1
|
Si PEH, Parker S, Abdelhafiz D, Summerbell A, Muzulu S, Abdelhafiz AH. Cardiovascular risk reduction in older people with type 2 diabetes mellitus-a comprehensive narrative review. Diabetes Res Clin Pract 2024; 211:111662. [PMID: 38599285 DOI: 10.1016/j.diabres.2024.111662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 04/01/2024] [Accepted: 04/07/2024] [Indexed: 04/12/2024]
Abstract
Metabolic targets are controversial in older people with type 2 diabetes due to functional heterogeneity and morbidity burden. Tight blood pressure and metabolic control appears beneficial in fit individuals who are newly diagnosed with type 2 diabetes and have fewer comorbidities. The benefits of low blood pressure and tight metabolic control is attenuated with the development of comorbidities, especially frailty. Guidelines consider frail older people as one category and recommend relaxed targets. However, sarcopenic obese frail individuals may benefit from tight targets and intensification of therapy due to their unfavourable metabolic profile, accelerated diabetes trajectory and high cardiovascular risk. In addition, the early use of sodium glucose transporter-2 inhibitors and glucagon like peptide-1 receptor agonists may be beneficial in this frailty phenotype due to their cardio-renal protection, which is independent of glycaemic control, provided they are able to engage in resistance exercise training to avoid loss of muscle mass. In the anorexic malnourished frail individual, early use of insulin, due to its weight gain and anabolic properties, is appropriate. In this phenotype, targets should be relaxed with deintensification of therapy due to significant weight loss, decelerated diabetes trajectory and increased risk of medication side effects.
Collapse
Affiliation(s)
- Pann Ei Hnynn Si
- Sheffield Kidney Institute, Sheffield Teaching Hospitals, Herries Road, Sheffield S5 7AU, UK
| | - S Parker
- Translational Health Sciences, Bristol Medical School, Bristol, BS8 1QU
| | - D Abdelhafiz
- Lancaster Medical School, Lancaster, LA1 4YG, UK
| | - A Summerbell
- Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham S60 2 UD, UK
| | - S Muzulu
- Department of Diabetes and Endocrinology Rotherham General Hospital, UK
| | - Ahmed H Abdelhafiz
- Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham S60 2 UD, UK.
| |
Collapse
|
2
|
O'Neil H, Todd A, Pearce M, Husband A. What are the consequences of over and undertreatment of type 2 diabetes mellitus in a frail population? A systematic review. Endocrinol Diabetes Metab 2024; 7:e00470. [PMID: 38411378 PMCID: PMC10897870 DOI: 10.1002/edm2.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 02/28/2024] Open
Abstract
AIMS This review aims to identify the evidence base for the consequences of over and undertreatment of type 2 diabetes mellitus in a frail population. METHOD In this systematic review, we searched MEDLINE, Embase, PubMed, CINAHL and the Cochrane Library for studies from January 2001 to 15th August 2022. We included a variety of study types that assessed and reported frailty including patients ≥18 years old. Studies included those that reported the prevalence of over or undertreatment of diabetes mellitus in a frail population and those examining outcomes related to glucose control in frail older people living with diabetes. Data were extracted using a bespoke extraction table using a narrative synthesis approach. RESULTS A total of 4114 articles were identified with 112 meeting inclusion criteria. These included 15,130 participants across the 11 studies with sample sizes ranging from 101 to 11,140. Several areas were identified in the included studies where under or overtreatment of diabetes impacted outcomes for patients. These included hospital admissions, readmissions, length of stay, falls, mortality, cognitive impairment and cardiovascular disease outcomes. CONCLUSION The results showed that there was a high heterogeneity of outcomes between the studies and that many examined small numbers of participants. In this review, both over and undertreatment were shown to increase adverse outcomes in frail older people. Further research around optimal glycaemic control for frail older people living with diabetes is required with the aim to identify ideal target ranges and produce practical clinical guidelines to promote attainment of these.
