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Sarma D, Padkins M, Smith R, Bennett CE, Murphy JG, Bell MR, Damluji AA, Anavekar NS, Barsness GW, Jentzer JC. Patients Aged 90 Years and Above With Acute Coronary Syndrome in the Cardiac Intensive Care Unit: Management and Outcomes. Am J Cardiol 2024; 215:19-27. [PMID: 38266797 PMCID: PMC11025344 DOI: 10.1016/j.amjcard.2023.12.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/03/2023] [Accepted: 12/24/2023] [Indexed: 01/26/2024]
Abstract
Limited data exist regarding outcomes after coronary angiography (CAG) and percutaneous coronary intervention (PCI) in patients aged ≥90 years admitted to the cardiac intensive care unit (CICU) with acute coronary syndrome (ACS). We studied sequential CICU patients ≥90 years admitted with ACS from 2007 to 2018. Three therapeutic approaches were defined: (1) No CAG; (2) CAG without PCI (CAG/No PCI); and (3) CAG with PCI (CAG/PCI). In-hospital mortality was evaluated using multivariable logistic regression. All-cause 1-year mortality was evaluated using Kaplan-Meier and multivariable Cox proportional hazards analysis. The study included 239 patients with a median age of 92 (range 90 to 100) years (57% females; 45% ST-elevation myocardial infarction; 8% cardiac arrest; 16% shock). The No CAG group had higher Day 1 Sequential Organ Failure Assessment scores, more co-morbidities, worse kidney function, and fewer ST-elevation myocardial infarctions. In-hospital mortality was 20.8% overall and did not differ between the No CAG (n = 103; 21.4%), CAG/No PCI (n = 47; 21.3%), and CAG/PCI (n = 90; 20.0%) groups, before or after adjustment. Overall 1-year mortality was 52.5% and did not differ between groups before or after adjustment. Median survival was 6.9 months overall and 41.2% of hospital survivors died within 1 year of CICU admission. CICU patients aged ≥90 years with ACS have a substantial burden of illness with high in-hospital and 1-year mortality that was not lower in those who underwent CAG or PCI. These results suggest that careful patient selection for invasive coronary procedures is essential in this vulnerable population.
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Affiliation(s)
- Dhruv Sarma
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mitchell Padkins
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ryan Smith
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Courtney E Bennett
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Joseph G Murphy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Malcolm R Bell
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Abdulla A Damluji
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Nandan S Anavekar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Gregory W Barsness
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
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Higuchi R, Nanasato M, Furuichi Y, Hosoya Y, Haraguchi G, Takayama M, Isobe M. Outcomes of Octogenarians and Nonagenarians in a Contemporary Cardiac Care Unit - Insights From 2,242 Patients Admitted Between 2019 and 2021. Circ Rep 2023; 5:430-436. [PMID: 37969231 PMCID: PMC10632070 DOI: 10.1253/circrep.cr-23-0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 11/17/2023] Open
Abstract
Background: The number of octo- and nonagenarians admitted to cardiac care units (CCUs) has been increasing in the context of an aging society; however, clinical details and outcomes for these patients are scarce. Methods and Results: Data from 2,242 consecutive patients admitted to the CCU between 2019 and 2021 (age <80 years, 1,390 [62%]; octogenarians, 655 [29%]; nonagenarians, 197 [8.7%]) were reviewed using the in-hospital database for the Tokyo CCU Network. The primary cause of admission was acute coronary syndrome in younger patients and octogenarians (58% and 49%, respectively) and acute heart failure (AHF) in nonagenarians (42%). The proportions of females, underweight, hypertension, atrial fibrillation, myocardial infarction, stroke, previous heart failure, anemia, and malnutrition were higher among octo- and nonagenarians than among younger patients. In-hospital and 1-year mortality rates were greater in octo- and nonagenarians (younger vs. octogenarian vs. nonagenarian, 2.0% vs. 3.8% vs. 5.6% and 4.1% vs. 11.9% vs. 19.0%, respectively). Multivariate analysis revealed that 1-year mortality was associated with octo-/nonagenarian status (odds ratio [OR] 2.24 and 2.64), AHF (OR 2.88), body mass index (OR per 1-kg/m2 0.91), and albumin concentration (OR per 1-g/dL 0.27). Conclusions: Approximately 40% of patients admitted to the CCU were octo- or nonagenarians, and being an octo- or nonagenarian, having AHF, a lower body mass index, and lower albumin concentrations were associated with 1-year mortality after CCU admission.
