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Li S, Zheng W, Wang X, Fan J, Ai H, Que B, Yan Y, Gong W, Nie S. The impact of obstructive sleep apnea and comorbidity status on cardiovascular outcomes in patients with acute coronary syndrome. Nutr Metab Cardiovasc Dis 2023; 33:2372-2383. [PMID: 37586922 DOI: 10.1016/j.numecd.2023.07.024] [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: 03/09/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND AND AIMS The association of comorbidities on the prognosis of patients with acute coronary syndrome (ACS) was well documented. However, the impact of obstructive sleep apnea (OSA) on this association has been less studied. METHODS AND RESULTS Between June 2015 to Jan 2020, we included consecutively eligible patients with ACS who underwent cardiorespiratory polygraphy. The definition of OSA was apnea-hypopnea index (AHI) ≥15 events/hour. Charlson Comorbidity Index (CCI) was used to evaluate the comorbidities. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), including cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, and hospitalization for unstable angina or heart failure. In the 1927 ACS patients, 1014 (52.6%) had OSA. The prevalence of the mild (CCI = 0), moderate (CCI = 1-2), and severe (CCI≥3) comorbidity were 23.6%, 65.9%, and 10.5%, respectively. During a median follow-up of 2.9 (1.5, 3.6) years, compared with patients without OSA, the presence of OSA increased the risk of MACCE in the moderate comorbidity group (22.6% vs. 17.5%; adjusted HR: 1.327; 95% CI: 1.019-1.728, p = 0.036) and severe comorbidity group (36.2% vs. 18.6%; adjusted HR: 2.194; 95% CI: 1.170-4.117, p = 0.014). There was no significant difference between OSA and non-OSA patients in the mild comorbidity group. CONCLUSION Among ACS patients, OSA was associated with an increased risk of subsequent events in the moderate and severe comorbidity groups but not in the mild comorbidity group. ACS patients with comorbidities should not be overlooked for OSA screening.
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Affiliation(s)
- Siyi Li
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Wen Zheng
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Xiao Wang
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Jingyao Fan
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Hui Ai
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Bin Que
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Yan Yan
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Wei Gong
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China.
| | - Shaoping Nie
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China.
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Pham HM, Nguyen AP, Nguyen HTT, Nguyen TN, Nguyen TX, Nguyen TTH, Nguyen HTT, Nguyen AT, Nguyen QN, Tran GS, Vu HTT. The Frail Scale - A Risk Stratification in Older Patients with Acute Coronary Syndrome. J Multidiscip Healthc 2023; 16:1521-1529. [PMID: 37274424 PMCID: PMC10239255 DOI: 10.2147/jmdh.s409535] [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: 03/16/2023] [Accepted: 05/22/2023] [Indexed: 06/06/2023] Open
Abstract
Purpose The aim of this study was to explore the impact of frailty on in-hospital adverse outcomes and net adverse clinical events (NACE) in older patients with acute coronary syndrome. Patients and Methods This observational study included elderly patients (≥60 years old), diagnosed with acute coronary syndrome (ACS) at admission from February 2021 to August 2021. The primary outcome was net adverse clinical events (NACE) defined as a composite of all-cause mortality, stroke, and major bleeding. Secondary outcome was in-hospital adverse outcomes including arrhythmia, acquired pneumonia, stroke, major bleeding, and all-cause mortality. Frailty was assessed using the Frail scale (FS). Data about socio-demographics, comorbidities, body mass index, ACS type, coronary angiography, left ventricular ejection fraction, and length of hospital stay were also collected. Univariate and multivariate logistic regressions were employed to identify the potential association between frailty and outcomes. Results Of the 116 ACS patients, 38 patients were frail (32.76%). Frail subjects were more often female (50%) and older (p < 0.01) and had higher rates of in-hospital adverse outcomes (OR = 2.37, p = 0.05) and NACE (OR = 7.12; p < 0.01). In univariate analysis, the increased frail score was significantly associated with increased odds of NACE (unadjusted OR = 1.98, 95% CI 1.17-3.35 for each score increase in Frail Score). In multivariable logistic regression, models controlling for age, gender, PCI, LVEF, and coronary angiography (adjusted OR 2.19, 95% CI 1.12-4.29 for each score increase in Frail Score). Conclusion This study revealed the reference data of frailty assessment in older patients with ACS in Vietnam. Our result indicated that over 30% of ACS older patients presented with frailty which was associated with an increased risk of in-hospital adverse outcomes and NACE. This study also provided promising information about the simple FRAIL scale's potential role in the risk stratification of older patients with ACS.
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Affiliation(s)
- Hung Manh Pham
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, 100000, Vietnam
- Department of Cardiology, Hanoi Medical University, Hanoi, 100000, Vietnam
| | - Anh Phuong Nguyen
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, 100000, Vietnam
- Department of Cardiology, Hanoi Medical University, Hanoi, 100000, Vietnam
| | - Huong Thi Thu Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, 100000, Vietnam
| | - Tam Ngoc Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, 100000, Vietnam
| | - Thanh Xuan Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, 100000, Vietnam
| | - Thu Thi Hoai Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, 100000, Vietnam
| | - Huong Thi Thanh Nguyen
- Physiology Department, Hanoi Medical University, Hanoi, 100000, Vietnam
- Dinh Tien Hoang Institute of Medicine, Hanoi, 100000, Vietnam
| | - Anh Trung Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, 100000, Vietnam
| | - Quang Ngoc Nguyen
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, 100000, Vietnam
- Department of Cardiology, Hanoi Medical University, Hanoi, 100000, Vietnam
| | - Giang Song Tran
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, 100000, Vietnam
| | - Huyen Thi Thanh Vu
- Department of Geriatrics, Hanoi Medical University, Hanoi, 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, 100000, Vietnam
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Sanchis J, Bueno H, Miñana G, Guerrero C, Martí D, Martínez-Sellés M, Domínguez-Pérez L, Díez-Villanueva P, Barrabés JA, Marín F, Villa A, Sanmartín M, Llibre C, Sionís A, Carol A, García-Blas S, Calvo E, Morales Gallardo MJ, Elízaga J, Gómez-Blázquez I, Alfonso F, García del Blanco B, Núñez J, Formiga F, Ariza-Solé A. Effect of Routine Invasive vs Conservative Strategy in Older Adults With Frailty and Non-ST-Segment Elevation Acute Myocardial Infarction: A Randomized Clinical Trial. JAMA Intern Med 2023; 183:407-415. [PMID: 36877502 PMCID: PMC9989957 DOI: 10.1001/jamainternmed.2023.0047] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/09/2023] [Indexed: 03/07/2023]
Abstract
Importance To our knowledge, no randomized clinical trial has compared the invasive and conservative strategies in frail, older patients with non-ST-segment elevation acute myocardial infarction (NSTEMI). Objective To compare outcomes of invasive and conservative strategies in frail, older patients with NSTEMI at 1 year. Design, Setting, and Participants This multicenter randomized clinical trial was conducted at 13 Spanish hospitals between July 7, 2017, and January 9, 2021, and included 167 older adult (≥70 years) patients with frailty (Clinical Frailty Scale score ≥4) and NSTEMI. Data analysis was performed from April 2022 to June 2022. Interventions Patients were randomized to routine invasive (coronary angiography and revascularization if feasible; n = 84) or conservative (medical treatment with coronary angiography for recurrent ischemia; n = 83) strategy. Main Outcomes and Measures The primary end point was the number of days alive and out of the hospital (DAOH) from discharge to 1 year. The coprimary end point was the composite of cardiac death, reinfarction, or postdischarge revascularization. Results The study was prematurely stopped due to the COVID-19 pandemic when 95% of the calculated sample size had been enrolled. Among the 167 patients included, the mean (SD) age was 86 (5) years, and mean (SD) Clinical Frailty Scale score was 5 (1). While not statistically different, DAOH were about 1 month (28 days; 95% CI, -7 to 62) greater for patients managed conservatively (312 days; 95% CI, 289 to 335) vs patients managed invasively (284 days; 95% CI, 255 to 311; P = .12). A sensitivity analysis stratified by sex did not show differences. In addition, we found no differences in all-cause mortality (hazard ratio, 1.45; 95% CI, 0.74-2.85; P = .28). There was a 28-day shorter survival in the invasive vs conservatively managed group (95% CI, -63 to 7 days; restricted mean survival time analysis). Noncardiac reasons accounted for 56% of the readmissions. There were no differences in the number of readmissions or days spent in the hospital after discharge between groups. Neither were there differences in the coprimary end point of ischemic cardiac events (subdistribution hazard ratio, 0.92; 95% CI, 0.54-1.57; P = .78). Conclusions and Relevance In this randomized clinical trial of NSTEMI in frail older patients, there was no benefit to a routine invasive strategy in DAOH during the first year. Based on these findings, a policy of medical management and watchful observation is recommended for older patients with frailty and NSTEMI. Trial Registration ClinicalTrials.gov Identifier: NCT03208153.
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Affiliation(s)
- Juan Sanchis
- Cardiology Department, University Clinic Hospital of València, University of València, INCLIVA, CIBERCV, València, Spain
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain, Cardiology Department, Universisty Hospital 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, CIBERCV, Madrid, Spain, Complutense University, Madrid, Spain
| | - Gema Miñana
- Cardiology Department, University Clinic Hospital of València, University of València, INCLIVA, CIBERCV, València, Spain
| | - Carme Guerrero
- Cardiology Department, University Hospital of Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - David Martí
- Central Defense Hospital, Madrid, Alcalá University, Madrid, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, University Hospital Gregorio Marañón, CIBERCV, Complutense University, European University, Madrid, Spain
| | - Laura Domínguez-Pérez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain, Cardiology Department, Universisty Hospital 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, CIBERCV, Madrid, Spain, Complutense University, Madrid, Spain
| | - Pablo Díez-Villanueva
- University Hospital La Princesa, Autonomous University of Madrid, IIS-IP, CIBERCV Madrid, Spain
| | | | - Francisco Marín
- University Hospital Virgen de la Arrixaca, IMIB-Arrixaca, CIBERCV, El Palmar, Murcia, Spain
| | - Adolfo Villa
- Southeast University Hospital, Arganda del Rey, Madrid, Spain
| | | | - Cinta Llibre
- University Hospital Germans Trias i Pujol, CIBERCV, Badalona, Barcelona, Spain
| | | | - Antoni Carol
- Moisés Broggi Hospital, Sant Joan Despí, Barcelona, Spain
| | - Sergio García-Blas
- Cardiology Department, University Clinic Hospital of València, University of València, INCLIVA, CIBERCV, València, Spain
| | - Elena Calvo
- Cardiology Department, University Hospital of Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | | | - Jaime Elízaga
- Cardiology Department, University Hospital Gregorio Marañón, CIBERCV, Complutense University, European University, Madrid, Spain
| | - Iván Gómez-Blázquez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain, Cardiology Department, Universisty Hospital 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, CIBERCV, Madrid, Spain, Complutense University, Madrid, Spain
| | - Fernando Alfonso
- University Hospital La Princesa, Autonomous University of Madrid, IIS-IP, CIBERCV Madrid, Spain
| | | | - Julio Núñez
- Cardiology Department, University Clinic Hospital of València, University of València, INCLIVA, CIBERCV, València, Spain
| | - Francesc Formiga
- Cardiology Department, University Hospital of Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Albert Ariza-Solé
- Cardiology Department, University Hospital of Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
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Kodesh A, Bental T, Vaknin-Assa H, Talmor-Barkan Y, Codner P, Levi A, Kornowski R, Perl L. The independent impact of dementia in patients undergoing percutaneous coronary intervention for acute myocardial infarction. Clin Cardiol 2023; 46:279-286. [PMID: 36632766 PMCID: PMC10018096 DOI: 10.1002/clc.23967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/07/2022] [Accepted: 12/19/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Although age and frailty are associated with worse prognoses for patients who undergo percutaneous coronary intervention (PCI), little is known regarding the independent impact of dementia. HYPOTHESIS The aim of this study was to evaluate the association between dementia and outcomes for patients with acute myocardial infarction (AMI). METHODS Consecutive patients with ST-elevation or non-ST elevation MI who had undergone PCI as part of our AMI registry were included in this study. We compared outcomes within the 1-year period of their PCI, including death and major adverse cardiac events (MACE) and corrected for confounders using Cox regression. RESULTS Of 28 274 patients, 9167 patients who had undergone PCI for AMI were included in this study, 250 with dementia; Mean age (77.4 ± 9.4 in the dementia group vs. 63.6 ± 12.7 in the control), female gender (32.4 vs. 24.2%, p = .003), diabetes mellitus (54.0 vs. 42.4%, p < .001) and chronic kidney disease (44.4 vs. 19.3%, p < .001) were higher. At 12 months, unadjusted rates of death (25.5 vs. 9.8%, p < .001) and MACE (33.8 vs. 17.6%, p < .001) were higher for patients with dementia. After standardizing for confounding variables, dementia remained an independent risk factor for death (HR 1.90; CI 1.37-2.65; p < .001) and MACE (HR 1.73; CI 1.30-2.31; p < .001), as well as in propensity score matched analysis (HR 1.54; CI: 1.03-2.28; p < .001 and HR 1.49; CI: 1.09-2.02; p < .001, respectively). CONCLUSIONS Dementia is an independent predictor of worse outcomes in patients undergoing PCI for AMI. Future intervention and specialized healthcare measures to mitigate this risk is warranted.