Collapse
Affiliation(s)
- Helen O'Neil
- School of PharmacyNewcastle UniversityNewcastleUK
- South Tyneside and Sunderland NHS Foundation TrustSinderlandUK
- NIHR North East and North Cumbria Applied Research Collaboration (NIHR NENC ARC)NewcastleUK
| | - Adam Todd
- School of PharmacyNewcastle UniversityNewcastleUK
| | - Mark Pearce
- Population Health Sciences Institute, Newcastle UniversityNewcastle upon TyneUK
| | | |
Collapse
|
3
|
Sinclair AJ, Abdelhafiz AH. Multimorbidity, Frailty and Diabetes in Older People-Identifying Interrelationships and Outcomes. J Pers Med 2022; 12:1911. [PMID: 36422087 PMCID: PMC9695437 DOI: 10.3390/jpm12111911] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 08/11/2023] Open
Abstract
Multimorbidity and frailty are highly prevalent in older people with diabetes. This high prevalence is likely due to a combination of ageing and diabetes-related complications and other diabetes-associated comorbidities. Both multimorbidity and frailty are associated with a wide range of adverse outcomes in older people with diabetes, which are proportionally related to the number of morbidities and to the severity of frailty. Although, the multimorbidity pattern or cluster of morbidities that have the most adverse effect are not yet well defined, it appears that mental health disorders enhance the multimorbidity-related adverse outcomes. Therefore, comprehensive diabetes guidelines that incorporate a holistic approach that includes screening and management of mental health disorders such as depression is required. The adverse outcomes predicted by multimorbidity and frailty appear to be similar and include an increased risk of health care utilisation, disability and mortality. The differential effect of one condition on outcomes, independent of the other, still needs future exploration. In addition, prospective clinical trials are required to investigate whether interventions to reduce multimorbidity and frailty both separately and in combination would improve clinical outcomes.
Collapse
Affiliation(s)
- Alan J. Sinclair
- Foundation for Diabetes Research in Older People (fDROP), King’s College, London WC2R 2LS, UK
- Rotherham General Hospital Foundation Trust, Rotherham S60 2UD, UK
| | - Ahmed H. Abdelhafiz
- Foundation for Diabetes Research in Older People (fDROP), King’s College, London WC2R 2LS, UK
- Department of Geriatric Medicine, Rotherham General Hospital, Rotherham S60 2UD, UK
| |
Collapse
|
4
|
Manusov EG, Gomez De Ziegler C, Diego VP, Munoz-Monaco G, Williams-Blangero S. Frailty Index in the Colonias on the US-Mexico Border: A Special Report. Front Med (Lausanne) 2021; 8:650259. [PMID: 34485319 PMCID: PMC8416248 DOI: 10.3389/fmed.2021.650259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 07/14/2021] [Indexed: 11/13/2022] Open
Abstract
Frailty is the age-related decline in well-being. The Frailty index (FI) measures the accumulation of health deficits and reflects biopsychosocial and cultural determinants of well-being. Frailty is measured as a static phenotype or as a Frailty Index comprising a ratio of suffered health deficits and total deficits. We report a Frailty Index calculated from routinely measured clinical variables gathered from residents of two Colonias (neighborhoods) in South Texas. A Colonia is a predominantly Hispanic, economically distressed, unincorporated neighborhood. We analyzed retrospective data from 894 patients that live in two Colonias located on the Texas-Mexico border. We calculated the FI with seven physiological variables, PHQ-9 score, and the 11 domain-specific Duke Profile scores, for a total of 19 possible health deficits. FI against age separately in males (n = 272) and females (n = 622) was regressed. Females had a significantly higher starting frailty, and males had a significantly greater change rate with age. FI against age for Cameron Park Colonia and Indian Hills Colonia was regressed. We calculated a significantly higher starting FI in Indian Hills and a significantly greater change rate in Cameron Park residents. Frailty's contributors are complex, especially in neighborhoods of poverty, immigration, low education level, and high prevalence of chronic disease. We report baseline Frailty Index data from two Colonias in South Texas and the clinical and research implications.
