlled). The results are presented as OR with corresponding 95% CI. A moderate CHIS was less likely to be reached by women (OR 0.90, 95% CI 0.69 to 1.00), those aged <55 years old (OR 0.62, 95% CI 0.53 to 0.76) and those with diabetes (OR 0.41, 95% CI 0.37 to 0.46). Attendance in cardiac rehabilitation was associated with better CHIS achievements (OR 1.62, 95% CI 1.42 to 1.87). Younger Asian and European patients had poorer risk factor management, whereas for patients from the Middle East age was not significantly associated with risk factor management. The availability and applicability of cardiac rehabilitation varied by region. Conclusions Overall, risk factor management was poorer in women, those younger than 55 years old, those with diabetes and those who did not participate in a cardiac rehabilitation. Determinants of cardiovascular risk factor management differed by region.
Collapse
Affiliation(s)
- Min Zhao
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Marie Therese Cooney
- St Vincent's University Hospital, Dublin, Ireland.,University College Dublin, Dublin, Ireland
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Global Geo Health Data Center, Utrecht University, Utrecht, The Netherlands
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands, Utrecht, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
92
|
Chaudhry AP, Samudrala S, Lopez-Jimenez F, Shellum JL, Nishimura RA, Chaudhry R, Liu H, Arruda-Olson AM. Provider Survey on Automated Clinical Decision Support for Cardiovascular Risk Assessment. Mayo Clin Proc Innov Qual Outcomes 2019; 3:23-29. [PMID: 30899905 PMCID: PMC6410336 DOI: 10.1016/j.mayocpiqo.2018.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate provider opinions regarding a clinical decision support (CDS) system for cardiovascular risk assessment and for the creation of a replacement system. METHODS From March to April 2018, an invitation letter with a link to a self-administered web-based survey was sent via e-mail to 279 providers with primary appointment in the Department of Cardiovascular Medicine, Mayo Clinic, Rochester. The e-mail was sent to providers on March 8, 2018 and the survey closed on April 16, 2018. RESULTS One hundred providers responded to the survey yielding an overall response rate of 35.8%. Of these, 52 (52%) indicated they had used the cardiovascular (CV) risk profile CDS system and were classified as users and prompted to continue the survey. Among users, 42 (80.8%) indicated use of the CDS was either important (25; 48.1%) or very important (17; 32.7%) in their clinical practice; 45 (86.5%) responded that the system was very easy (17; 32.7%) or easy (28; 53.8%) to use. In addition, 48 (96.0%) users indicated that the CV risk profile supported their thought process at the point-of-care; 47 (97.9%) users indicated similar functionalities should be implemented into the new electronic health record system and 41 (85.4%) users reported new functionalities should also be incorporated. CONCLUSIONS For most users, the CDS system was easy to use and supported clinical thought process at the point-of-care. Users also felt their practice was supported and should continue to be supported by CDS systems providing individualized patient information at the point-of-care.
Collapse
Affiliation(s)
- Alisha P. Chaudhry
- Department of Cardiovascular Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Sujith Samudrala
- Department of Cardiovascular Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN
| | | | - Jane L. Shellum
- Center for Translational Informatics and Knowledge Management, Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Rick A. Nishimura
- Department of Cardiovascular Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN
- Center for Translational Informatics and Knowledge Management, Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Rajeev Chaudhry
- Department of Internal Medicine and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Hongfang Liu
- Department of Health Science Research, Mayo Clinic and Mayo Foundation, Rochester, MN
| | | |
Collapse
|
93
|