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Affiliation(s)
- Afek Kodesh
- Cardiovascular Department, Rabin Medical Center, Beilinson Hospital, The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tamir Bental
- Cardiovascular Department, Rabin Medical Center, Beilinson Hospital, The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Hana Vaknin-Assa
- Cardiovascular Department, Rabin Medical Center, Beilinson Hospital, The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yeela Talmor-Barkan
- Cardiovascular Department, Rabin Medical Center, Beilinson Hospital, The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Pablo Codner
- Cardiovascular Department, Rabin Medical Center, Beilinson Hospital, The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amos Levi
- Cardiovascular Department, Rabin Medical Center, Beilinson Hospital, The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ran Kornowski
- Cardiovascular Department, Rabin Medical Center, Beilinson Hospital, The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Leor Perl
- Cardiovascular Department, Rabin Medical Center, Beilinson Hospital, The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Bai W, Hao B, Meng W, Qin J, Xu W, Qin L. Association between frailty and short- and long-term mortality in patients with critical acute myocardial infarction: Results from MIMIC-IV. Front Cardiovasc Med 2022; 9:1056037. [PMID: 36588580 PMCID: PMC9797732 DOI: 10.3389/fcvm.2022.1056037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
Background Frailty has been recognized as an important prognostic indicator in patients with acute myocardial infarction (AMI). However, no study has focused on critical AMI patients. We aimed to determine the impact of frailty on short- and long-term mortality risk in critical AMI patients. Methods Data from the Medical Information Mart for Intensive Care (MIMIC)-IV database was used. Frailty was assessed using the Hospital Frailty Risk Score (HFRS). Outcomes were in-hospital mortality and 1-year mortality. Logistic regression and Cox proportional-hazards models were used to investigate the association between frailty and outcomes. Results Among 5,003 critical AMI patients, 2,176 were non-frail (43.5%), 2,355 were pre-frail (47.1%), and 472 were frail (9.4%). The in-hospital mortality rate was 13.8%, and the 1-year mortality rate was 29.5%. In our multivariable model, frailty was significantly associated with in-hospital mortality [odds ratio (OR) = 1.30, 95% confidence interval (CI): 1.20-1.41] and 1-year mortality [hazard ratio (HR) = 1.29, 95% CI: 1.24-1.35] as a continuous variable (per five-score increase). When assessed as categorical variables, pre-frailty and frailty were both associated with in-hospital mortality (OR = 2.80, 95% CI: 2.19-3.59 and OR = 2.69, 95% CI: 1.93-3.73, respectively) and 1-year mortality (HR = 2.32, 95% CI: 2.00-2.69 and HR = 2.81, 95% CI: 2.33-3.39, respectively) after adjustment for confounders. Subgroup analysis showed that frailty was only associated with in-hospital mortality in critically ill patients with non-ST-segment elevation myocardial infarction (STEMI) but not STEMI (p for interaction = 0.012). In addition, frailty was associated with 1-year mortality in both STEMI and non-STEMI patients (p for interaction = 0.447). The addition of frailty produced the incremental value over the initial model generated by baseline characteristics for both in-hospital and 1-year mortality. Conclusion Frailty, as assessed by the HFRS, was associated with both in-hospital and 1-year mortality in critical AMI patients. Frailty improves the prediction of short- and long-term mortality in critical AMI patients and may have potential clinical applications.
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Affiliation(s)
- Weimin Bai
- Department of Emergency, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, China
| | - Benchuan Hao
- Medical School of Chinese People’s Liberation Army (PLA), Beijing, China,Department of Cardiology, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Wenwen Meng
- The Northern District of PLA General Hospital, Beijing, China
| | - Ji Qin
- Medical School of Chinese People’s Liberation Army (PLA), Beijing, China,Department of Cardiology, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Weihao Xu
- Haikou Cadre’s Sanitarium of Hainan Military Region, Haikou, China,*Correspondence: Weihao Xu,
| | - Lijie Qin
- Department of Emergency, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, China,Lijie Qin,
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Bai W, Hao B, Xu L, Qin J, Xu W, Qin L. Frailty index based on laboratory tests improves prediction of short-and long-term mortality in patients with critical acute myocardial infarction. Front Med (Lausanne) 2022; 9:1070951. [PMID: 36561712 PMCID: PMC9763273 DOI: 10.3389/fmed.2022.1070951] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
Background Previous studies have shown that the frailty index based on laboratory tests (FI-Lab) can identify older adults at increased risk of adverse health outcomes. This study aimed to determine whether the FI-Lab is associated with mortality risk and can provide incremental improvements in risk stratification of patients with critical acute myocardial infarction (AMI). Materials and methods We conducted a secondary analysis of data from the Medical Information Mart for Intensive Care (MIMIC)-IV database. A 33-item FI-Lab was constructed. Outcomes of interest were in-hospital and 1-year mortality. Logistic regression models were used to investigate the association between the FI-Lab and outcomes. For the assessment of the incremental predictive value, the FI-Lab was added to several risk stratification scoring systems for critically ill patients, and the following indices were calculated: Δ C-statistic, integrated discrimination improvement (IDI), and net reclassification improvement (NRI). Results Out of 2,159 patients, 477 died in hospital (22.1%), and 898 died during the 1-year follow-up period. After adjustment for confounders, the FI-Lab was associated with increased in-hospital mortality [odds ratio (OR) = 1.06, 95% confidence interval (CI): 1.05-1.07] and 1-year mortality (OR = 1.05, 95% CI: 1.04-1.06) when assessed as a continuous variable (per 0.01-score increase). When assessed as a categorical variable, the FI-Lab was associated with in-hospital mortality (2nd Quartile: OR = 1.89, 95% CI: 1.18-3.03; 3rd Quartile: OR = 3.46, 95% CI: 2.20-5.46; and 4th Quartile: OR = 5.79, 95% CI: 3.61-9.28 compared to 1st Quartile) as well as 1-year mortality (2nd Quartile: OR = 1.66, 95% CI: 1.23-2.24; 3rd Quartile: OR = 2.40, 95% CI: 1.76-3.26; and 4th Quartile: OR = 3.76, 95% CI: 2.66-5.30 compared to 1st Quartile) after adjustment for confounders. The addition of the FI-Lab to all disease severity scores improved discrimination and significantly reclassified in-hospital and 1-year mortality risk. Conclusion The FI-Lab was a strong predictor of short- and long-term mortality in patients with critical AMI. The FI-Lab improved the ability to predict mortality in patients with critical AMI and therefore might be useful in the clinical decision-making process.
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Affiliation(s)
- Weimin Bai
- Department of Emergency, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, China
| | - Benchuan Hao
- Medical School of Chinese PLA, Beijing, China,Department of Cardiology, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Lijun Xu
- Department of Emergency, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, China
| | - Ji Qin
- Medical School of Chinese PLA, Beijing, China,Department of Cardiology, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Weihao Xu
- Haikou Cadre’s Sanitarium of Hainan Military Region, Haikou, China,*Correspondence: Weihao Xu,
| | - Lijie Qin
- Department of Emergency, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, China,Lijie Qin,
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Influence of the Danish Co-morbidity Index Score on the Treatment and Outcomes of 2.5 Million Patients Admitted With Acute Myocardial Infarction in the United States. Am J Cardiol 2022; 179:1-10. [PMID: 35843732 DOI: 10.1016/j.amjcard.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 11/20/2022]
Abstract
This study aimed to determine the association between the Danish Co-morbidity Index for Acute Myocardial Infarction (DANCAMI) and restricted DANCAMI (rDANCAMI) scores and clinical outcomes in patients hospitalized with AMI. Using the National Inpatient Sample, all AMI hospitalizations were stratified into four groups based on their DANCAMI and rDANCAMI score (0; 1 to 3; 4 to 5; ≥6). The primary outcome was all-cause mortality, whereas secondary outcomes were major adverse cardiovascular/cerebrovascular events, major bleeding, ischemic stroke, and receipt of coronary angiography or percutaneous coronary intervention. Multivariate logistic regression was used to determine adjusted odds ratios (aOR) with 95% confidence intervals (95% CIs). Patients with DANCAMI risk score ≥6 were more likely to suffer mortality (aOR 2.30, 95% CI 2.24 to 2.37) and bleeding (aOR 5.85, 95% CI 5.52 to 6.21) and were less likely to receive coronary angiography (aOR 0.34, 95% CI 0.33 to 0.34) and percutaneous coronary intervention (aOR 0.29, 95% CI 0.28 to 0.29) compared with patients with DANCAMI score of 0. Similar results were observed for the rDANCAMI score. In conclusion, increased DANCAMI and rDANCAMI scores were associated with worse in-hospital outcomes in patients with AMI and lower odds of invasive management. The use of co-morbidity scores identifies patients at high risk of adverse outcomes and highlights disparities in care.
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He YY, Chang J, Wang XJ. Frailty as a predictor of all-cause mortality in elderly patients undergoing percutaneous coronary intervention: A systematic review and meta-analysis. Arch Gerontol Geriatr 2022; 98:104544. [DOI: 10.1016/j.archger.2021.104544] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/27/2021] [Accepted: 09/30/2021] [Indexed: 12/14/2022]
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García-Blas S, Bonanad C, Fernández-Cisnal A, Sastre-Arbona C, Ruescas-Nicolau MA, González D’Gregorio J, Valero E, Miñana G, Palau P, Tarazona-Santabalbina FJ, Ruiz Ros V, Núñez J, Sanchis J. Frailty Scales for Prognosis Assessment of Older Adult Patients after Acute Myocardial Infarction. J Clin Med 2021; 10:jcm10184278. [PMID: 34575389 PMCID: PMC8465296 DOI: 10.3390/jcm10184278] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/10/2021] [Accepted: 09/16/2021] [Indexed: 12/30/2022] Open
Abstract
We aimed to compare the prognostic value of two different measures, the Fried's Frailty Scale (FFS) and the Clinical Frailty Scale (CFS), following myocardial infarction (MI). We included 150 patients ≥ 70 years admitted from AMI. Frailty was evaluated on the day before discharge. The primary endpoint was number of days alive and out of hospital (DAOH) during the first 800 days. Secondary endpoints were mortality and a composite of mortality and reinfarction. Frailty was diagnosed in 58% and 34% of patients using the FFS and CFS scales, respectively. During the first 800 days 34 deaths and 137 admissions occurred. The number of DAOH decreased significantly with increasing scores of both FFS (p < 0.001) and CFS (p = 0.049). In multivariate analysis, only the highest scores (FFS = 5, CFS ≥ 6) were independently associated with fewer DAOH. At a median follow-up of 946 days, frailty assessed both by FFS and CFS was independently associated with death and MI (HR = 2.70 95%CI = 1.32-5.51 p = 0.001; HR = 2.01 95%CI = 1.1-3.66 p = 0.023, respectively), whereas all-cause mortality was only associated with FFS (HR = 1.51 95%CI = 1.08-2.10 p = 0.015). Frailty by FFS or CFS is independently associated with shorter number DAOH post-MI. Likewise, frailty assessed by either scale is associated with a higher rate of death and reinfarction, whereas FFS outperforms CFS for mortality prediction.