Collapse
Affiliation(s)
- Eron G Manusov
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Carolina Gomez De Ziegler
- Knapp Family Medicine Residency Program, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Vincent P Diego
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Gerardo Munoz-Monaco
- Knapp Family Medicine Residency Program, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Sarah Williams-Blangero
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, United States.,South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley, Edinburg, TX, United States
| |
Collapse
|
5
|
Artime E, Romera I, Díaz-Cerezo S, Delgado E. Epidemiology and Economic Burden of Cardiovascular Disease in Patients with Type 2 Diabetes Mellitus in Spain: A Systematic Review. Diabetes Ther 2021; 12:1631-1659. [PMID: 33942247 PMCID: PMC8179862 DOI: 10.1007/s13300-021-01060-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/12/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in people with type 2 diabetes mellitus (T2DM). The objectives of this systematic literature review were to identify and synthesize published data describing the epidemiology and mortality of CVD in the T2DM population and the associated economic burden. METHODS We conducted a systematic review searching the PubMed and MEDES databases from 2009 to 2019 using predefined selection criteria. Peer-reviewed observational studies reporting primary or secondary data on CVD prevalence, incidence, mortality, resource use and costs in patients with T2DM in Spain, written in English and Spanish, were included. Data were tabulated and summarized descriptively. RESULTS Of 706 articles identified, 52 were included in the review. Most studies were based on data from hospital discharge databases and registries. The reported prevalence of CVD among patients with T2DM ranged from 6.9 to 40.8%. The prevalence of coronary heart disease ranged from 4.7 to 37%, stroke from 3.5 to 19.6%, peripheral artery disease from 2.5 to 13.0%, and heart failure from 4.3 to 20.1%. In-hospital CVD mortality rates ranged from 5.6 to 10.8%. Direct costs due to CVD in hospitalized patients with T2DM were increased (> 50%) compared with patients without CVD. No studies analysed indirect costs of CVD in patients with T2DM. CONCLUSIONS The burden of CVD among patients with T2DM, combined with the elevated costs of care, highlights the importance of early prevention as part of integrated management of the disease to improve clinical and economic outcomes.
Collapse
Affiliation(s)
- Esther Artime
- Eli Lilly and Company, Avda. de la Industria 30, Alcobendas, 28108, Madrid, Spain.
| | - Irene Romera
- Eli Lilly and Company, Avda. de la Industria 30, Alcobendas, 28108, Madrid, Spain
| | - Silvia Díaz-Cerezo
- Eli Lilly and Company, Avda. de la Industria 30, Alcobendas, 28108, Madrid, Spain
| | - Elías Delgado
- Department of Endocrinology and Nutrition, University of Oviedo, Oviedo, Spain
- Central University Hospital of Asturias, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- Spanish Biomedical Research Network in Rare Diseases, Madrid, Spain
| |
Collapse
|
6
|
Bonanad C, Guerrero C, Bianchi C. Milestones of the Section on Geriatric Cardiology of the Spanish Society of Cardiology: the r-evolution from 1995 to 2020. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2020; 73:981-984. [PMID: 32798150 DOI: 10.1016/j.rec.2020.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 06/04/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Clara Bonanad
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain.
| | - Carme Guerrero
- Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Claudia Bianchi
- Servicio de Cardiología, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| |
Collapse
|
7
|
Bonanad C, Guerrero C, Bianchi C. [Milestones of the Section on Geriatric Cardiology of the Spanish Society of Cardiology: the r-evolution from 1995 to 2020]. Rev Esp Cardiol 2020; 73:981-984. [PMID: 32836660 PMCID: PMC7319918 DOI: 10.1016/j.recesp.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Clara Bonanad
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, España
| | - Carme Guerrero
- Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Claudia Bianchi
- Servicio de Cardiología, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, España
| |
Collapse
|
8
|
Diabetes mellitus, revascularization and outcomes in elderly patients with myocardial infarction-related cardiogenic shock. J Geriatr Cardiol 2020; 17:604-611. [PMID: 33224179 PMCID: PMC7657943 DOI: 10.11909/j.issn.1671-5411.2020.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background The prognostic role of diabetes mellitus (DM) in elderly patients with myocardial infarction-related cardiogenic shock (MI-CS) remains controversial. Little information exists about the impact of intensive cardiac care unit (ICCU) and revascularization on outcomes of elderly patients with MI-CS. We aimed to assess the prognostic impact of DM according to age in patients with MI-CS, and to analyze the impact ICCU management and revascularization on in-hospital mortality in MI-CS patients at older ages. Methods Discharge episodes with diagnosis of CS associated with MI were selected from the Spanish National Health System's Basic Data Set. Centers were classified according to their availability of ICCU. Main outcome measured was in-hospital mortality. Results A total of 23, 590 episodes of MI-CS were identified, of whom 12, 447 (52.8%) were in patients aged ≥ 75 years. The impact of DM on in-hospital mortality was different among age subgroups. While in younger patients, DM was associated to a higher mortality risk (0.52 vs. 0.47, OR = 1.12, 95% CI: 1.06-1.18, χ2 < 0.001), this association became non-significant in older patients (0.76 vs. 0.81, χ2 = 0.09). Adjusted mortality rate of MI-CS aged ≥ 75 years was lower in patients admitted to hospitals with ICCU (adjusted mortality rate: 74.2% vs. 77.7%, P < 0.001) and in patients undergoing revascularization (74.9% vs. 77.3%, P < 0.001). Conclusions Prognostic impact of DM in patients with MI-CS was different according to age, with a significantly lower impact at older ages. The availability of ICCU and revascularization were associated with better outcomes in these complex patients.
