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Bruoha S, Maller T, Loutati R, Perel N, Tabi M, Taha L, Yosefy C, Jafari J, Braver O, Amsalem I, Hitter R, Manassra M, Levy N, Abu-Alkean I, Hamyil K, Steinmetz Y, Karameh H, Karmi M, Marmor D, Wolak A, Glikson M, Asher E. Nonagenarians admission and prognosis in a tertiary center intensive coronary care unit - a prospective study. BMC Geriatr 2023; 23:152. [PMID: 36941571 PMCID: PMC10029169 DOI: 10.1186/s12877-023-03851-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/27/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND With increasing life expectancy, the prevalence of nonagenarians with cardiovascular disease is steadily growing. However, this population is underrepresented in randomized trials and thus poorly defined, with little quality evidence to support and guide optimal management. The aim of the present study was to evaluate the clinical management, therapeutic approach, and outcomes of nonagenarians admitted to a tertiary care center intensive coronary care unit (ICCU). METHODS We prospectively collected all patients admitted to a tertiary care center ICCU between July 2019 - July 2022 and compared nonagenarians to all other patients. The primary outcome was in-hospital mortality. RESULTS A total of 3807 patients were included in the study. Of them 178 (4.7%) were nonagenarians and 93 (52%) females. Each year the prevalence of nonagenarians has increased from 4.0% to 2019, to 4.2% in 2020, 4.6% in 2021 and 5.3% in 2022. Admission causes differed between groups, including a lower rate of acute coronary syndromes (27% vs. 48.6%, p < 0.001) and a higher rate of septic shock (4.5% vs. 1.2%, p < 0.001) in nonagenarians. Nonagenarians had more comorbidities, such as hypertension, renal failure, and atrial fibrillation (82% vs. 59.6%, 23% vs. 12.9%, 30.3% vs. 14.4% p < 0.001, respectively). Coronary intervention was the main treatment approach, although an invasive strategy was less frequent in nonagenarians in comparison to younger subjects. In-hospital mortality rate was 2-fold higher in the nonagenarians (5.6% vs. 2.5%, p = 0.025). CONCLUSION With increasing life expectancy, the prevalence of nonagenarians in ICCU's is expected to increase. Although nonagenarian patients had more comorbidities and higher in-hospital mortality, they generally have good outcomes after admission to the ICCU. Hence, further studies to create evidence-based practices and to support and guide optimal management in these patients are warranted.
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Affiliation(s)
- Sharon Bruoha
- Department of Cardiology, Barzilai Medical Center, The Ben-Gurion University of the Negev, Hahistadrout 2, Ashkelon, 7830604, Israel.
| | - Tomer Maller
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ranel Loutati
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nimrod Perel
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Meir Tabi
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Louay Taha
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Chaim Yosefy
- Department of Cardiology, Barzilai Medical Center, The Ben-Gurion University of the Negev, Hahistadrout 2, Ashkelon, 7830604, Israel
| | - Jamal Jafari
- Department of Cardiology, Barzilai Medical Center, The Ben-Gurion University of the Negev, Hahistadrout 2, Ashkelon, 7830604, Israel
| | - Omri Braver
- Department of Cardiology, Barzilai Medical Center, The Ben-Gurion University of the Negev, Hahistadrout 2, Ashkelon, 7830604, Israel
| | - Itshak Amsalem
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rafael Hitter
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mohamed Manassra
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nir Levy
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ismael Abu-Alkean
- Department of Cardiology, Barzilai Medical Center, The Ben-Gurion University of the Negev, Hahistadrout 2, Ashkelon, 7830604, Israel
| | - Kamal Hamyil
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yoed Steinmetz
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hani Karameh
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mohamed Karmi
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - David Marmor
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Arik Wolak
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michael Glikson
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Elad Asher
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
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Volle K, Delmas C, Ferrières J, Toulza O, Blanco S, Lairez O, Lhermusier T, Biendel C, Galinier M, Carrié D, Elbaz M, Bouisset F. Prevalence and Prognosis Impact of Frailty Among Older Adults in Cardiac Intensive Care Units. CJC Open 2021; 3:1010-1018. [PMID: 34505040 PMCID: PMC8413242 DOI: 10.1016/j.cjco.2021.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 03/18/2021] [Indexed: 11/25/2022] Open
Abstract
Background Whether frailty, defined as a biological syndrome that reflects a state of decreased physiological reserve and vulnerability to stressors, may impact the outcomes of elderly patients admitted to a cardiac intensive care unit (CICU) remains unclear. We aimed to determine the prevalence of frailty and its impact on mortality in patients aged ≥ 80 years admitted to a CICU. Methods This prospective single-centre observational study was conducted among patients aged ≥ 80 years admitted to a CICU in a tertiary centre. Frailty was assessed using the Edmonton Frail Scale (EFS), which provides a score ranging from 0 (not frail) to 17 (very frail). The population was divided into 3 classes: EFS-score of 0-3, EFS-score of 4-6, and EFS-score > 7. Results A total of 199 patients were included, and median follow-up duration was 365 days. The mean age was 84.8 years, and 50 patients (25.1%) died during the follow-up period. In all, 45 (22.6%), 60 (30.2%), and 94 patients (47.2%) had an EFS-score of 0-3, 4-6, and ≥ 7, respectively. The all-cause mortality rate was 4.4%, 27.1%, and 37.2% in the 0-3, 4-6, and ≥ 7 EFS-score groups, respectively (P < 0.001). After multivariate analysis, frailty status remained associated with all-cause mortality: hazard ratio was 2.60 (95% confidence interval 0.54-12.45) within the 4-6 EFS-score group, and 5.46 (95% confidence interval 1.23-24.08) within the ≥ 7 EFS-score group. Conclusions Frailty is highly prevalent in older adults admitted to the population hospitalized in a CICU and represents a strong prognostic factor for 1-year all-cause mortality.