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Affiliation(s)
- Sergio García-Blas
- Cardiology Department, University Clinic Hospital of Valencia, 46010 Valencia, Spain; (S.G.-B.); (C.B.); (A.F.-C.); (C.S.-A.); (J.G.D.); (E.V.); (G.M.); (P.P.); (V.R.R.); (J.N.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Clara Bonanad
- Cardiology Department, University Clinic Hospital of Valencia, 46010 Valencia, Spain; (S.G.-B.); (C.B.); (A.F.-C.); (C.S.-A.); (J.G.D.); (E.V.); (G.M.); (P.P.); (V.R.R.); (J.N.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Department of Medicine, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain
| | - Agustín Fernández-Cisnal
- Cardiology Department, University Clinic Hospital of Valencia, 46010 Valencia, Spain; (S.G.-B.); (C.B.); (A.F.-C.); (C.S.-A.); (J.G.D.); (E.V.); (G.M.); (P.P.); (V.R.R.); (J.N.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Clara Sastre-Arbona
- Cardiology Department, University Clinic Hospital of Valencia, 46010 Valencia, Spain; (S.G.-B.); (C.B.); (A.F.-C.); (C.S.-A.); (J.G.D.); (E.V.); (G.M.); (P.P.); (V.R.R.); (J.N.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | | | - Jessika González D’Gregorio
- Cardiology Department, University Clinic Hospital of Valencia, 46010 Valencia, Spain; (S.G.-B.); (C.B.); (A.F.-C.); (C.S.-A.); (J.G.D.); (E.V.); (G.M.); (P.P.); (V.R.R.); (J.N.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Ernesto Valero
- Cardiology Department, University Clinic Hospital of Valencia, 46010 Valencia, Spain; (S.G.-B.); (C.B.); (A.F.-C.); (C.S.-A.); (J.G.D.); (E.V.); (G.M.); (P.P.); (V.R.R.); (J.N.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Gema Miñana
- Cardiology Department, University Clinic Hospital of Valencia, 46010 Valencia, Spain; (S.G.-B.); (C.B.); (A.F.-C.); (C.S.-A.); (J.G.D.); (E.V.); (G.M.); (P.P.); (V.R.R.); (J.N.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Department of Medicine, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain
| | - Patricia Palau
- Cardiology Department, University Clinic Hospital of Valencia, 46010 Valencia, Spain; (S.G.-B.); (C.B.); (A.F.-C.); (C.S.-A.); (J.G.D.); (E.V.); (G.M.); (P.P.); (V.R.R.); (J.N.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Department of Medicine, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain
| | | | - Vicente Ruiz Ros
- Cardiology Department, University Clinic Hospital of Valencia, 46010 Valencia, Spain; (S.G.-B.); (C.B.); (A.F.-C.); (C.S.-A.); (J.G.D.); (E.V.); (G.M.); (P.P.); (V.R.R.); (J.N.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Department of Medicine, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain
| | - Julio Núñez
- Cardiology Department, University Clinic Hospital of Valencia, 46010 Valencia, Spain; (S.G.-B.); (C.B.); (A.F.-C.); (C.S.-A.); (J.G.D.); (E.V.); (G.M.); (P.P.); (V.R.R.); (J.N.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Department of Medicine, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain
| | - Juan Sanchis
- Cardiology Department, University Clinic Hospital of Valencia, 46010 Valencia, Spain; (S.G.-B.); (C.B.); (A.F.-C.); (C.S.-A.); (J.G.D.); (E.V.); (G.M.); (P.P.); (V.R.R.); (J.N.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Department of Medicine, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain
- Correspondence:
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10
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García-Blas S, Cordero A, Diez-Villanueva P, Martinez-Avial M, Ayesta A, Ariza-Solé A, Mateus-Porta G, Martínez-Sellés M, Escribano D, Gabaldon-Perez A, Bodi V, Bonanad C. Acute Coronary Syndrome in the Older Patient. J Clin Med 2021; 10:4132. [PMID: 34575243 PMCID: PMC8467899 DOI: 10.3390/jcm10184132] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 01/21/2023] Open
Abstract
Coronary artery disease is one of the leading causes of morbidity and mortality, and its prevalence increases with age. The growing number of older patients and their differential characteristics make its management a challenge in clinical practice. The aim of this review is to summarize the state-of-the-art in diagnosis and treatment of acute coronary syndromes in this subgroup of patients. This comprises peculiarities of ST-segment elevation myocardial infarction (STEMI) management, updated evidence of non-STEMI therapeutic strategies, individualization of antiplatelet treatment (weighting ischemic and hemorrhagic risks), as well as assessment of geriatric conditions and ethical issues in decision making.
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Affiliation(s)
- Sergio García-Blas
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA Biomedical Research Institute, University of Valencia, 46010 Valencia, Spain; (S.G.-B.); (A.G.-P.); (V.B.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain; (A.C.); (M.M.-S.); (D.E.)
| | - Alberto Cordero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain; (A.C.); (M.M.-S.); (D.E.)
- Cardiology Department, Hospital Universitario de San Juan, 03550 Alicante, Spain
| | - Pablo Diez-Villanueva
- Cardiology Department, Hospital Universitario de La Princesa, 28006 Madrid, Spain; (P.D.-V.); (M.M.-A.)
| | - Maria Martinez-Avial
- Cardiology Department, Hospital Universitario de La Princesa, 28006 Madrid, Spain; (P.D.-V.); (M.M.-A.)
| | - Ana Ayesta
- Cardiology Department, Hospital Central de Asturias, 33011 Oviedo, Spain;
| | - Albert Ariza-Solé
- Cardiology Department, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.A.-S.); (G.M.-P.)
| | - Gemma Mateus-Porta
- Cardiology Department, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.A.-S.); (G.M.-P.)
| | - Manuel Martínez-Sellés
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain; (A.C.); (M.M.-S.); (D.E.)
- Cardiology Department, Hospital Universitario Gregorio Marañón, Universidad Europea, Universidad Complutense, 28007 Madrid, Spain
| | - David Escribano
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain; (A.C.); (M.M.-S.); (D.E.)
- Cardiology Department, Hospital Universitario de San Juan, 03550 Alicante, Spain
| | - Ana Gabaldon-Perez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA Biomedical Research Institute, University of Valencia, 46010 Valencia, Spain; (S.G.-B.); (A.G.-P.); (V.B.)
| | - Vicente Bodi
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA Biomedical Research Institute, University of Valencia, 46010 Valencia, Spain; (S.G.-B.); (A.G.-P.); (V.B.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain; (A.C.); (M.M.-S.); (D.E.)
| | - Clara Bonanad
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA Biomedical Research Institute, University of Valencia, 46010 Valencia, Spain; (S.G.-B.); (A.G.-P.); (V.B.)
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11
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Wang P, Zhang S, Zhang K, Tian J. Frailty Predicts Poor Prognosis of Patients After Percutaneous Coronary Intervention: A Meta-Analysis of Cohort Studies. Front Med (Lausanne) 2021; 8:696153. [PMID: 34490292 PMCID: PMC8416907 DOI: 10.3389/fmed.2021.696153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Frailty has been related to a higher risk of cardiovascular events, while the association between frailty and outcomes for patients with coronary artery disease (CAD) after percutaneous coronary intervention (PCI) remains unclear. We performed a meta-analysis of cohort studies to evaluate the above association. Methods: Cohort studies aiming to determine the potential independent association between frailty and clinical outcomes after PCI were identified by search of PubMed, Embase, and Web of Science databases from inception to February 22, 2021. A random-effects model that incorporates the possible heterogeneity among the included studies was used to combine the results. Results: Ten cohort studies with 7,449,001 patients were included. Pooled results showed that frailty was independently associated with higher incidence of all-cause mortality [adjusted risk ratio (RR) = 2.94, 95% confidence intervals (CI): 1.90-4.56, I 2 = 56%, P < 0.001] and major adverse cardiovascular events [(MACEs), adjusted RR = 2.11, 95% CI: 1.32-3.66, I 2 = 0%, P = 0.002]. Sensitivity analyses limited to studies including elderly patients showed consistent results (mortality: RR = 2.27, 95% CI: 1.51-3.41, I 2 = 23%, P < 0.001; MACEs: RR = 2.44, 95% CI: 1.44-4.31, I 2 = 0%, P = 0.001). Subgroup analyses showed that characteristics of study design, follow-up duration, or type of PCI did not seem to significantly affect the associations (P-values for subgroup analyses all >0.05). Conclusions: Frailty may be an independent risk factor of poor prognosis for patients with CAD after PCI.
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Affiliation(s)
- Peng Wang
- Department of Gerontology, Fuling Central Hospital of Chongqing City, Chongqing, China
| | - Shutang Zhang
- Department of Gerontology, Fuling Central Hospital of Chongqing City, Chongqing, China
| | - Ke Zhang
- Department of Gerontology, Fuling Central Hospital of Chongqing City, Chongqing, China
| | - Jie Tian
- Department of Gerontology, Fuling Central Hospital of Chongqing City, Chongqing, China
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12
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Sanchis J, García Acuña JM, Raposeiras S, Barrabés JA, Cordero A, Martínez-Sellés M, Bardají A, Díez-Villanueva P, Marín F, Ruiz-Nodar JM, Vicente-Ibarra N, Alonso Salinas GL, Rigueiro P, Abu-Assi E, Formiga F, Núñez J, Núñez E, Ariza-Solé A. Carga de comorbilidad y beneficio de la revascularización en ancianos con síndrome coronario agudo. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.06.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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13
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Rodríguez-Queraltó O, Guerrero C, Formiga F, Calvo E, Lorente V, Sánchez-Salado JC, Llaó I, Mateus G, Alegre O, Ariza-Solé A. Geriatric Assessment and In-Hospital Economic Cost of Elderly Patients With Acute Coronary Syndromes. Heart Lung Circ 2021; 30:1863-1869. [PMID: 34083151 DOI: 10.1016/j.hlc.2021.05.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/27/2021] [Accepted: 05/04/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Elderly patients with acute coronary syndromes (ACS) are at higher risk for complications and health care resources expenditure. No previous study has assessed the specific contribution of frailty and other geriatric syndromes to the in-hospital economic cost in this setting. METHOD Unselected patients with ACS aged ≥75 years were prospectively included. A comprehensive geriatric assessment was performed during hospitalisation. Hospitalisation-related cost per patient was calculated with an analytical accountability method, including hospital stay-related expenditures, interventions, and consumption of devices. Expenditure was expressed in Euros (2019). The contribution of geriatric syndromes and clinical factors to the economic cost was assessed with a linear regression method. RESULTS A total of 194 patients (mean age 82.6 years) were included. Mean length of hospital stay was 11.3 days. The admission-related economic cost was €6,892.15 per patient. Most of this cost was attributable to hospital length of stay (77%). The performance of an invasive strategy during the admission was associated with economic cost (p=0.008). Of all the ageing-related variables, comorbidity showed the most significant association with economic cost (p=0.009). Comorbidity, disability, nutritional risk, and frailty were associated with the hospital length of stay-related component of the economic cost. The final predictive model of economic cost included age, previous heart failure, systolic blood pressure, Killip class at admission, left main disease, and Charlson index. CONCLUSIONS Management of ACS in elderly patients is associated with a significant economic cost, mostly due to hospital length of stay. Comorbidity mostly contributes to in-hospital resources expenditure, as well as the severity of the coronary event.
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Affiliation(s)
| | - Carme Guerrero
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francesc Formiga
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Elena Calvo
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Victòria Lorente
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Isaac Llaó
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Gemma Mateus
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Oriol Alegre
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Albert Ariza-Solé
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
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14
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Tkacheva ON, Kotovskaya YV, Runihina NK, Frolova EV, Milto AS, Aleksanyan LA, Tyukhmenev EA, Shedrina AY, Rozanov AV, Ostapenko VS, Sharashkina NV, Eruslanova KA, Esenbekova EE, Fedin MA. Comprehensive geriatric assessment in elderly and senile patients with cardiovascular diseases. Expert opinion of the Russian Association of Gerontologists and Geriatricians. ACTA ACUST UNITED AC 2021; 61:71-78. [PMID: 34112078 DOI: 10.18087/cardio.2021.5.n1349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/01/2020] [Indexed: 11/18/2022]
Abstract
Senile asthenia syndrome (SAS) is a geriatric syndrome characterized by age-associated decline of the physiological reserve and function in multiple systems, which results in higher vulnerability to effects of endo- and exogenous factors and a high risk of unfavorable outcomes, loss of self-sufficiency, and death. Generally, SAS is observed in elderly patients with comorbidities. In cardiovascular diseases, SAS is associated with a poor prognosis, including a higher incidence of exacerbation and death both during acute events and in chronic disease. However, SAS is often not taken into account in developing diagnostic and therapeutic programs for managing elderly patients with cardiovascular diseases (CVD). This article analyzes available scientific information about SAS, algorithms for SAS diagnosis, and the scales that may be useful in developing individual plans for management of elderly patients with CVD.