Collapse
|
9
|
Liuu E, Saulnier PJ, Gand E, Ragot S, Valero S, Jamet A, Hadjadj S, Paccalin M. Frailty and diabetes status in older patients with cancer: impact on mortality in the ANCRAGE cohort. Aging Clin Exp Res 2020; 32:1809-1819. [PMID: 31898171 DOI: 10.1007/s40520-019-01362-9] [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: 07/12/2019] [Accepted: 09/21/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Frailty, diabetes and cancer are associated with aging, but the relationship between these conditions is not well defined. AIMS We studied older patients with cancer from the prospective single-center cohort ANCRAGE (ANalyses of CanceR in AGEd) aiming to determine the impact of type 2 diabetes (T2D) and its vascular complications (VC) on frailty and adverse outcomes (mortality, unplanned readmission) during follow-up. METHODS Analysis of cohort patients ≥ 75 years, included between 2009 and 2017, who underwent a comprehensive geriatric assessment (CGA). Variables of interest were history of T2D and VC, tumor site and metastatic status, CGA including eight domains (social environment, functional status, mobility, nutrition, mood, cognition, polypharmacy and comorbidities) and frailty. RESULTS Among 1092 patients (47% female, mean age 82 ± 5 years), 219 (20%) had a reported diagnosis of T2D at baseline including 152 (69%) with VC. The most common tumor sites were prostate (15%), breast (15%), skin (12%), and colorectum (11%); 29% of patients had a metastatic disease. Frailty was highly prevalent (84%). During follow-up (median of 15.3 months), 653 (60%) patients died (60% no T2D, 43% T2D without VC, 66% with VC). After adjustment for age, gender and metastatic status, diabetics with VC had a higher risk of all-cause death (aHR1.89, 1.24-2.86, p = 0.004). Death was more frequently due to a non-cancer cause (p < 0.001). No difference in unplanned readmissions was observed in the three groups. Frailty was an independent risk factor for mortality and unplanned readmissions (p < 0.001 both). CONCLUSION In older cancer patients from the prospective ANCRAGE cohort, all-cause mortality was significantly higher in frail patients and those with complicated T2D, a finding questioning the quality of care management in such vulnerable patients, and stimulating further research in this multidisciplinary field.