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Affiliation(s)
- Ryosuke Higuchi
- Department of Cardiology, Sakakibara Heart Institute Fuchu Japan
| | - Mamoru Nanasato
- Department of Cardiology, Sakakibara Heart Institute Fuchu Japan
| | - Yuko Furuichi
- Department of Anesthesiology, Sakakibara Heart Institute Fuchu Japan
| | - Yumiko Hosoya
- Department of Cardiology, Sakakibara Heart Institute Fuchu Japan
| | - Go Haraguchi
- Department of Intensive Care, Sakakibara Heart Institute Fuchu Japan
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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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Padkins M, Breen T, Anavekar N, van Diepen S, Henry TD, Baran DA, Barsness GW, Kashani K, Holmes DR, Jentzer JC. Age and shock severity predict mortality in cardiac intensive care unit patients with and without heart failure. ESC Heart Fail 2020; 7:3971-3982. [PMID: 32909377 PMCID: PMC7754759 DOI: 10.1002/ehf2.12995] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/31/2020] [Accepted: 08/17/2020] [Indexed: 12/15/2022] Open
Abstract
AIMS Age is an important risk factor for mortality among patients with cardiogenic shock and heart failure (HF). We sought to assess the extent to which age modified the performance of the Society for Cardiovascular Angiography and Interventions (SCAI) shock stage for in-hospital and 1 year mortality in cardiac intensive care unit (CICU) patients with and without HF. METHODS AND RESULTS We retrospectively reviewed unique admissions to the Mayo Clinic CICU during 2007-2015 and stratified patients by age and SCAI shock stage. The association between age and in-hospital mortality was analysed using multivariable logistic regression, and 1 year mortality was analysed using Cox proportional hazards analysis, both in the entire cohort and among patients with an admission diagnosis of HF or acute coronary syndrome (ACS). The final study population included 10 004 unique patients with a mean age of 67 ± 15 years, including 46.1% with HF and 43.1% with ACS. Older patients more frequently had HF and had more extensive co-morbidities, higher illness severity, more organ failure, and differential use of critical care therapies. The percentage of patients with SCAI shock stages A, B, C, D, and E were 46%, 30%, 16%, 7%, and 1%, respectively. Patients with HF were older, had greater severity of illness and higher SCAI shock stage, and had higher rates of death at all time points. In-hospital mortality occurred in 908 (9%) patients, including 549 (12%) patients with HF (61% of all hospital deaths). Age was independently associated with hospital mortality (adjusted odds ratio per 10 years 1.3, 95% confidence interval 1.2-1.4, P < 0.001) and 1 year mortality (adjusted hazard ratio per 10 years 1.2, 95% confidence interval 1.2-1.3, P < 0.001) in the overall cohort. The associations of age with both hospital mortality (adjusted odds ratio 1.6 vs. 1.3 per 10 years older) and 1 year mortality (adjusted hazard ratio 1.5 vs. 1.3 per 10 years older) were higher for patients with ACS compared with patients with HF. Older age was associated with higher adjusted hospital mortality and 1 year mortality in each SCAI shock stage (all P < 0.05). Additive increases in both hospital mortality and 1 year mortality were observed with increasing age and SCAI shock stage. CONCLUSIONS Age is an independent risk factor for mortality that modifies the relationship between the SCAI shock stage and mortality risk in CICU patients, providing robust risk stratification for in-hospital and 1 year mortality. Although patients with HF had a higher risk of dying, age was more strongly associated with mortality among patients with ACS.