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Affiliation(s)
- O N Tkacheva
- Pirogov Russian National Research Medical University, Russian Gerintology Research and Clinical Centre, Moscow, Russia
| | - Yu V Kotovskaya
- Pirogov Russian National Research Medical University, Russian Gerintology Research and Clinical Centre, Moscow, Russia
| | - N K Runihina
- Pirogov Russian National Research Medical University, Russian Gerintology Research and Clinical Centre, Moscow, Russia
| | - E V Frolova
- North-Western State Medical University named after I.I. Mechnikov
| | - A S Milto
- Moscow Regional Research and Clinical Institute (MONIKI) named after M.F. Vladimirskogo
| | - L A Aleksanyan
- Pirogov Russian National Research Medical University, Russian Gerintology Research and Clinical Centre, Moscow, Russia
| | - E A Tyukhmenev
- Moscow Regional Research and Clinical Institute (MONIKI) named after M.F. Vladimirskogo
| | - A Yu Shedrina
- Pirogov Russian National Research Medical University, Russian Gerintology Research and Clinical Centre, Moscow, Russia
| | - A V Rozanov
- Pirogov Russian National Research Medical University, Russian Gerintology Research and Clinical Centre, Moscow, Russia
| | - V S Ostapenko
- Pirogov Russian National Research Medical University, Russian Gerintology Research and Clinical Centre, Moscow, Russia
| | - N V Sharashkina
- Pirogov Russian National Research Medical University, Russian Gerintology Research and Clinical Centre, Moscow, Russia
| | - K A Eruslanova
- Pirogov Russian National Research Medical University, Russian Gerintology Research and Clinical Centre, Moscow, Russia
| | - E E Esenbekova
- Pirogov Russian National Research Medical University, Russian Gerintology Research and Clinical Centre, Moscow, Russia
| | - M A Fedin
- Pirogov Russian National Research Medical University, Russian Gerintology Research and Clinical Centre, Moscow, Russia
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15
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Sanchis J, Sastre C, Ruescas A, Ruiz V, Valero E, Bonanad C, García-Blas S, Fernández-Cisnal A, González J, Miñana G, Núñez J. Randomized Comparison of Exercise Intervention Versus Usual Care in Older Adult Patients with Frailty After Acute Myocardial Infarction. Am J Med 2021; 134:383-390.e2. [PMID: 33228950 DOI: 10.1016/j.amjmed.2020.09.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Older adult patients with frailty are rarely involved in rehabilitation programs after myocardial infarction. Our aim was to investigate the benefits of exercise intervention in these patients. METHODS A total of 150 survivors after acute myocardial infarction, ≥70 years and with pre-frailty or frailty (Fried scale ≥1 points), were randomized to control (n = 77) or intervention (n = 73) groups. The intervention consisted of a 3-month exercise program, under physiotherapist supervision, followed by an independent home-based program. The main outcome was frailty (Fried scale) at 3 months and 1 year. Secondary endpoints were clinical events (mortality or any readmission) at 1 year. RESULTS Mean age was 80 years (range = 70-96). In the intervention group, 44 (60%) out of 73 patients participated in the program and 23 (32%) completed it. Overall, there was a decrease in the Fried score in the intervention group at 3 months, with no effect at 1 year. However, in the intention-to-treat analysis, such change did not achieve statistical significance (P = 0.110). Only treatment comparisons made among the subgroups that participated in (P = 0.033) and completed (P = 0.018) the program achieved statistical significance. There were no differences in clinical events. Worse Fried score trajectory along follow-up increased mortality risk (hazard ratio [HR] = 2.38, 95% confidence interval [CI] 1.24-4.55, P = 0.009) CONCLUSIONS: Recruitment and retention for a physical program in older adult patients with frailty after myocardial infarction was challenging. Frailty status improved in the subgroup that participated in the program, although this benefit was attenuated after shifting to a home-based program. A better frailty trajectory might influence midterm prognosis. (ClinicalTrials.govNCT02715453).
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Affiliation(s)
- Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, Valencia, Spain.
| | - Clara Sastre
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, Valencia, Spain
| | - Arantxa Ruescas
- Departamento de Fisioterapia. Universidad de Valencia, Valencia, Spain
| | - Vicente Ruiz
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, Valencia, Spain
| | - Ernesto Valero
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, Valencia, Spain
| | - Clara Bonanad
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, Valencia, Spain
| | - Sergio García-Blas
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, Valencia, Spain
| | - Agustín Fernández-Cisnal
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, Valencia, Spain
| | - Jessika González
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, Valencia, Spain
| | - Gema Miñana
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, Valencia, Spain
| | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, Valencia, Spain
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16
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Long-Term Prognostic Value of Cognitive Impairment on Top of Frailty in Older Adults after Acute Coronary Syndrome. J Clin Med 2021; 10:jcm10030444. [PMID: 33498816 PMCID: PMC7865569 DOI: 10.3390/jcm10030444] [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: 01/05/2021] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 11/17/2022] Open
Abstract
Frailty is a marker of poor prognosis in older adults after acute coronary syndrome. We investigated whether cognitive impairment provides additional prognostic information. The study population consisted of a prospective cohort of 342 older (>65 years) adult survivors after acute coronary syndrome. Frailty (Fried score) and cognitive function (Pfeiffer's Short Portable Mental Status Questionnaire-SPMSQ) were assessed at discharge. The endpoints were mortality or acute myocardial infarction at 8.7-year median follow-up. Patient distribution according to SPMSQ results was: no cognitive impairment (SPMSQ = 0 errors; n = 248, 73%), mild impairment (SPMSQ = 1-2 errors; n = 52, 15%), and moderate to severe impairment (SPMSQ ≥3 errors; n = 42, 12%). A total of 245 (72%) patients died or had an acute myocardial infarction, and 216 (63%) patients died. After adjustment for clinical data, comorbidities, and Fried score, the SPMSQ added prognostic value for death or myocardial infarction (per number of errors; HR = 1.11, 95%, CI 1.04-1.19, p = 0.002) and death (HR = 1.11, 95% 1.03-1.20, p = 0.007). An SPMSQ with ≥3 errors identified the highest risk subgroup. Geriatric conditions (SPSMQ and Fried score) explained 19% and 43% of the overall chi-square of the models for predicting death or myocardial infarction and death, respectively. Geriatric assessment after acute coronary syndrome should include both frailty and cognitive function. This is particularly important given that cognitive impairment without dementia can be subclinical and thus remain undetected.
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Sanchis J, Ruiz V, Sastre C, Bonanad C, Ruescas A, Fernández-Cisnal A, Mollar A, Valero E, Blas SG, González J, Pernias V, Miñana G, Núñez J, Ariza-Solé A. Frailty Tools for Assessment of Long-term Prognosis After Acute Coronary Syndrome. Mayo Clin Proc Innov Qual Outcomes 2020; 4:642-648. [PMID: 33367209 PMCID: PMC7749270 DOI: 10.1016/j.mayocpiqo.2020.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective To evaluate the 5 components of the Fried frailty phenotype (self-reported unintentional weight loss, physical activity questionnaire, gait speed, grip strength, and self-reported exhaustion) for long-term outcomes in elderly survivors of acute coronary syndrome. Methods A total of 342 consecutive patients (from October 1, 2010, to February 1, 2012) were included. The 5 components of the Fried score and albumin concentration, as malnutrition index, were assessed before hospital discharge. Patients were followed up until April 2020 (median follow-up, 8.7 years). The end point was postdischarge all-cause mortality. Results Mean ± SD age was 77±7 years and mean ± SD Fried score was 2.0±1.1 points. A total of 216 (63%) patients died. After adjusting for clinical covariates, the Fried phenotype was associated with mortality (per points, hazard ratio [HR], 1.35; 95% CI, 1.17 to 1.57; P<.001). Among Fried components, physical activity (HR, 2.21; 95% CI, 1.34 to 3.65; P=.002) and gait speed (HR, 1.77; 95% CI, 1.29 to 2.43; P<.001) were the deficits independendtly associated with mortality. Albumin level provided further prognostic information (per increase in g/dL; HR, 0.63, 95% CI, 0.45 to 0.88; P=.007). The model adding the components of the Fried score and albumin level to the clinical model showed the highest risk reclassification (integrated discrimination improvement, 0.040; 95% CI, 0.018 to 0.075; P=.001; continuous net reclassification improvement, 0.291; 95% CI, 0.132 to 0.397; P=.001) in comparison with the model using clinical covariates alone. Conclusion Frailty assessment using the Fried phenotype has prognostic value for long-term mortality in elderly survivors of acute coronary syndrome. Physical activity and gait speed are the predictive components of the Fried score. Albumin level provides incremental prognostic information.
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Affiliation(s)
- Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Vicent Ruiz
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Clara Sastre
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Clara Bonanad
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Arancha Ruescas
- Departamento de Fisioterapia, Universidad de Valencia, Valencia, Spain
| | - Agustín Fernández-Cisnal
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Anna Mollar
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Ernesto Valero
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Sergio García Blas
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Jessika González
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Vicente Pernias
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Gema Miñana
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Albert Ariza-Solé
- Servicio de Cardiología, Hospital Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Sanchis J, García Acuña JM, Raposeiras S, Barrabés JA, Cordero A, Martínez-Sellés M, Bardají A, Díez-Villanueva P, Marín F, Ruiz-Nodar JM, Vicente-Ibarra N, Alonso Salinas GL, Rigueiro P, Abu-Assi E, Formiga F, Núñez J, Núñez E, Ariza-Solé A. Comorbidity burden and revascularization benefit in elderly patients with acute coronary syndrome. ACTA ACUST UNITED AC 2020; 74:765-772. [PMID: 32778402 DOI: 10.1016/j.rec.2020.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/11/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND OBJECTIVES To evaluate the interaction between comorbidity burden and the benefits of in-hospital revascularization in elderly patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). METHODS This retrospective study included 7211 patients aged ≥ 70 years from 11 Spanish NSTEACS registries. Six comorbidities were evaluated: diabetes, peripheral artery disease, cerebrovascular disease, chronic pulmonary disease, renal failure, and anemia. A propensity score was estimated to enable an adjusted comparison of in-hospital revascularization and conservative management. The end point was 1-year all-cause mortality. RESULTS In total, 1090 patients (15%) died. The in-hospital revascularization rate was 60%. Revascularization was associated with lower 1-year mortality; the strength of the association was unchanged by the addition of comorbidities to the model (HR, 0.61; 95%CI, 0.53-0.69; P=.0001). However, the effects of revascularization were attenuated in patients with renal failure, peripheral artery disease, and chronic pulmonary disease (P for interaction=.004, .007, and .03, respectively) but were not modified by diabetes, anemia, and previous stroke (P=.74, .51, and .28, respectively). Revascularization benefits gradually decreased as the number of comorbidities increased (from a HR of 0.48 [95%CI, 0.39-0.61] with 0 comorbidities to 0.83 [95%CI, 0.62-1.12] with ≥ 5 comorbidities; omnibus P=.016). The results were similar for the propensity score model. The same findings were obtained when invasive management was considered the exposure variable. CONCLUSIONS In-hospital revascularization improves 1-year mortality regardless of comorbidities in elderly patients with NSTEACS. However, the revascularization benefit is progressively reduced with an increased comorbidity burden. Renal failure, peripheral artery disease, and chronic lung disease were the comorbidities with the most detrimental effects on revascularization benefits.
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Affiliation(s)
- Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Jose María García Acuña
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Sergio Raposeiras
- Servicio de Cardiología. Hospital Álvaro Cunqueiro de Vigo, Vigo, Pontevedra, Spain
| | - Jose A Barrabés
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Alberto Cordero
- Servicio de Cardiología, Hospital Clínico Universitario de San Juan, Alicante, Spain
| | - Manuel Martínez-Sellés
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Universidad Complutense, Universidad Europea, Madrid, Spain
| | - Alfredo Bardají
- Servicio de Cardiología, Hospital Universitario de Tarragona Joan XXIII, IISPV, Universitat Rovira i Virgili, Tarragona, Spain
| | | | - Francisco Marín
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, El Palmar, Murcia, Spain
| | - Juan M Ruiz-Nodar
- Servicio de Cardiología, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Gonzalo L Alonso Salinas
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Ramón y Cajal de Madrid, Madrid, Spain
| | - Pedro Rigueiro
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Emad Abu-Assi
- Servicio de Cardiología. Hospital Álvaro Cunqueiro de Vigo, Vigo, Pontevedra, Spain
| | - Frances Formiga
- Servicio de Medicina Interna, Hospital Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Eduardo Núñez
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Albert Ariza-Solé
- Servicio de Cardiología, Hospital Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Zhang S, Meng H, Chen Q, Wang X, Zou J, Hao Q, Yang M, Wu J. Is frailty a prognostic factor for adverse outcomes in older patients with acute coronary syndrome? Aging Clin Exp Res 2020; 32:1435-1442. [PMID: 31489598 DOI: 10.1007/s40520-019-01311-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 08/06/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND There is very limited guidance in regard to how biological age should be estimated and how different comorbidity conditions influence the benefit-risk ration of interventions. Frailty is an important health-related problem in patients, especially in older adults. It is a reflection of biologic rather than chronologic age; frailty may explain why there remains substantial heterogeneity in clinical outcomes within the older patients' population. AIMS We aimed to review the prognostic value of frailty for adverse outcomes in older patients with acute coronary syndrome (ACS). METHODS Studies published until December 31, 2018, identified by systematic Medline, Embase, and Cochrane Controlled Register of Trials (CENTRAL) searches were reviewed for the association between frailty and mortality in older patients with ACS. We used the Newcastle-Ottawa Quality Assessment Scale to assess the quality of the included studies. We extracted the information of hazard ratios (HR) and odds ratios (OR) with accompanying 95% confidence intervals (CI), and P values of multivariable analysis. Heterogeneity across studies was determined using the Cochran Q value by Review Manager 5.3. RESULTS A total of 11 articles involving 7212 patients were included in this meta-analysis. Two studies (Sujino, Y 2015 and Alonso, S.GL 2016; n = 264) reported that frailty was significantly associated with in-hospital mortality in patients with ACS (range of reported OR between 6.38 and 12.0). We performed a subgroup analysis of the other nine studies based on differences in the follow-up time. Pooled meta-analysis demonstrates that frailty was associated with short-term, medium-term, and long-term mortality (HR = 3.67, 4.09, 1.66). There was no association between frailty and bleeding in older patients with ACS. CONCLUSIONS Frailty measured by Canadian Study of Health and Aging Clinical Frailty Scale (CSHA-CFS), the Edmonton Frail Scale (EFS), Fried score, Green scores, frailty instrument from the Survey of Health, Ageing and Retirement in Europe (SHARE-FI) index, and FRAIL (Fatigue, Resistance, Ambulation, Illnesses, Loss of weight) scale, leads to significantly higher mortality rates in older patients with ACS.