Collapse
|
10
|
Rodríguez-Queraltó O, Formiga F, Carol A, Llibre C, Martínez-Sellés M, Marín F, Díez-Villanueva P, Sanchis J, Bonanad C, Corbí M, Aboal J, Angel Perez-Rivera J, Alegre O, Bernal E, Vicent L, Ariza-Solé A. Impact of Diabetes Mellitus and Frailty on Long-Term Outcomes in Elderly Patients with Acute Coronary Syndromes. J Nutr Health Aging 2020; 24:723-729. [PMID: 32744568 DOI: 10.1007/s12603-020-1409-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Diabetes mellitus (DM) and frailty are common in older patients with acute coronary syndromes (ACS). No data exists about its prognostic impact on long-term outcomes and their possible interaction in this setting. DESIGN Observational prospective study. SETTING Multicenter registry conducted in 44 hospitals in Spain. PARTICIPANTS Consecutive patients with ACS aged 80≥years. MEASUREMENTS A comprehensive geriatric evaluation was performed during hospitalization, including frailty assessment by the FRAIL score. The impact of DM and frailty on the incidence of mortality/readmission at 24 months was analysed by a Cox regression model. RESULTS A total of 498 patients were included (mean age 84.3 years). Prevalence of previous DM was 199/498 (40.0%). The rate of frail patients was 135/498 (27.1%). The incidence of mortality/readmission was higher frail patients (HR 2.49) (both p<0.001). In contrast, DM was not significantly associated to a higher rate of outcomes (HR 1.23, p=0.060) in the whole cohort. Among non-frail patients, patients with DM had a similar incidence of mortality or readmission (p=0.959). In contrast, among frail patients, DM was significantly associated with a higher incidence of events (HR 1.51, p=0.034). CONCLUSIONS Unlike frailty status, DM was not associated to poorer long-term outcome in elderly patients with ACS. Among frail patients the presence of DM seems to provide additional prognostic information.
Collapse
Affiliation(s)
- O Rodríguez-Queraltó
- Albert Ariza Solé. Cardiology Department. Bellvitge University Hospital, Feixa Llarga s/n. 08907. L'Hospitalet de Llobregat. Barcelona. Spain, Email address: , Fax Number +34932607618; Telephone number +34932607924
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Korzeniowska K, Cieślewicz A, Chmara E, Jabłecka A, Pawlaczyk M. Photosensitivity reactions in the elderly population: questionnaire-based survey and literature review. Ther Clin Risk Manag 2019; 15:1111-1119. [PMID: 31571889 PMCID: PMC6748316 DOI: 10.2147/tcrm.s215308] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/24/2019] [Indexed: 12/14/2022] Open
Abstract
Purpose Older people are at risk of developing adverse drug reactions, including photosensitivity reactions. Therefore, the aim of the study was to assess the use of potentially photosensitizing medications and photoprotection in the elderly population. Patients and methods Three hundred and fifty-six respondents (223 [63%] women and 133 [37%] men) aged ≥65 years filled in the original questionnaire concerning photosensitivity reactions to drugs. The diagnosis of drug-induced photosensitivity was based on medical history and clinical examination. Results and conclusion We found that drugs potentially causing phototoxic/photoallergic reactions comprised more than one fifth of all drugs used by the participants. The most numerous group was patients treated with 3–5 drugs potentially causing phototoxic/photoallergic reactions simultaneously. Of all drugs, ketoprofen was found to cause the highest number of photosensitivity reactions. Cutaneous adverse reactions were also observed for hydrochlorothiazide, atorvastatin, simvastatin, telmisartan, and metformin. Moreover, it was found that the incidence of photosensitivity reactions can be significantly reduced by using proper photoprotection.
Collapse
Affiliation(s)
- Katarzyna Korzeniowska
- Department of Clinical Pharmacology, Poznan University of Medical Sciences, Poznań 61-848, Poland
| | - Artur Cieślewicz
- Department of Clinical Pharmacology, Poznan University of Medical Sciences, Poznań 61-848, Poland
| | - Ewa Chmara
- Department of Clinical Pharmacology, Poznan University of Medical Sciences, Poznań 61-848, Poland
| | - Anna Jabłecka
- Department of Clinical Pharmacology, Poznan University of Medical Sciences, Poznań 61-848, Poland
| | - Mariola Pawlaczyk
- Department of Geriatric Medicine and Gerontology, Poznan University of Medical Sciences, Poznań 60-781, Poland
| |
Collapse
|
12
|
Formiga F, Díez-Villanueva P, Ariza-Solé A. [The LONGEVO-SCA Study: An example of collaboration between cardiology and geriatrics]. Rev Esp Geriatr Gerontol 2019; 54:187-188. [PMID: 31160137 DOI: 10.1016/j.regg.2019.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 05/10/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Francesc Formiga
- Programa de Geriatría, Servicio de Medicina Interna, Hospital de Bellvitge, ĹHospitalet de Llobregat, Barcelona, España.
| | | | - Albert Ariza-Solé
- Servicio de Cardiología, Hospital de Bellvitge, ĹHospitalet de Llobregat, Barcelona, España
| |
Collapse
|