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Affiliation(s)
- Mitchell Padkins
- Mayo Clinic School of Graduate Medical Education, Mayo Clinic, Rochester, MN, USA
| | - Thomas Breen
- Mayo Clinic School of Graduate Medical Education, Mayo Clinic, Rochester, MN, USA
| | - Nandan Anavekar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sean van Diepen
- Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta Hospital, Edmonton, AB, Canada
| | - Timothy D Henry
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital Health Network, Cincinnati, OH, USA
| | - David A Baran
- Advanced Heart Failure Center and Eastern Virginia Medical School, Sentara Heart Hospital, Norfolk, VA, USA
| | | | - Kianoush Kashani
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.,Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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5
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Vallabhajosyula S, Vallabhajosyula S, Dunlay SM, Hayes SN, Best PJM, Brenes-Salazar JA, Lerman A, Gersh BJ, Jaffe AS, Bell MR, Holmes DR, Barsness GW. Sex and Gender Disparities in the Management and Outcomes of Acute Myocardial Infarction-Cardiogenic Shock in Older Adults. Mayo Clin Proc 2020; 95:1916-1927. [PMID: 32861335 PMCID: PMC7582223 DOI: 10.1016/j.mayocp.2020.01.043] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/11/2020] [Accepted: 01/31/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate outcomes by sex in older adults with cardiogenic shock complicating acute myocardial infarction (AMI-CS). MATERIALS AND METHODS A retrospective cohort of older (≥75 years) AMI-CS admissions during January 1, 2000, to December 31, 2014, was identified using the National Inpatient Sample. Interhospital transfers were excluded. Use of angiography, percutaneous coronary intervention (PCI), mechanical circulatory support (MCS), and noncardiac interventions was identified. The primary outcome was in-hospital mortality stratified by sex, and secondary outcomes included temporal trends of prevalence, in-hospital mortality, use of cardiac and noncardiac interventions, hospitalization costs, and length of stay. RESULTS In this 15-year period, there were 134,501 AMI-CS admissions 75 years or older, of whom 51.5% (n=69,220) were women. Women were on average older, were more often Hispanic or nonwhite race, and had lower comorbidity, acute organ failure, and concomitant cardiac arrest. Compared with older men (n=65,281), older women (n=69,220) had lower use of coronary angiography (55.4% [n=35,905] vs 49.2% [n=33,918]), PCI (36.3% [n=23,501] vs 34.4% [n=23,535]), MCS (34.3% [n=22,391] vs 27.2% [n=18,689]), mechanical ventilation, and hemodialysis (all P<.001). Female sex was an independent predictor of higher in-hospital mortality (adjusted odds ratio, 1.05; 95% CI, 1.02-1.08; P<.001) and more frequent discharges to a skilled nursing facility. In subgroup analyses of ethnicity, presence of cardiac arrest, and those receiving PCI and MCS, female sex remained an independent predictor of increased mortality. CONCLUSION Female sex is an independent predictor of worse in-hospital outcomes in older adults with AMI-CS in the United States.
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Affiliation(s)
- Saraschandra Vallabhajosyula
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN; Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN.