Abhilash KPP, Tephilah R, Pradeeptha S, Gunasekaran K, Chandy GM. Injury Patterns and Outcomes of Trauma in the Geriatric Population Presenting to the Emergency Department in a Tertiary Care Hospital of South India. J Emerg Trauma Shock 2019; 12:198-202. [PMID: 31543643 PMCID: PMC6735206 DOI: 10.4103/jets.jets_79_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: The geriatric population is more prone for injuries with complications due to their associated comorbidities. This study was done to understand the mode, severity, and outcome of injuries among geriatric patients presenting to the emergency department (ED). Materials and Methods: This retrospective study included all patients >60 years who presented with trauma between October 2014 and March 2015. Details of the incident, injuries, and hospital outcome were noted. Results: Among 8563 geriatric patients, who presented to the ED during the study, 427 (4.9%) patients were trauma related. The mean age was 69 (standard deviation: 6.76) years with 87.6% being young-old (60–79 years) and 12.4% being old-old (>80 years). Majority (63.2%) were Priority 2 patients. The median time between the incident and ED arrival among Priority 1 patients was 3 h (interquartile range: 2–5). Common modes of injuries were slip and fall (37.4%), two-wheeler accidents (25.8%), fall from height (9.1%), and pedestrian (8.9%). The ED team alone managed 25.8% of patients. Specialty departments referred to included orthopedics (48%), neurosurgery (18.3%), plastic surgery (4.2%), HLRS (4%), and others. Injuries due to slip and fall were significantly more among the old-old (P = 0.001), and two-wheeler accidents were more among the young-old (P = 0.001), respectively. Superficial head injuries (28.8%), extremity (24.8%), facial (18.7%), and traumatic brain injuries (17.8%) were common presentations. Thoracic injuries were significantly more among the old-old (P < 0.001). Half (46.3%) of the young-old were discharged stable (P = 0.017). In-hospital mortality rate was 0.7% (3/427), while 12.9% (55/427) left against medical advice due to poor prognosis. Conclusion: Our study demonstrates the pattern of injury seen in the elderly in an urban setting in India. From this, we perceive the need for a prospective study evaluating the causes for geriatric trauma, which would help work on ways to prevent and minimize injuries in the elderly.
Collapse
Affiliation(s)
| | - R Tephilah
- Department of Emergency Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sharon Pradeeptha
- Department of Emergency Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Gina Maryann Chandy
- Department of Emergency Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| |
Collapse
|
94
|
Geriatric-HIV Medicine: the geriatrician’s role. Eur Geriatr Med 2018; 10:259-265. [DOI: 10.1007/s41999-018-0144-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 11/24/2018] [Indexed: 12/21/2022]
|
95
|
Sisa I. Gender differences in cardiovascular risk assessment in elderly adults in Ecuador: evidence from a national survey. J Investig Med 2018; 67:736-742. [PMID: 30518558 DOI: 10.1136/jim-2018-000789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2018] [Indexed: 11/03/2022]
Abstract
The present study aimed to predict the risk of developing cardiovascular disease (CVD) over a 5-year period and how it might vary by sex in an ethnically diverse population of older adults. We used a novel CVD risk model built and validated in older adults named the Systematic Coronary Risk Evaluation in Older Persons (SCORE OP). A population-based study analyzed a total of 1307 older adults. Analyses were done by various risk categories and sex. Of the study population, 54% were female with a mean age of 75±7.1 years. According to the SCORE OP model, individuals were classified as having low (9.8%), moderate (48.1%), and high or very high risk (42.1%) of CVD-related mortality. Individuals at higher risk of CVD were more likely to be male compared with females, 53.9% vs 31.8%, respectively (p<0.01). Males were more likely to be younger, living in rural areas, had higher levels of schooling, and with the exception of smoking status and serum triglycerides, had lower values of traditional risk factors than females. In addition, males were less likely to require blood pressure-lowering therapy and statin drugs than females. This gender inequality could be driven by sociocultural determinants and a risk factor paradox in which lower levels of the cardiovascular risk factors are associated with an increase rather than a reduction in mortality. These data can be used to tailor primary prevention strategies such as lifestyle counseling and therapeutic measures in order to improve male elderly health, especially in low-resource settings.