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Affiliation(s)
- Shaomin Zhang
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | | | - Qian Chen
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xiaoling Wang
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jiatong Zou
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Qiukui Hao
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ming Yang
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Jinhui Wu
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China.
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20
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Baechli C, Koch D, Bernet S, Gut L, Wagner U, Mueller B, Schuetz P, Kutz A. Association of comorbidities with clinical outcomes in patients after acute myocardial infarction. IJC HEART & VASCULATURE 2020; 29:100558. [PMID: 32566721 PMCID: PMC7298557 DOI: 10.1016/j.ijcha.2020.100558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/01/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Multimorbidity becomes more prevalent in patients admitted for acute myocardial infarction (AMI). We investigated the association of an increasing number of comorbidities with the excess risk of in-hospital mortality and other clinically outcomes in hospitalized AMI patients. METHODS In this population-based cohort study, we analyzed 104'906 admissions for AMI between 2012 and 2018 in Switzerland. We stratified patients based on four different age categories and investigated the association of the number of five common comorbidities (diabetes, chronic kidney-, chronic obstructive pulmonary-, cerebrovascular-, and peripheral artery disease) and risk of in-hospital mortality and other outcomes. RESULTS A total of 5'029 admitted AMI patients (4.8%) died during the hospital stay. We found a stepwise increase in mortality risk with each additional comorbidity. Compared to AMI patients with no comorbidity, comorbid patients had a 26% increased risk for mortality (adjusted odds ratio [OR] 1.26, 95% confidence interval [CI] 1.20 to 1.33) with a pronounced association in younger patients. The overall risk for ICU admission, prolonged length of hospital stay (LOS), and 30-day readmission was higher in comorbid patients as compared to those without a comorbidity of interest (ICU: OR 1.19, 95% CI 1.16 to 1.22; LOS: OR 1.84, 95% CI 1.79 to 1.89; Readmission: OR 1.23, 95% CI 1.19 to 1.28), respectively. Again, the association of the numbers of prevalent comorbidities with adverse outcomes was strongest in the youngest patient population. CONCLUSIONS In patients with AMI, the burden of comorbidities has a strong association with in-hospital mortality and other adverse outcomes - especially in younger patients.
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Affiliation(s)
- Ciril Baechli
- Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Daniel Koch
- Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Selina Bernet
- Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Lara Gut
- Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Ulrich Wagner
- Foundation National Institute for Cancer Epidemiology and Registration (NICER), University of Zurich, Zurich, Switzerland
| | - Beat Mueller
- Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Philipp Schuetz
- Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Alexander Kutz
- Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
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21
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FRAIL Scale also Predicts Long-Term Outcomes in Older Patients With Acute Coronary Syndromes. J Am Med Dir Assoc 2020; 21:683-687.e1. [DOI: 10.1016/j.jamda.2019.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/02/2019] [Accepted: 10/06/2019] [Indexed: 11/23/2022]
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22
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Xu W, Cai Y, Liu H, Fan L, Wu C. Frailty as a predictor of all-cause mortality and readmission in older patients with acute coronary syndrome : A systematic review and meta-analysis. Wien Klin Wochenschr 2020; 132:301-309. [PMID: 32342196 DOI: 10.1007/s00508-020-01650-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 03/28/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Evidence from longitudinal studies linking frailty and outcome after acute coronary syndrome (ACS) is mixed. This systematic review and meta-analysis aimed to examine whether frailty is a predictor of all-cause mortality and hospital readmission in older patients with ACS. METHODS A systematic search was carried out in PubMed, EMBASE and Web of Science databases for studies evaluating the association between frailty and outcomes in older patients with ACS. A meta-analysis was performed to determine the pooled effect estimate for the association between frailty and mortality and hospital readmission, respectively. RESULTS A total of 1459 articles were retrieved based on our search strategy. Fifteen studies involving 10,245 patients were included in the meta-analysis. The pooled prevalence of frailty was 32% (95% confidence interval [CI]: 25-39%), and the pooled prevalence of pre-frailty was 33% (95% CI: 26-40%) in elderly patients with ACS. Pooled analyses showed that frailty was associated with significantly higher risk of all-cause mortality and readmission (hazard ratios [HRs] = 2.43 and 2.32, respectively). Pre-frailty was also associated with significantly higher risk of all-cause mortality and readmission, respectively (HRs = 1.55 and 1.34, respectively). CONCLUSIONS Both frailty and pre-frailty are risk factors for all-cause mortality and readmission in older patients with ACS. Therefore, frailty assessment should be given sufficient attention in the management of older patients with ACS to help improve survival and reduce readmission rate.
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Affiliation(s)
- Weihao Xu
- Geriatric Cardiology Department of The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, 100853, Beijing, China
| | - Yulun Cai
- Geriatric Cardiology Department of The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, 100853, Beijing, China
| | - Hongbin Liu
- Geriatric Cardiology Department of The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, 100853, Beijing, China.
| | - Li Fan
- Geriatric Cardiology Department of The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, 100853, Beijing, China.
| | - Chenkai Wu
- Global Health Research Center, Duke Kunshan University, 215316, Kunshan, Jiangsu, China. .,Duke Global Health Institute, Duke University, Durham, NC, USA.
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Relation of Low Lymphocyte Count to Frailty and its Usefulness as a Prognostic Biomarker in Patients >65 Years of Age With Acute Coronary Syndrome. Am J Cardiol 2020; 125:1033-1038. [PMID: 31959430 DOI: 10.1016/j.amjcard.2020.01.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/02/2020] [Accepted: 01/03/2020] [Indexed: 12/26/2022]
Abstract
Low lymphocyte count, as a marker of inflammation and immunosuppression, may be useful for identifying frail patients. In this work, we aimed to evaluate the association between low-relative lymphocyte count (Lymph%) and frailty status in patients >65 years old with acute coronary syndromes (ACS), and whether Lymph% is associated with morbimortality beyond standard prognosticators and frailty. In this prospective observational study, we included 488 hospital survivors of an episode of an ACS >65 years old. Total and differential white blood cells and frailty status were assessed at discharge. Frailty was evaluated using the Fried score at discharge and defined as Fried≥3. The independent association between Lymph% and Fried≥3 was evaluated by multivariate logistic regression analysis. The associations between Lymph% with long-term all-cause mortality and recurrent admission were evaluated with Cox regression and shared frailty regression, respectively. The mean age of the sample was 78 ± 7 years and 41% were females. The median (interquartile range) of the Lymph% was 21% (15 to 27) and 41% showed Fried≥3. In multivariate analysis, Lymph% was inversely related to the odds of frailty with an exponential increase risk from values below 15% (p = 0.001). Likewise, Lymph% was inverse and independently associated with a higher risk of long-term mortality (p = 0.011), recurrent all-cause (p = 0.020), and cardiovascular readmissions (p = 0.024). In conclusion, in patients >65 years with a recent ACS, low Lymph% evaluated at discharge is associated with a higher risk of frailty. Low Lymph% was also associated with a higher risk of long-term mortality and recurrent admissions beyond standard prognosticators and Fried score.
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Brucato A, Ferrari A, Tiraboschi M, Zucchi A, Cogliati C, Torzillo D, Dentali F, Tavecchia L, Gessi V, Squizzato A, Moretti S, Permunian ET, Carobbio A, Pasina L, De Stefano F, Tombetti E, Cumetti D, Tognoni G, Barbui T. Three-month mortality in permanently bedridden medical non-oncologic patients. The BECLAP study (permanently BEdridden, creatinine CLearance, albumin, previous hospital admissions study). Eur J Intern Med 2020; 72:60-66. [PMID: 31757579 DOI: 10.1016/j.ejim.2019.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/18/2019] [Accepted: 10/12/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To predict the 3-months mortality in permanently bedridden medical non-oncologic inpatients. PATIENTS AND METHODS 2788 consecutive patients admitted in 5 Italian Internal Medicine units from January 2016 through January 2017 were prospectively screened; 644 oncologic patients were excluded; 2144 non-oncologic patients (1021 female) were followed-up for mortality for 6 months. Main outcome was 3-months mortality in permanently bedridden inpatients with at least 2 of: creatinine clearance <35 ml/min; albumin < 2.5 g/dl; at least 2 hospital admissions in the previous 6 months. Advanced dementia and dysphagia were also recorded. RESULTS Mean age of the 2144 patients was 73.9 (SD, 14.9) years; 374 (17%) were permanently bedridden, 435 (20%) had a creatinine clearance <35 ml/min, 217 (10%) albumin <2,5 g/dl, 112 (5%) at least 2 hospital admissions in the previous 6 months. Seventy-seven (4%) patients were permanently bedridden with at least 2 of the above mentioned items, and 48 of them died within 3 months (62%) (p < 0.001;95% CI 51-73%). Regression coefficients of the variables associated with 3-months mortality in multivariate analysis in 998 patients of unit 1 (training cohort) were used to create a simple score, which was validated in the 1146 patients of the other units (validation cohort) and performed well in predicting the 3-months mortality (https://www.ejcrim.com/beclap/). CONCLUSIONS Approximately two out of three non-oncologic medical patients permanently bedridden having 2 of the abovementioned items are dead 3 months after index admission; a simple score including bedridden status, creatinine clearance, albumin, dysphagia, age and sex may help discuss management priorities.
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Affiliation(s)
- Antonio Brucato
- Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi d Milano, Ospedale Fatebenefratelli, Italy; Ospedale Papa Giovanni XXIII, Bergamo, Italy.
| | - Alberto Ferrari
- Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | - Mara Tiraboschi
- Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi d Milano, Ospedale Fatebenefratelli, Italy
| | - Alberto Zucchi
- Epidemiology Unit, Health Protection Agency, Bergamo, Italy
| | - Chiara Cogliati
- Internal Medicine Department, L. Sacco Hospital, ASST fbf-sacco, Milan, Italy
| | - Daniela Torzillo
- Internal Medicine Department, L. Sacco Hospital, ASST fbf-sacco, Milan, Italy
| | - Francesco Dentali
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Luca Tavecchia
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Vera Gessi
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | - Sara Moretti
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | | | - Luca Pasina
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Fabio De Stefano
- Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi d Milano, Ospedale Fatebenefratelli, Italy
| | | | - Davide Cumetti
- Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi d Milano, Ospedale Fatebenefratelli, Italy
| | - Gianni Tognoni
- Dipartimento di Anestesia-Rianimazione e Emergenza Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Tiziano Barbui
- Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy.
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25
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Fukui S, Kawakami M, Otaka Y, Ishikawa A, Yashima F, Hayashida K, Oguma Y, Fukuda K, Liu M. Preoperative Instrumental Activities of Daily Living Predicts Survival After Transcatheter Aortic Valve Implantation. Circ Rep 2020; 2:83-88. [PMID: 33693212 PMCID: PMC7929760 DOI: 10.1253/circrep.cr-19-0109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background:
This aim of this study was to clarify prognosis after transcatheter aortic valve implantation (TAVI) in patients with aortic stenosis (AS) and to identify baseline factors associated with mortality. Methods and Results:
We prospectively enrolled 257 consecutive elderly persons with AS who were referred to Keio University Hospital and who underwent assessment of cardiac, physical (walking speed), cognitive, and renal functions, nutritional status, activities of daily living (ADL), instrumental ADL (IADL) assessed with the Frenchay activities index (FAI), and comorbidities. The primary outcome was postoperative death. Differences in basic characteristics were compared between a group that survived for a median of 661 days (IQR, 0–1,289 days) after TAVI and a group that did not. Multivariate hazard ratios (HR) were calculated for independent factors selected in Cox proportional hazard models. Thirty-one individuals died during follow-up. Walking speed was significantly faster (0.87±0.25 vs. 0.70±0.24 m/s, P<0.001) and FAI was significantly higher (21.2±8.0 vs. 15.7±8.0, P=0.026) in the survival group compared with those who died. Multivariate HR for mortality according to walking speed was 0.05 (95% CI: 0.028–0.091) in model 1 and 0.04 (95% CI: 0.020–0.081) in model 2, and those for FAI were 0.94 (95% CI: 0.92–0.95) and 0.92 (95% CI: 0.90–0.92), respectively. Conclusions:
Preoperative walking speed and IADL are crucial factors associated with prognosis after TAVI even after adjustment.