| | | | - Shannon M Dunlay
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN
| | - Sharonne N Hayes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Jorge A Brenes-Salazar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Division of Geriatric Medicine and Gerontology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Bernard J Gersh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Allan S Jaffe
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Division of Clinical Core Laboratory Services, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Malcolm R Bell
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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6
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Jentzer JC, Anavekar NS, Brenes-Salazar JA, Wiley B, Murphree DH, Bennett C, Murphy JG, Keegan MT, Barsness GW. Admission Braden Skin Score Independently Predicts Mortality in Cardiac Intensive Care Patients. Mayo Clin Proc 2019; 94:1994-2003. [PMID: 31585582 DOI: 10.1016/j.mayocp.2019.04.038] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 04/02/2019] [Accepted: 04/08/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine whether a low Braden skin score (BSS), reflecting increased risk for skin pressure injury, would predict lower survival in cardiac intensive care unit (CICU) patients after adjustment for illness severity and comorbidities. PATIENTS AND METHODS This retrospective cohort study included consecutive unique adult patients admitted to a single tertiary care referral hospital CICU from January 1, 2007, through December 31, 2015, who had a BSS documented on CICU admission. The primary outcome was all-cause hospital mortality, using elastic net penalized logistic regression to determine predictors of hospital mortality. The secondary outcome was all-cause post-discharge mortality, using Cox proportional hazards models to determine predictors of post-discharge mortality. RESULTS The study included 9552 patients with a mean age of 67.4±15.2 years (3589 [37.6%] were females) and a hospital mortality rate of 8.3%. Admission BSS was inversely associated with hospital mortality (unadjusted odds ratio, 0.70; 95% CI, 0.68-0.72; P<.001; area under the receiver operator curve, 0.80; 95% CI, 0.78-0.82), with increased short-term mortality as a function of decreasing admission BSS. After adjustment for illness severity and comorbidities using multivariable analysis, admission BSS remained inversely associated with hospital mortality (adjusted odds ratio, 0.88; 95% CI, 0.85-0.92; P<.001). Among hospital survivors, admission BSS was inversely associated with post-discharge mortality after adjustment for illness severity and comorbidities (adjusted hazard ratio, 0.89; 95% CI, 0.88-0. 90; P<.001). CONCLUSION The admission BSS, a simple inexpensive bedside nursing assessment potentially reflecting frailty and overall illness acuity, was independently associated with hospital and post-discharge mortality when added to established multiparametric illness severity scores among contemporary CICU patients.
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Affiliation(s)
- Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
| | | | | | - Brandon Wiley
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Courtney Bennett
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Joseph G Murphy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Mark T Keegan
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
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7
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Comparison of Mortality Risk Prediction Among Patients ≥70 Versus <70 Years of Age in a Cardiac Intensive Care Unit. Am J Cardiol 2018; 122:1773-1778. [PMID: 30227963 DOI: 10.1016/j.amjcard.2018.08.011] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/27/2018] [Accepted: 08/02/2018] [Indexed: 11/21/2022]
Abstract
Older adults account for an increasing number of cardiac intensive care unit (CICU) admissions. This study sought to determine the predictive value of illness severity scores for mortality in CICU patients ≥70 years of age. Adult patients admitted to the CICU from 2007 to 2015 at one tertiary care hospital were reviewed. Severity of illness scores were calculated on the first CICU day. Area under the receiver-operator characteristic curve (AUROC) values were used to assess discrimination for hospital mortality in patients ≥70 versus <70 years of age. We included 10,004 patients with a mean age of 67.4 ± 15.2 years (37.4% female); 4,771 patients (47.7%) were ≥70 years of age. Patients ≥70 years of age had greater illness severity and more extensive co-morbidities compared with patients <70 years of age. Patients ≥70 years of age had higher hospital mortality (11.6% vs 6.8%, odds ratio 1.80, 95% confidence interval 1.57 to 2.07, p <0.001), with a progressive increase in mortality as a function of decade. Severity of illness scores had lower AUROC values for hospital mortality in patients ≥70 years of age compared with patients <70 years of age (all p <0.05 by DeLong test). The Braden skin score on CICU admission predicted hospital mortality with an AUROC value only slightly lower than these scores. Increasing age decade was associated with decreased postdischarge survival by Kaplan-Meier analysis (p <0.001 by log-rank). In conclusion, contemporary CICU patients ≥70 years of age have greater illness severity, more co-morbidities and higher mortality than patients <70 years of age, yet severity of illness scores are less accurate for predicting mortality in CICU patients ≥70 years of age, emphasizing the need for more effective risk-stratification methods in this population.