Collapse
Affiliation(s)
- Ivan Sisa
- School of Medicine, College of Health Sciences, Universidad San Francisco de Quito, Quito, Ecuador
| |
Collapse
|
96
|
Mostaza JM, Lahoz C, Salinero-Fort MA, Cardenas J. Cardiovascular disease in nonagenarians: Prevalence and utilization of preventive therapies. Eur J Prev Cardiol 2018; 26:356-364. [DOI: 10.1177/2047487318813723] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Aims Nonagenarians are a fast growing segment of industrialized countries' populations. Despite a greater risk of cardiovascular disease, there are limited data about their use of preventive therapies and factors guiding decisions regarding their prescription. The aim of this study was to evaluate the prevalence of cardiovascular diseases and the patterns of use of cardiovascular treatments in subjects ≥90 years old. Methods Population-based, cross-sectional study, in all nonagenarians residing in the Community of Madrid (Spain). Data were obtained from their electronic clinical records in primary care. Results Data were available from 59,423 subjects (mean age 93.3 years, 74.2% female, 13.5% with dementia). Prevalence of cardiovascular disease was 24.1% (10.9% with coronary artery disease (CAD), 13.1% with cerebrovascular disease (CVD) and 2.7% with peripheral artery disease(PAD)). In primary prevention, the use of statins and antiplatelet agents was 21.9% and 26.7%, respectively. Of subjects with vascular disease 27.7% were receiving a combined preventive strategy (use of antithrombotics, plus statins, plus blood pressure below 140/90 mmHg). Factors favourably associated with a combined preventive strategy were: female sex (odds ratio (OR) 1.29; 95% confidence interval (CI): 1.11–1.49), being independent versus totally dependent (OR 1.94; 95% CI: 1.43–2.65), diabetes (OR 1.42; 95% CI: 1.20–1.68), and negatively, age (OR 0.87; 95% CI: 0.85–0.90), CVD versus CAD (OR 0.41; 95% CI: 0.35–0.47), PAD versus CAD (OR 0.23; 95% CI: 0.18–0.30), dementia (OR 0.61; 95% CI: 0.49–0.76) and nursing home residency (OR 0.73; 95% CI: 0.57–0.93). Conclusion Nonagenarians have a great burden of cardiovascular diseases and receive a great number of preventive therapies, even in primary prevention, despite their unproven efficacy at these ages.
Collapse
Affiliation(s)
- Jose M Mostaza
- Department of Internal Medicine. Hospital Carlos III, Madrid, Spain
| | - Carlos Lahoz
- Department of Internal Medicine. Hospital Carlos III, Madrid, Spain
| | | | - Juan Cardenas
- Dirección Técnica de Sistemas de Información Sanitaria, Gerencia Adjunta de Procesos Asistenciales, Gerencia Asistencial de Atención Primaria, Madrid, Spain
| |
Collapse
|
97
|
Beattie JM, Kirkpatrick JN, Patton KK, Eiser AR. Hardwired for Life? Implantable Defibrillator Dilemmas in Older Patients. Am J Med 2018; 131:1143-1145. [PMID: 29856961 DOI: 10.1016/j.amjmed.2018.04.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 04/23/2018] [Indexed: 10/14/2022]
Affiliation(s)
| | | | | | - Arnold R Eiser
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia.
| |
Collapse
|
98
|
Tisminetzky M, Gurwitz JH, Fan D, Reynolds K, Smith DH, Magid DJ, Sung SH, Murphy TE, Goldberg RJ, Go AS. Multimorbidity Burden and Adverse Outcomes in a Community-Based Cohort of Adults with Heart Failure. J Am Geriatr Soc 2018; 66:2305-2313. [PMID: 30246862 DOI: 10.1111/jgs.15590] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To assess multimorbidity burden and its association with clinical outcomes in adults with heart failure (HF) according to sex, age, and HF type. DESIGN Retrospective cohort study. SETTING Five healthcare delivery systems across the United States. PARTICIPANTS Adults with HF (N=114,553). MEASUREMENTS We characterized participants with respect to the presence of 26 chronic conditions categorized into quartiles based on overall burden of comorbidity (<5, 5-6, 7-8, ≥9). Outcomes included all-cause death and hospitalization for HF or any cause. Multivariable Cox regression was used to evaluate the adjusted association between categorized burden of multimorbidity burden and outcomes. RESULTS Individuals with more morbidities were more likely to die than those with fewer then 5 morbidities (5-6 morbidities: adjusted hazard ratio (aHR)=1.27 (95% confidence interval (CI)=1.24-1.31; 7-8 morbidities: aHR=1.52, 95% CI=1.48-1.57; ≥9 morbidities: aHR=1.92, 95% CI=1.86-1.99). There was a graded, higher adjusted rate of any-cause hospitalization associated with 5 or 6 (aHR=1.28, 95% CI=1.25-1.30), 7 or 8 (aHR=1.47, 95% CI=1.44-1.50), or 9 or more (aHR=1.77, 95% CI=1.73-1.82) morbidities (vs <5). Similar findings were observed for HF-specific hospitalization in those with 5 or 6 (aHR=1.22, 95% CI=1.19-1.26), 7 or 8 (aHR=1.39, 95% CI=1.34-1.44), or 9 or more (aHR 1.68, 95% CI=1.61-1.74) morbidities (vs <5). Consistent findings were seen according to sex, age group, and HF type (preserved, reduced, borderline HF), in the association between categorical burden of multimorbidity and outcomes especially prominent in individuals younger than 65. CONCLUSION After adjustment, higher levels of multimorbidity predicted worse HF outcomes and may be an important consideration in strategies to improve clinical and person-centered outcomes. J Am Geriatr Soc 66:2305-2313, 2018.