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Affiliation(s)
- Shogo Fukui
- Department of Rehabilitation Medicine, Keio University School of Medicine Tokyo Japan.,Graduate School of Health Management, Keio University Tokyo Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Keio University School of Medicine Tokyo Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University Toyoake Japan
| | - Aiko Ishikawa
- Department of Rehabilitation Medicine, Keio University School of Medicine Tokyo Japan
| | - Fumiaki Yashima
- Department of Cardiology, Keio University School of Medicine Tokyo Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine Tokyo Japan
| | - Yuko Oguma
- Graduate School of Health Management, Keio University Tokyo Japan.,Sports Medicine Research Center, Keio University Tokyo Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine Tokyo Japan
| | - Meigen Liu
- Department of Rehabilitation Medicine, Keio University School of Medicine Tokyo Japan
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Ariza-Solé A, Lorente V, Formiga F, López-Palop R, Sanchís J, Marín F, Vidán MT, Martínez-Sellés M, Sánchez-Salado JC, Garay A, Guerrero C, Bueno H, Alegre O, Abu-Assi E, Cequier À. Prognostic impact of anemia according to frailty status in elderly patients with acute coronary syndromes. J Cardiovasc Med (Hagerstown) 2020; 21:27-33. [DOI: 10.2459/jcm.0000000000000884] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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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.
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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
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Gual M, Formiga F, Ariza-Solé A, López-Palop R, Sanchís J, Marín F, Vidán MT, Martínez-Sellés M, Sionis A, Sánchez-Salado JC, Lorente V, Díez-Villanueva P, Vives-Borrás M, Cordero A, Bueno H, Alegre O, Abu-Assi E, Cequier À. Diabetes mellitus, frailty and prognosis in very elderly patients with acute coronary syndromes. Aging Clin Exp Res 2019; 31:1635-1643. [PMID: 30671867 DOI: 10.1007/s40520-018-01118-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 12/31/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND The magnitude of the association between diabetes (DM) and outcomes in elderly patients with acute coronary syndromes (ACS) is controversial. No study assessed the prognostic impact of DM according to frailty status in these patients. METHODS The LONGEVO-SCA registry included unselected ACS patients aged ≥ 80 years. Frailty was assessed by the FRAIL scale. We evaluated the impact of previous known DM on the incidence of death or readmission at 6 months according to status frailty by the Cox regression method. RESULTS A total of 532 patients were included. Mean age was 84.3 years, and 212 patients (39.8%) had previous DM diagnosis. Patients with DM had more comorbidities and higher prevalence of frailty (33% vs 21.9%, p = 0.002). The incidence of death or readmission at 6 months was higher in patients with DM (HR 1.52, 95% CI 1.12-2.05, p 0.007), but after adjusting for potential confounders this association was not significant. The association between DM and outcomes was not significant in robust patients, but it was especially significant in patients with frailty [HR 1.72 (1.05-2.81), p = 0.030, p value for interaction = 0.049]. CONCLUSIONS About 40% of elderly patients with ACS had previous known DM diagnosis. The association between DM and outcomes was different according to frailty status.
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Affiliation(s)
- Miquel Gual
- Cardiology Department, Bellvitge University Hospital, Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Francesc Formiga
- Cardiology Department, Bellvitge University Hospital, Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Albert Ariza-Solé
- Cardiology Department, Bellvitge University Hospital, Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
| | | | - Juan Sanchís
- Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBER-CV, Valencia, Spain
| | - Francisco Marín
- Hospital Virgen de la Arrixaca, IMIB-Arrixaca, CIBER-CV, Murcia, Spain
| | - María T Vidán
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Manuel Martínez-Sellés
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
- CIBERCV, Universidad Complutense, Universidad Europea, Madrid, Spain
| | - Alessandro Sionis
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José C Sánchez-Salado
- Cardiology Department, Bellvitge University Hospital, Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Victòria Lorente
- Cardiology Department, Bellvitge University Hospital, Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | | | - Miquel Vives-Borrás
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Héctor Bueno
- Hospital Doce de Octubre, Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Oriol Alegre
- Cardiology Department, Bellvitge University Hospital, Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | | | - Àngel Cequier
- Cardiology Department, Bellvitge University Hospital, Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
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Sanchis J, Ruiz V, Bonanad C, Sastre C, Ruescas A, Díaz M, Rodríguez E, Valero E, García-Blas S, Carratalá A, Núñez E, Núñez J. Growth differentiation factor 15 and geriatric conditions in acute coronary syndrome. Int J Cardiol 2019; 290:15-20. [PMID: 31130280 DOI: 10.1016/j.ijcard.2019.05.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/11/2019] [Accepted: 05/15/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Growth differentiation factor 15 (GDF-15) is a marker of cell senescence. Age is a well-known determinant of GDF-15 levels, yet no study has analyzed the relationship between geriatric conditions and GDF-15. We hypothesize that geriatric conditions reflecting biological age might be stronger determinants of GDF-15 than chronological age in elderly patients with acute coronary syndrome. METHODS A total of 208 patients (mean age = 78.3 ± 7.0 years) were included. Prior to discharge, a thorough geriatric assessment was performed and GDF-15 measured. Predictors of GDF-15 (transformed by its natural logarithm) were determined with linear regression. Furthermore, Cox regression was used for the analysis of all-cause mortality. The median follow-up was 728 days. RESULTS Median GDF-15 concentration was 2432 pg/ml. In multivariate analysis, frailty (Fried score, p = 0.001), and comorbidity (Charlson index, p = 0.003) were independent determinants of lnGDF-15 while age was not significant (p = 0.17). Other covariates included in the model were male gender (p = 0.017), diabetes (p = 0.169), Killip class ≥2 (p = 0.046) and glomerular filtration rate (p = 0.001). The Fried score and Charlson index provided significant incremental value in the R2 model (0.362 vs 0.447; p = 0.0001). A total of 66 (32%) patients died. LnGDF-15 was a significant mortality predictor (HR = 1.82, 95% CI 1.12-2.94, p = 0.015) along with the Fried score (p = 0.013) and the Charlson index (p = 0.030). CONCLUSIONS Geriatric conditions are strong determinants of GDF-15 levels on top of age in acute coronary syndromes. Furthermore, GDF-15 was associated with mortality independently of geriatric status. Geriatric assessment and GDF-15 are complementary tools.
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Affiliation(s)
- Juan Sanchis
- Servei de Cardiologia, Hospital Clínic Universitari de València, INCLIVA, Universitat de València, CIBERCV, València, Spain.
| | - Vicente Ruiz
- Facultat d'Infermeria, Universitat de València, València, Spain
| | - Clara Bonanad
- Servei de Cardiologia, Hospital Clínic Universitari de València, INCLIVA, Universitat de València, CIBERCV, València, Spain
| | - Clara Sastre
- Servei de Cardiologia, Hospital Clínic Universitari de València, INCLIVA, Universitat de València, CIBERCV, València, Spain
| | - Arantxa Ruescas
- Departament de Fisioteràpia, Universitat de València, València, Spain
| | - Macarena Díaz
- Servei de Bioquímica Clínica, Hospital Clínic Universitari de València, València, Spain
| | - Enrique Rodríguez
- Servei de Bioquímica Clínica, Hospital Clínic Universitari de València, València, Spain
| | - Ernesto Valero
- Servei de Cardiologia, Hospital Clínic Universitari de València, INCLIVA, Universitat de València, CIBERCV, València, Spain
| | - Sergio García-Blas
- Servei de Cardiologia, Hospital Clínic Universitari de València, INCLIVA, Universitat de València, CIBERCV, València, Spain
| | - Arturo Carratalá
- Servei de Bioquímica Clínica, Hospital Clínic Universitari de València, València, Spain
| | - Eduardo Núñez
- Servei de Cardiologia, Hospital Clínic Universitari de València, INCLIVA, Universitat de València, CIBERCV, València, Spain
| | - Julio Núñez
- Servei de Cardiologia, Hospital Clínic Universitari de València, INCLIVA, Universitat de València, CIBERCV, València, Spain
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Sanchis J, Ruiz V, Ariza-Solé A, Ruescas A, Bonanad C, Núñez J. Combining Disability and Frailty in an Integrated Scale for Prognostic Assessment After Acute Coronary Syndrome. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2019; 72:430-431. [PMID: 29857973 DOI: 10.1016/j.rec.2018.04.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 04/23/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Juan Sanchis
- Servei de Cardiologia, Hospital Clínic Universitari, Institut d'Investigació Sanitària Clínic València (INCLIVA), Universitat de València, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Valencia, Spain.
| | - Vicente Ruiz
- Facultat d'Infermeria, Universitat de València, Valencia, Spain
| | - Albert Ariza-Solé
- Servei de Cardiologia, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Arantxa Ruescas
- Departament de Fisioteràpia, Universitat de València, Valencia, Spain
| | - Clara Bonanad
- Servei de Cardiologia, Hospital Clínic Universitari, Institut d'Investigació Sanitària Clínic València (INCLIVA), Universitat de València, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Valencia, Spain
| | - Julio Núñez
- Servei de Cardiologia, Hospital Clínic Universitari, Institut d'Investigació Sanitària Clínic València (INCLIVA), Universitat de València, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Valencia, Spain
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Combinación de discapacidad y fragilidad en una escala integrada para la valoración pronóstica después de un síndrome coronario agudo. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.04.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Sanchis J, Soler M, Núñez J, Ruiz V, Bonanad C, Formiga F, Valero E, Martínez-Sellés M, Marín F, Ruescas A, García-Blas S, Miñana G, Abu-Assi E, Bueno H, Ariza-Solé A. Comorbidity assessment for mortality risk stratification in elderly patients with acute coronary syndrome. Eur J Intern Med 2019; 62:48-53. [PMID: 30711360 DOI: 10.1016/j.ejim.2019.01.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/18/2019] [Accepted: 01/29/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND The Charlson's is the most used comorbidity index. It comprises 19 comorbidities, some of which are infrequent in elderly patients with acute coronary syndrome (ACS), while some others are manifestations of cardiac disease rather than comorbidities. Our goal was to simplify comorbidity assessment in elderly non-ST-segment elevation ACS patients. METHODS The study group consisted of 1 training (n = 920, 76 ± 7 years) and 1 testing (n = 532; 84 ± 4 years) cohorts. The end-point was all-cause mortality at 1-year follow-up. Comorbidities were assessed selecting those medical disorders other than cardiac disease that were independently associated with mortality by multivariable analysis. RESULTS A total of 130 (14%) patients died in the training cohort. Six comorbidities were predictive: renal failure, anemia, diabetes, peripheral artery disease, cerebrovascular disease and chronic lung disease. The increase in the number of comorbidities yielded a gradient of risk on top of well-known clinical predictors: ≥3 comorbidities (27% mortality, HR = 1.90, 95% CI 1.20-3.03, p = .006); 2 comorbidities (16% mortality, HR = 1.29, 95% CI 0.81-2.04, p = .30); and 0-1 comorbidities (7.6% mortality, reference category). The discrimination accuracy (C-statistic = 0.80) and calibration (Hosmer-Lemeshow test, p = .20) of the predictive model using the 6 comorbidities was comparable to the predictive model using the Charlson index (C-statistic = 0.80; Hosmer-Lemeshow test, p = .70). Similar results were reproduced in the testing cohort (≥3 comorbidities: 24% mortality, HR = 2.37, 95% CI 1.25-4.49, p = .008; 2 comorbidities: 14% mortality, HR = 1.59, 95% CI 0.82-3.07, p = .20; 0-1 comorbidities: 7.5% reference category). CONCLUSION A simplified comorbidity assessment comprising 6 comorbidities provides useful risk stratification in elderly patients with ACS.