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8
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Goldfarb M, Afilalo J, Chan A, Herscovici R, Cercek B. Early mobility in frail and non-frail older adults admitted to the cardiovascular intensive care unit. J Crit Care 2018; 47:9-14. [PMID: 29879568 DOI: 10.1016/j.jcrc.2018.05.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/18/2018] [Accepted: 05/27/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE Little is known about the effects of early mobilization in older adults in the Cardiovascular Intensive Care Unit (CICU). MATERIALS AND METHODS We reviewed consecutive patients ≥60 years of age admitted to the CICU at an academic tertiary care center from 2016 to 2017. The level of function (LOF) was assessed prehospital, at CICU admission, and at CICU transfer using a graded scale ranging from LOF 1 (bedbound) to 4 (walk > 50 ft). The prehospital frailty status was assessed using Rockwood's Clinical Frailty Scale. We sought to determine whether the mean change of LOF during CICU admission differed based on frailty status. RESULTS There were 264 patients in the cohort (77.1 ± 9.3 years old; 40% female; 34% frail). Frail patients were more likely to have lower prehospital, CICU admission, day of transfer LOFs (all P < 0.001). The mean LOF improvement during CICU stay was 0.5 ± 0.8 and did not differ based on frailty status. Frailty was not predictive of EM responsiveness in the adjusted analysis. CONCLUSIONS EM is feasible in older adults admitted to the CICU. Functional status improved in both frail and non-frail older adults during CICU admission. Prospective studies are needed to determine whether frail older adults may benefit from EM.
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Affiliation(s)
- Michael Goldfarb
- Divisions of Cardiology and Pulmonary and Critical Care, Cedars-Sinai Medical Center; Los Angeles, CA, United States.
| | - Jonathan Afilalo
- Division of Cardiology, Jewish General Hospital, McGill University; Montreal, QC, Canada
| | - Alice Chan
- Department of Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Romana Herscovici
- Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Bojan Cercek
- Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
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9
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Erben Y, Mena-Hurtado CI, Miller SM, Jean RA, Sumpio BJ, Velasquez CA, Mojibian H, Aruny J, Dardik A, Sumpio BE. Increased mortality in octogenarians treated for lifestyle limiting claudication. Catheter Cardiovasc Interv 2018; 91:1331-1338. [DOI: 10.1002/ccd.27523] [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: 09/25/2017] [Accepted: 01/15/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Young Erben
- Section of Vascular and Endovascular Surgery, Department of Surgery; Yale University School of Medicine; New Haven Connecticut
| | - Carlos I. Mena-Hurtado
- Section of Cardiovascular Medicine, Department of Internal Medicine; Yale University School of Medicine; New Haven Connecticut
| | - Samuel M. Miller
- Warren Alpert Medical School at Brown University; Providence Rhode Island
| | - Raymond A. Jean
- Department of Surgery; Yale University School of Medicine; New Haven Connecticut
- National Clinician Scholars Program, Department of Internal Medicine; Yale School of Medicine; New Haven Connecticut
| | - Brandon J. Sumpio
- Department of Surgery; Yale University School of Medicine; New Haven Connecticut
| | | | - Hamid Mojibian
- Section of Vascular Interventional Radiology, Department of Radiology; Yale University School of Medicine; New Haven Connecticut
| | - John Aruny
- Section of Vascular Interventional Radiology, Department of Radiology; Yale University School of Medicine; New Haven Connecticut
| | - Alan Dardik
- Section of Vascular and Endovascular Surgery, Department of Surgery; Yale University School of Medicine; New Haven Connecticut
| | - Bauer E. Sumpio
- Section of Vascular and Endovascular Surgery, Department of Surgery; Yale University School of Medicine; New Haven Connecticut
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