Collapse
Affiliation(s)
- Mayra Tisminetzky
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts.,Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.,Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jerry H Gurwitz
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts.,Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.,Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Dongjie Fan
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - David H Smith
- Center for Health Research, Kaiser Permanente Northwest, Oregon, Portland
| | - David J Magid
- The Kaiser Institute for Health Research Denver, Denver, Colorado
| | - Sue Hee Sung
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Terrence E Murphy
- Section of Geriatrics, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Robert J Goldberg
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts.,Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, California.,Departments of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.,Departments of Medicine, University of California, San Francisco, San Francisco, California.,Department of Health Research and Policy, School of Medicine, Stanford University, Stanford, California
| |
Collapse
|
99
|
Pilot testing of the effectiveness of nurse-guided, patient-centered heart failure education for older adults. Geriatr Nurs 2018; 39:376-381. [DOI: 10.1016/j.gerinurse.2017.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/11/2017] [Accepted: 11/20/2017] [Indexed: 11/22/2022]
|
100
|
Panchal AR, Cash RE, Crowe RP, Coute R, Way D, Aufderheide T, Merchant RM. Delphi Analysis of Science Gaps in the 2015 American Heart Association Cardiac Arrest Guidelines. J Am Heart Assoc 2018; 7:JAHA.118.008571. [PMID: 29960986 PMCID: PMC6064902 DOI: 10.1161/jaha.118.008571] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background Current cardiac arrest guidelines have limited high‐quality scientific evidence to support recommendations for care. The quality of scientific evidence on which guidelines are based may correlate with improved patient outcomes and meaningful survival. We sought to develop a prioritized list of knowledge gaps in resuscitation to assist researchers, policy makers, and funding agencies in their decision‐making process. Methods and Results A 4‐stage modified Delphi method was used with a panel of cardiac arrest experts. Experts addressed the prompt: “What are the top 3 gaps in knowledge involving cardiac arrest care that should be research priorities for National Institutes of Health/American Heart Association funding to have the greatest impact on public health?” Knowledge gaps were identified in the initial round, rated in a second round, and rank ordered in the third round, and they underwent final review and consensus (final round). The outcome was 10 knowledge gaps, with prioritization of the top 3 gaps. A total of 61 gaps, with 19 distinct themes, were identified by participants. The 10 knowledge gaps most likely to affect public health identified by the expert panel included, in order, the following: telecommunicator cardiopulmonary resuscitation, hemodynamic monitoring for goal‐directed resuscitation, reasons why bystanders fail to respond, optimization of postarrest care, out‐of‐hospital cardiac arrest identification and response, individualizing resuscitation strategies, predicting patients at risk, tools for neuroprognostication, optimal airway management, and optimizing educational strategies. Conclusions Ten priorities for cardiac arrest research were identified, but consensus was not reached on the prioritized top 3. Future research should address these gaps to potentially improve resuscitation guideline evidence quality.
Collapse
Affiliation(s)
- Ashish R Panchal
- Ohio State University Wexner Medical Center, Columbus, OH .,National Registry of Emergency Medical Technicians (NREMT), Columbus, OH
| | - Rebecca E Cash
- National Registry of Emergency Medical Technicians (NREMT), Columbus, OH
| | - Remle P Crowe
- National Registry of Emergency Medical Technicians (NREMT), Columbus, OH
| | - Ryan Coute
- Kansas City University of Medicine and Biosciences, Kansas City, MO
| | - David Way
- Ohio State University Wexner Medical Center, Columbus, OH
| | | | | |
Collapse
|