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Affiliation(s)
- Juan Sanchis
- Servei de Cardiologia, Hospital Clínic Universitari de València, INCLIVA, Universitat de València, CIBERCV, València, Spain.
| | - Meritxell Soler
- Servei de Cardiologia, Hospital Clínic Universitari de València, INCLIVA, Universitat de València, CIBERCV, València, Spain
| | - Julio Núñez
- Servei de Cardiologia, Hospital Clínic Universitari de València, INCLIVA, Universitat de València, CIBERCV, València, Spain
| | - Vicente Ruiz
- Facultat d'Infermeria, Universitat de València, València, Spain
| | - Clara Bonanad
- Servei de Cardiologia, Hospital Clínic Universitari de València, INCLIVA, Universitat de València, CIBERCV, València, Spain
| | - Francesc Formiga
- Unitat de Medicina Geriàtrica, Servei de medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ernesto Valero
- Servei de Cardiologia, Hospital Clínic Universitari de València, INCLIVA, Universitat de València, CIBERCV, València, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Universidad Complutense, Universidad Europea, Madrid, Spain
| | - Francisco Marín
- Servicio de Cardiologı'a, Hospital Virgen de la Arrixaca, IMIB-Arrixaca, CIBERCV, El Palmar, Murcia, Spain
| | - Arancha Ruescas
- Departament de Fisioteràpia, Universitat de València, València, Spain
| | - Sergio García-Blas
- Servei de Cardiologia, Hospital Clínic Universitari de València, INCLIVA, Universitat de València, CIBERCV, València, Spain
| | - Gema Miñana
- Servei de Cardiologia, Hospital Clínic Universitari de València, INCLIVA, Universitat de València, CIBERCV, València, Spain
| | - Emad Abu-Assi
- Servicio de Cardiologia, Hospital Alvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Héctor Bueno
- Servicio de Cardiología, Hospital 12 de Octubre, Madrid, Spain
| | - Albert Ariza-Solé
- Servei de Cardiologia, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Frequency of Renal Dysfunction and Frailty in Patients ≥80 Years of Age With Acute Coronary Syndromes. Am J Cardiol 2019; 123:729-735. [PMID: 30593340 DOI: 10.1016/j.amjcard.2018.11.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 11/14/2018] [Accepted: 11/20/2018] [Indexed: 11/22/2022]
Abstract
Although a significant association between renal function and outcomes in patients with acute coronary syndromes (ACS) has been consistently described, little information exists about the magnitude of this association in patients at older ages. No study assessed the prognostic role of renal function according to frailty in patients with ACS. The LONGEVO-SCA registry included unselected ACS patients aged ≥80 years. Frailty was asessesed by the FRAIL scale, and baseline creatinine clearance was calculated by the Cockroff-Gault formula. We evaluated the impact of renal function on mortality or readmission at 6-months according to frailty status by the Cox regression method. A total of 473 patients were assessed, with a mean age of 84.2 years. The distribution of patients across estimated glomerular filtration rate (eGFR) subgroups was as follows: (1) <30 ml/min: n = 76 (16.1%); (2) 30 to 44 ml/min: n = 147 (31.1%); (3) 45 to 60 ml/min: n = 136 (28.8%); and (4) >60 ml/min: n = 114 (24.1%). Patients with lower eGFR values were older, had a higher proportion of comorbidities and other geriatric syndromes (p = 0.001) and underwent less often an invasive management during admission (p < 0.001). The incidence of mortality or readmission at 6 months progressively increased across renal function subgroups (p = 0.001). After adjusting for potential confounders, this association became nonsignificant (p = 0.802). The association between eGFR and outcomes was only significant in patients without frailty (p = 0.001). In conclusion, most patients aged ≥80 years with NSTEACS had renal function impairment at admission. The association between renal function and outcomes was different according to frailty status.
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Estrategia invasiva frente a conservadora en pacientes frágiles con IAMSEST. Diseño del ensayo clínico MOSCA-FRAIL. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.01.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Díez-Villanueva P, Arizá-Solé A, Vidán MT, Bonanad C, Formiga F, Sanchis J, Martín-Sánchez FJ, Ruiz Ros V, Sanmartín Fernández M, Bueno H, Martínez-Sellés M. Recomendaciones de la Sección de Cardiología Geriátrica de la Sociedad Española de Cardiología para la valoración de la fragilidad en el anciano con cardiopatía. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.06.015] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Díez-Villanueva P, Arizá-Solé A, Vidán MT, Bonanad C, Formiga F, Sanchis J, Martín-Sánchez FJ, Ruiz Ros V, Sanmartín Fernández M, Bueno H, Martínez-Sellés M. Recommendations of the Geriatric Cardiology Section of the Spanish Society of Cardiology for the Assessment of Frailty in Elderly Patients With Heart Disease. ACTA ACUST UNITED AC 2018; 72:63-71. [PMID: 30269913 DOI: 10.1016/j.rec.2018.06.035] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/25/2018] [Indexed: 12/27/2022]
Abstract
Frailty is an age-associated clinical syndrome characterized by a decrease in physiological reserve in situations of stress, constituting a state of vulnerability that involves a higher risk of adverse events. Its prevalence in Spain is high, especially in elderly individuals with comorbidity and chronic diseases. In cardiovascular disease, frailty is associated worse clinical outcomes and higher morbidity and mortality in all scenarios, in both acute and chronic settings, and could consequently influence diagnosis and treatment. However, frailty is often not addressed or included when planning the management of elderly patients with heart disease. In this article, we review the available scientific evidence and highlight the most appropriate scales for the measurement and assessment of frailty, some of which are more useful and have better predictive capacity than others, depending on the clinical context. We also underline the importance of properly identifying and assessing frailty in order to include it in the treatment and care plan that best suits each patient.
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Affiliation(s)
| | - Albert Arizá-Solé
- Servicio de Cardiología, Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - María Teresa Vidán
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Clara Bonanad
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Francesc Formiga
- Programa de Geriatría, Servicio de Medicina Interna, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Juan Sanchis
- Servei de Cardiologia, Hospital Clínic Universitari, INCLIVA, Universitat de València, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Valencia, Spain
| | - F Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Vicente Ruiz Ros
- Servei de Cardiologia, Hospital Clínic Universitari, INCLIVA, Universitat de València, Valencia, Spain
| | | | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain; Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Universidad Complutense de Madrid, Universidad Europea de Madrid, Madrid, Spain
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Adamski P, Adamska U, Ostrowska M, Navarese EP, Kubica J. Evaluating current and emerging antithrombotic therapy currently available for the treatment of acute coronary syndrome in geriatric populations. Expert Opin Pharmacother 2018; 19:1415-1425. [PMID: 30132731 DOI: 10.1080/14656566.2018.1510487] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Acute coronary syndromes (ACS) represent one of the most perilous presentations of ischemic heart disease. Temporal trends clearly demonstrate that ACS occur later and later in life. Elderly patients with ACS comprise a populous and growing group, with more than half of individuals presenting with myocardial infarction being 75 years or older. Nevertheless, geriatric patients are greatly underrepresented in the landmark ACS trials evaluating innovative pharmacological strategies. AREAS COVERED The authors critically summarize recently published research on contemporary and emerging antithrombotic therapy for the treatment of ACS in geriatric patients. EXPERT OPINION Elderly ACS patients are characterized by simultaneously increased risk of cardiovascular events and bleeding. Very few studies assessing the efficacy and safety of novel ACS pharmacotherapy in geriatric patients are currently available. Guidelines on the treatment of ACS are based on the overall results of major randomized clinical trials (RCTs), and data supporting the recommended therapy in elderly mainly derive from subanalyses of these RCTs. Properly designed and powered RCTs are necessary to properly evaluate the net effect of current and emerging pharmacotherapy in geriatric patients. Until such data are available, elderly ACS patients should receive treatment according to the general recommendations.
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Affiliation(s)
- Piotr Adamski
- a Collegium Medicum , Nicolaus Copernicus University , Bydgoszcz , Poland
| | - Urszula Adamska
- a Collegium Medicum , Nicolaus Copernicus University , Bydgoszcz , Poland
| | | | - Eliano Pio Navarese
- a Collegium Medicum , Nicolaus Copernicus University , Bydgoszcz , Poland.,b Interventional Cardiology and Cardiovascular Medicine Research, Inova Center for Thrombosis Research and Drug Development , Inova Heart and Vascular Institute , Falls Church , VA , USA.,c SIRIO MEDICINE Research Network, Inova Heart and Vascular Institute, Inova Center for Thrombosis Research and Drug Development , Fairfax , VA , USA
| | - Jacek Kubica
- a Collegium Medicum , Nicolaus Copernicus University , Bydgoszcz , Poland
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Yamada S, Adachi T, Izawa H, Murohara T, Kondo T. A multicenter prospective cohort study to develop frailty-based prognostic criteria in heart failure patients (FLAGSHIP): rationale and design. BMC Cardiovasc Disord 2018; 18:159. [PMID: 30071828 PMCID: PMC6090927 DOI: 10.1186/s12872-018-0897-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 07/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Heart failure (HF) and frailty often co-exist, and frailty in HF results in a poor prognosis. However, in Asian populations, prognostic criteria are needed to examine the effect of frailty on HF. Therefore, we conducted a nationwide cohort study to develop frailty-based prognostic criteria in HF patients (FLAGSHIP). FLAGSHIP mainly aims to 1) develop the frailty criteria based on HF-specific outcomes, 2) propose a hypothesis of the potential mechanisms of frailty manifestations in HF, and 3) examine the effects of outpatient cardiac rehabilitation on frailty. METHODS In this prospective study, we consecutively enroll ambulatory patients admitted because of acute HF or exacerbation of HF and elderly patients admitted for acute myocardial infarction (age ≥ 70 years). They will be followed up for 2 years to assess frailty and hard clinical events. The primary endpoints of FLAGSHIP are cardiac events including cardiac mortality and HF-related readmission after discharge. Secondary endpoints are readmissions because of fracture or pneumonia and all-cause mortality. We used clinical data, including the items related to the frailty phenotype to develop diagnostic criteria for frailty and known prognostic factors of HF. Cognitive function, depression, and anorexia are also considered as potential components of frailty. As of March 2018, 2650 patients (85% was patients admitted for HF) have been registered from 30 collaborating hospitals nationwide in Japan. DISCUSSION FLAGSHIP provides diagnostic criteria and fundamental information on frailty manifestations to develop the best practices for the long-term management of HF. Diagnostic criteria on frailty developed by FLAGSHIP is expected to become a novel indicator for the stratification of patients at risk to functional decline after medical or surgical treatment, and in turn to contribute to the best practices in the long-term management of HF.
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Affiliation(s)
- Sumio Yamada
- Department of Health Sciences, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-minami, Higashi-ku, Nagoya, 461-8673, Japan.
| | - Takuji Adachi
- Program in Physical and Occupational Therapy, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-minami, Higashi-ku, Nagoya, 461-8673, Japan
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University Banbuntane Hotokukai Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, 454-8509, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takaaki Kondo
- Department of Health Sciences, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-minami, Higashi-ku, Nagoya, 461-8673, Japan
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González-D'Gregorio J, Miñana G, Núñez J, Núñez E, Ruiz V, García-Blas S, Bonanad C, Mollar A, Valero E, Amiguet M, Sastre C, Sanchis J. Iron deficiency and long-term mortality in elderly patients with acute coronary syndrome. Biomark Med 2018; 12:987-999. [PMID: 30043644 DOI: 10.2217/bmm-2018-0021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
AIM We evaluated the relationship between iron deficiency (ID) and long-term mortality risk in elderly patients with acute coronary syndrome (ACS). METHODS In this prospective observational study, we included 252 patients older than 65 years with ACS. Transferrin saturation (TSAT) and ferritin were collected before discharge. RESULTS Mean age, hemoglobin and GRACE score were 78 ± 7 years, 12.4 ± 1.8 g/dl and 138.8 ± 25.3, respectively, 112(44.4%) patients were women, and 151(59.9%) presented ID. During the follow-up, 121 (48%) patients died. Mortality rates among TSAT quartiles were: 2.38, 1.60, 0.90 and 0.95 × 10 person-years for Q1TSAT to Q4TSAT, respectively (p < 0.001) and did not differ across ferritin quartiles (p = 0.601), whereas ID definition was borderline associated (p = 0.060). Adjusted TSAT levels remained inverse, nonlinearly associated with long-term mortality risk (p < 0.001), with an exponential increased-risk from values about 20% and below. CONCLUSION Lower TSAT levels were independently associated with increased mortality risk in these patients.
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Affiliation(s)
| | - Gema Miñana
- Cardiology Department. Hospital Clínico Universitario de Valencia. Valencia, Spain.,Department of Medicine, Universitat de Valencia, Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
| | - Julio Núñez
- Cardiology Department. Hospital Clínico Universitario de Valencia. Valencia, Spain.,Department of Medicine, Universitat de Valencia, Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
| | - Eduardo Núñez
- Cardiology Department. Hospital Clínico Universitario de Valencia. Valencia, Spain
| | - Vicente Ruiz
- Cardiology Department. Hospital Clínico Universitario de Valencia. Valencia, Spain.,Department of Medicine, Universitat de Valencia, Valencia, Spain
| | - Sergio García-Blas
- Cardiology Department. Hospital Clínico Universitario de Valencia. Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
| | - Clara Bonanad
- Cardiology Department. Hospital Clínico Universitario de Valencia. Valencia, Spain
| | - Anna Mollar
- Cardiology Department. Hospital Clínico Universitario de Valencia. Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
| | - Ernesto Valero
- Cardiology Department. Hospital Clínico Universitario de Valencia. Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
| | - Martina Amiguet
- Cardiology Department. Hospital Clínico Universitario de Valencia. Valencia, Spain
| | - Clara Sastre
- Cardiology Department. Hospital Clínico Universitario de Valencia. Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
| | - Juan Sanchis
- Cardiology Department. Hospital Clínico Universitario de Valencia. Valencia, Spain.,Department of Medicine, Universitat de Valencia, Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
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Llaó I, Ariza-Solé A, Sanchis J, Alegre O, López-Palop R, Formiga F, Marín F, Vidán MT, Martínez-Sellés M, Sionis A, Vives-Borrás M, Gómez-Hospital JA, Gómez-Lara J, Roura G, Díez-Villanueva P, Núñez-Gil I, Maristany J, Asmarats L, Bueno H, Abu-Assi E, Cequier À. Invasive strategy and frailty in very elderly patients with acute coronary syndromes. EUROINTERVENTION 2018; 14:e336-e342. [PMID: 29616624 DOI: 10.4244/eij-d-18-00099] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Current guidelines recommend an early invasive strategy in patients with non-ST-segment elevation acute coronary syndromes (NSTEACS). The role of an invasive strategy in frail elderly patients remains controversial. The aim of this substudy was to assess the impact of an invasive strategy on outcomes according to the degree of frailty in these patients. METHODS AND RESULTS The LONGEVO-SCA registry included unselected NSTEACS patients aged ≥80 years. A geriatric assessment, including frailty, was performed during hospitalisation. During the admission, we evaluated the impact of an invasive strategy on the incidence of cardiac death, reinfarction or new revascularisation at six months. From 531 patients included, 145 (27.3%) were frail. Mean age was 84.3 years. Most patients underwent an invasive strategy (407/531, 76.6%). Patients undergoing an invasive strategy were younger and had a lower proportion of frailty (23.3% vs. 40.3%, p<0.001). The incidence of cardiac events was more common in patients managed conservatively, after adjusting for confounding factors (sub-hazard ratio [sHR] 2.32, 95% confidence interval [CI]: 1.26-4.29, p=0.007). This association remained significant in non-frail patients (sHR 3.85, 95% CI: 2.13-6.95, p=0.001), but was not significant in patients with established frailty criteria (sHR 1.40, 95% CI: 0.72-2.75, p=0.325). The interaction invasive strategy-frailty was significant (p=0.032). CONCLUSIONS An invasive strategy was independently associated with better outcomes in very elderly patients with NSTEACS. This association was different according to frailty status.