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Affiliation(s)
- Kim Volle
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France
| | - Clément Delmas
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France
| | - Jean Ferrières
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France.,UMR1027, INSERM-Toulouse University III, Toulouse, France.,Department of Epidemiology, University Hospital of Toulouse, Toulouse, France
| | - Olivier Toulza
- Department of Gerontology, University Hospital of Toulouse, Toulouse, France
| | - Stephanie Blanco
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France
| | - Olivier Lairez
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France
| | | | - Caroline Biendel
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France
| | - Michel Galinier
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France
| | - Didier Carrié
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France
| | - Meyer Elbaz
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France
| | - Frédéric Bouisset
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France.,UMR1027, INSERM-Toulouse University III, Toulouse, France
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Dillinger JG, Laine M, Bouajila S, Paganelli F, Henry P, Bonello L. Antithrombotic strategies in elderly patients with acute coronary syndrome. Arch Cardiovasc Dis 2021; 114:232-245. [PMID: 33632631 DOI: 10.1016/j.acvd.2020.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 12/21/2020] [Accepted: 12/21/2020] [Indexed: 12/22/2022]
Abstract
Elderly patients represent a growing proportion of the acute coronary syndrome population in Western countries. However, their frequent atypical symptoms at presentation often lead to delays in management and to misdiagnosis. Furthermore, their prognosis is poorer than that of younger patients because of physiological changes in platelet function, haemostasis and fibrinolysis, but also a higher proportion of comorbidities and frailty, both of which increase the risk of recurrent thrombotic and bleeding events. This complex situation, with ischaemic and haemorrhagic risk factors often being intertwined, may lead to confusion about the required treatment strategy, sometimes resulting in inadequate management or even to therapeutic nihilism. It is therefore critical to provide a comprehensive overview of our understanding of the pathophysiological processes underlying acute coronary syndrome in elderly patients, and to summarise the results from the latest clinical trials to help decision making for these high-risk patients.
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Affiliation(s)
- Jean-Guillaume Dillinger
- Department of cardiology, Hôpital Lariboisière, AP-HP, Inserm U-942, Université de Paris, 2, rue Ambroise-Paré, 75010 Paris, France.
| | - Marc Laine
- Mediterranean Association for research and studies in cardiology (MARS cardio), Centre for cardiovascular and nutrition research, AP-HM, Aix-Marseille University, INSERM 1263, INRA 1260, 13015 Marseille, France; Cardiology department, Hôpital Nord, 13015 Marseille, France; Mediterranean Association for research and studies in cardiology (MARS cardio), 13015 Marseille, France
| | - Sara Bouajila
- Department of cardiology, Hôpital Lariboisière, AP-HP, Inserm U-942, Université de Paris, 2, rue Ambroise-Paré, 75010 Paris, France
| | - Franck Paganelli
- Mediterranean Association for research and studies in cardiology (MARS cardio), Centre for cardiovascular and nutrition research, AP-HM, Aix-Marseille University, INSERM 1263, INRA 1260, 13015 Marseille, France; Cardiology department, Hôpital Nord, 13015 Marseille, France
| | - Patrick Henry
- Department of cardiology, Hôpital Lariboisière, AP-HP, Inserm U-942, Université de Paris, 2, rue Ambroise-Paré, 75010 Paris, France
| | - Laurent Bonello
- Mediterranean Association for research and studies in cardiology (MARS cardio), Centre for cardiovascular and nutrition research, AP-HM, Aix-Marseille University, INSERM 1263, INRA 1260, 13015 Marseille, France; Cardiology department, Hôpital Nord, 13015 Marseille, France; Mediterranean Association for research and studies in cardiology (MARS cardio), 13015 Marseille, France
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