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Affiliation(s)
- Isaac Llaó
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Canivell S, Muller O, Gencer B, Heg D, Klingenberg R, Räber L, Carballo D, Matter C, Lüscher T, Windecker S, Mach F, Rodondi N, Nanchen D. Prognosis of cardiovascular and non-cardiovascular multimorbidity after acute coronary syndrome. PLoS One 2018; 13:e0195174. [PMID: 29649323 PMCID: PMC5896917 DOI: 10.1371/journal.pone.0195174] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/16/2018] [Indexed: 02/02/2023] Open
Abstract
Objective To examine the prognosis of patients with cardiovascular and non-cardiovascular multimorbidity after acute coronary syndrome compared to patients without prior multimorbidity. Methods This multicenter prospective cohort study in Switzerland included 5,635 patients hospitalized with acute coronary syndrome between 2009 and 2014, with a one-year follow-up period. We defined cardiovascular and non-cardiovascular multimorbidity as having at least two prior comorbidities before the index hospitalization. Multivariable adjusted Cox proportional models were built to assess the one-year risk of recurrent cardiovascular events, defined as cardiovascular mortality and non-fatal myocardial infarction or stroke. The final model was adjusted for age, gender, body mass index, tobacco consumption, education, and family history of cardiovascular disease, prescription of high-dose statinsat discharge and use of cardiac rehabilitation after discharge. Results Overall, 3,664 patients (65%) had no multimorbidity, 1,839 (33%) had cardiovascular multimorbidity, 62 (1%) had non-cardiovascular multimorbidity, and 70 (1%) had both cardiovascular and non-cardiovascular multimorbidity. The multivariate risk of recurrent cardiovascular events was increased among patients with cardiovascular multimorbidity (hazard ratio (HR) 2.05, 95% CI: 1.54–2.73, p<0.001) and patients with non-cardiovascular multimorbidity (HR 2.57, 95% CI: 1.04–6.35, p = 0.04) compared to patients without multimorbidity. Patients with cardiovascular and non-cardiovascular multimorbidity had the highest risk of recurrence with a HR of 5.19, 95% CI: 2.79–9.64, p<0.001, compared to patients without multimorbidity. Conclusions Multimorbidity increased by two-fold the risk of cardiovascular events over the year after an acute coronary syndrome. The magnitude of this increased risk was similar for patients with cardiovascular or non-cardiovascular multimorbidity.
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Affiliation(s)
- Silvia Canivell
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Olivier Muller
- Service of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Baris Gencer
- Division of Cardiology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Dik Heg
- Institute of Social and Preventive Medicine, and Clinical Trials Unit, Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Roland Klingenberg
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Lorenz Räber
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - David Carballo
- Division of Cardiology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Christian Matter
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Lüscher
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Stephan Windecker
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - François Mach
- Division of Cardiology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - David Nanchen
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
- * E-mail:
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Sanchis J, Ariza-Solé A, Abu-Assi E, Alegre O, Alfonso F, Barrabés JA, Baz JA, Carol A, Díez Villanueva P, García Del Blanco B, Elízaga J, Fernandez E, García Del Egido A, García Picard J, Gómez Blázquez I, Gómez Hospital JA, Hernández-Antolín R, Llibre C, Marín F, Martí Sánchez D, Martín R, Martínez Sellés M, Miñana G, Morales Gallardo MJ, Núñez J, Pérez de Prado A, Pinar E, Sanmartín M, Sionis A, Villa A, Marrugat J, Bueno H. Invasive Versus Conservative Strategy in Frail Patients With NSTEMI: The MOSCA-FRAIL Clinical Trial Study Design. ACTA ACUST UNITED AC 2018. [PMID: 29525724 DOI: 10.1016/j.rec.2018.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION AND OBJECTIVES Although clinical guidelines recommend invasive management in non-ST-segment elevation myocardial infarction (NSTEMI), this strategy is underused in frail elderly patients in the real world. Furthermore, these patients are underrepresented in clinical trials and therefore the evidence is scarce. Our hypothesis is that an invasive strategy will improve prognosis in elderly frail patients with NSTEMI. METHODS This will be a prospective, multicenter, randomized trial, in which the conservative and invasive strategies will be compared in patients meeting all of the following inclusion criteria: NSTEMI diagnosis, age ≥ 70 years, and frailty defined by a category ≥ 4 in the Clinical Frailty Scale. Participants will be randomized to an invasive (coronary angiogram and revascularization if anatomically amenable) or conservative (medical treatment and coronary angiogram only if persistent clinical instability) strategy. The primary endpoint will be the number of days alive out of hospital during the first year. The coprimary endpoint will be the time until the first cardiac event (cardiac death, reinfarction or postdischarge revascularization). We estimate a sample size of 178 patients (89 per arm), considering an increase of 20% in the proportion of days alive out of hospital with the invasive management. RESULTS The results of this study will add important knowledge to inform the management of frail elderly patients hospitalized with NSTEMI. CONCLUSIONS We hypothesize that the invasive strategy will improve outcomes in frail elderly patients with NSTEMI. If this is confirmed, frailty status should not dissuade physicians from implementing an invasive management strategy. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov.Identifier: NCT03208153.
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Affiliation(s)
- Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, Valencia, Spain.
| | - Albert Ariza-Solé
- Servicio de Cardiología, Hospital Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Emad Abu-Assi
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Oriol Alegre
- Servicio de Cardiología, Hospital Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Fernando Alfonso
- Servicio de Cardiología, Hospital Universitario La Princesa, Madrid, Spain
| | - José Antonio Barrabés
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, CIBERCV, Barcelona, Spain
| | - José Antonio Baz
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Antonio Carol
- Servicio de Cardiología, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | | | | | - Jaime Elízaga
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Universidad Complutense, Universidad Europea, Madrid, Spain
| | - Eduard Fernandez
- Servicio de Cardiología, Hospital Germans Trias i Pujol, CIBERCV, Badalona, Barcelona, Spain
| | | | | | | | | | | | - Cinta Llibre
- Servicio de Cardiología, Hospital Germans Trias i Pujol, CIBERCV, Badalona, Barcelona, Spain
| | - Francisco Marín
- Servicio de Cardiología, Hospital Virgen de la Arrixaca, CIBERCV, El Palmar, Murcia, Spain
| | | | - Roberto Martín
- Servicio de Cardiología, Hospital 12 de Octubre, Madrid, Spain
| | - Manuel Martínez Sellés
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Universidad Complutense, Universidad Europea, Madrid, Spain
| | - Gema Miñana
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, Valencia, Spain
| | | | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, Valencia, Spain
| | | | - Eduardo Pinar
- Servicio de Cardiología, Hospital Virgen de la Arrixaca, CIBERCV, El Palmar, Murcia, Spain
| | - Marcelo Sanmartín
- Servicio de Cardiología, Hospital Ramon y Cajal, CIBERCV, Madrid, Spain
| | - Alessandro Sionis
- Servicio de Cardiología, Hospital Sant Pau, CIBERCV, Barcelona, Spain
| | - Adolfo Villa
- Servicio de Cardiología, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain
| | - Jaume Marrugat
- Grupo de Epidemiología y Genética Cardiovascular, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), CIBERCV, Barcelona, Spain
| | - Héctor Bueno
- Servicio de Cardiología, Hospital 12 de Octubre, Madrid, Spain
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An Easy Assessment of Frailty at Baseline Independently Predicts Prognosis in Very Elderly Patients With Acute Coronary Syndromes. J Am Med Dir Assoc 2017; 19:296-303. [PMID: 29153753 DOI: 10.1016/j.jamda.2017.10.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 10/05/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Information about the impact of frailty in patients with acute coronary syndromes (ACS) is scarce. No study has assessed the prognostic impact of frailty as measured by the FRAIL scale in very elderly patients with ACS. METHODS The prospective multicenter LONGEVO-SCA registry included unselected patients with ACS aged 80 years or older. A comprehensive geriatric assessment was performed during hospitalization, including frailty assessment by the FRAIL scale. The primary endpoint was mortality at 6 months. RESULTS A total of 532 patients were included. Mean age was 84.3 years, 61.7% male. Most patients had positive troponin levels (84%) and high GRACE risk score values (mean 165). A total of 205 patients were classified as prefrail (38.5%) and 145 as frail (27.3%). Frail and prefrail patients had a higher prevalence of comorbidities, lower left ventricle ejection fraction, and higher mean GRACE score value. A total of 63 patients (11.8%) were dead at 6 months. Both prefrailty and frailty were associated with higher 6-month mortality rates (P < .001). After adjusting for potential confounders, this association remained significant (hazard ratio [HR] 2.71; 95% confidence interval [CI] 1.09-6.73 for prefrailty and HR 2.99; 95% CI 1.20-7.44 for frailty, P = .024). The other independent predictors of mortality were age, Charlson Index, and GRACE risk score. CONCLUSIONS The FRAIL scale is a simple tool that independently predicts mortality in unselected very elderly patients with ACS. The presence of prefrailty criteria also should be taken into account when performing risk stratification of these patients.
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Tse G, Gong M, Nunez J, Sanchis J, Li G, Ali-Hasan-Al-Saegh S, Wong WT, Wong SH, Wu WKK, Bazoukis G, Yan GX, Lampropoulos K, Baranchuk AM, Tse LA, Xia Y, Liu T, Woo J. Frailty and Mortality Outcomes After Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2017; 18:1097.e1-1097.e10. [PMID: 29079033 DOI: 10.1016/j.jamda.2017.09.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 09/07/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Frailty has been identified as a risk factor for mortality. However, whether frailty increases mortality risk in patients undergoing percutaneous coronary intervention (PCI) has been controversial. Therefore, we conducted a systematic review and meta-analysis of the frailty measures and mortality outcomes in this setting. METHODS PubMed and EMBASE were searched until July 23, 2017 for studies evaluating the association between frailty measures and mortality in individuals who have undergone PCI. RESULTS A total of 141 entries were retrieved from our search strategy. A total of 8 studies involving 2332 patients were included in the final meta-analysis (mean age: 69 years; 68% male, follow-up duration was 30 ± 28 months). Frailty was a significant predictor of all-cause mortality after PCI, with a hazard ratio (HR) of 2.97 [95% confidence interval (CI) 1.56-5.66, P = .001]. This was substantial heterogeneity present (I2: 79%). Subgroup analysis using the Fried score reduced I2 to 68% without altering the pooled HR (2.78, 95% CI 1.02-7.76; P < .05). Using the Canadian Study of Health and Aging Clinical Frailty Scale reduced I2 to 0% while preserving the pooled HR (5.99, 95% CI 2.77-12.95, P < .001). CONCLUSIONS Frailty leads to significantly higher mortality rates in patients who have undergone PCI. Both the Fried score and Canadian Study of Health and Aging Clinical Frailty Scale are powerful predictors of mortality. These findings may support the notion that an alternative to invasive strategy should be considered in frail patients who are indicated for revascularization.
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Affiliation(s)
- Gary Tse
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, P.R. China; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, P.R. China
| | - Mengqi Gong
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Julia Nunez
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Departamento de Medicina, Universitat de València, Valencia, Spain; CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Departamento de Medicina, Universitat de València, Valencia, Spain; CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Guangping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | | | - Wing Tak Wong
- School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Sunny Hei Wong
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, P.R. China; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, P.R. China
| | - William K K Wu
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, P.R. China; Department of Anesthesia and Intensive Care, State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - George Bazoukis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Gan-Xin Yan
- Lankenau Institute for Medical Research and Lankenau Medical Center, Wynnewood, Pennsylvania; Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Konstantinos Lampropoulos
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Adrian M Baranchuk
- Department of Medicine, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Lap Ah Tse
- Division of Occupational and Environmental Health, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Yunlong Xia
- Department of Cardiovascular Medicine, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China.
| | - Jean Woo
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, P.R. China
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