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Chronic Coronary Syndrome in Frail Old Population. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081133. [PMID: 36013312 PMCID: PMC9410393 DOI: 10.3390/life12081133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 12/30/2022]
Abstract
The demographic trend of aging is associated with an increased prevalence of comorbidities among the elderly. Physical, immunological, emotional and cognitive impairment, in the context of the advanced biological age segment, leads to the maintenance and precipitation of cardiovascular diseases. Thus, more and more data are focused on understanding the pathophysiological mechanisms underlying each fragility phenotype and how they potentiate each other. The implications of inflammation, sarcopenia, vitamin D deficiency and albumin, as dimensions inherent in fragility, in the development and setting of chronic coronary syndromes (CCSs) have proven their patent significance but are still open to research. At the same time, the literature speculates on the interdependent relationship between frailty and CCSs, revealing the role of the first one in the development of the second. In this sense, depression, disabilities, polypharmacy and even cognitive disorders in the elderly with ischemic cardiovascular disease mean a gradual and complex progression of frailty. The battery of tests necessary for the evaluation of the elderly with CCSs requires a permanent update, according to the latest guidelines, but also an individualized approach related to the degree of frailty and the conditions imposed by it. By summation, the knowledge of frailty screening methods, through the use of sensitive and individualized tools, is the foundation of secondary prevention and prognosis in the elderly with CCSs. Moreover, a comprehensive geriatric assessment remains the gold standard of the medical approach of these patients. The management of the frail elderly, with CCSs, brings new challenges, also from the perspective of the treatment particularities. Sometimes the risk–benefit balance is difficult to achieve. Therefore, the holistic, individualized and updated approach of these patients remains a desired objective, by understanding and permanently acquiring knowledge on the complexity of the frailty syndrome.
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Saini RK, Chaudhury S, Singh N, Chadha DS, Kapoor R. Depression, anxiety, and quality of life after percuataneous coronary interventions. Ind Psychiatry J 2022; 31:6-18. [PMID: 35800859 PMCID: PMC9255611 DOI: 10.4103/ipj.ipj_126_21] [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: 05/31/2021] [Revised: 07/25/2021] [Accepted: 08/29/2021] [Indexed: 11/04/2022] Open
Abstract
Coronary artery disease (CAD) is the leading cause of morbidity and mortality in the world. However, some fascinating advances in the field of cardiology have not only added years to people's life but life to years as well. Percutaneous coronary intervention (PCI), commonly known as coronary angioplasty is a nonsurgical procedure used to treat stenotic coronary arteries. In recent years, PCI has become the preferred modality of treatment for occluded coronary arteries. However, there has been growing interest in the quality of life (QOL) issues for those who undergo such procedures. Depression, anxiety, vital exhaustion, hostility, anger, and acute mental stress have been evaluated as risk factors for the development and progression of CAD. Further, they also have strong bearing toward recovery from an acute coronary event. The current article discusses the role of depression, anxiety, and QOL of patients undergoing PCI.
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Affiliation(s)
- Rajiv Kumar Saini
- Department of Psychiatry, Command Hospital (Eastern Command), Kolkata, West Bengal, India
| | - Suprakash Chaudhury
- Department of Psychiatry, Dr D Y Patil Medical College, Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pimpri, Pune, India
| | - Navreet Singh
- Department of Cardiology, CH (WC) Chandimandir, Panchkula, India
| | - D S Chadha
- Department of Cardiology, CH (IAF), Bengaluru, Karnataka, India
| | - Rajneesh Kapoor
- Department of Interventional Cardiology, Medanta Medicity, Gurgaon, Haryana, India
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Yan BP, Chan LLY, Lee VWY, Yu CM, Wong MCS, Sanderson J, Reid CM. Sustained 3-Year Benefits in Quality of Life After Percutaneous Coronary Interventions in the Elderly: A Prospective Cohort Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:423-431. [PMID: 29680099 DOI: 10.1016/j.jval.2017.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 10/03/2017] [Accepted: 10/05/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND Impact of percutaneous coronary interventions (PCI) on health-related quality of life (HRQOL) is important but under-reported in elderly patients. OBJECTIVES To evaluate long-term health status in elderly patients who underwent PCI. METHODS Consecutive patients who underwent PCI at a university-affiliated hospital from September 2009 to June 2012 were prospectively enrolled with HRQOL assessment at baseline (up to 2 weeks before PCI) and at 6-, 12-, and 36-month follow-up using the EuroQol five-dimensional questionnaire descriptive profile and visual analogue scale (VAS). Minimally important benefit (MIB) in HRQOL was defined as greater than half an SD improvement in the baseline VAS score. RESULTS Of 1957 patients, 49.9%, 29.1%, and 21.0% were aged younger than 65 years, 65 to 74 years, and 75 years and older, respectively. Mean VAS scores at baseline (50.1 ± 20.5 vs. 51.6 ± 20.5 vs. 52.6 ± 21.8; P = 0.09) and at 36 months (72.9 ± 14.0 vs. 72.8 ± 16.1 vs. 72.0 ± 14.8; P = 0.77) were similar between the three age groups, respectively. MIB at 36 months was observed in 65.7%, 61.9%, and 61.2% of patients in each age group, respectively. Proportion of patients aged 75 years and older reporting problems in pain/discomfort and self-care reduced from 91.2% and 24.8% at baseline to 41.4% and 10.1% at 36 months, respectively (both P < 0.01). Independent predictors of MIB in HRQOL at 36 months in patients 75 years and older included poor baseline HRQOL, MIB at 6 months, and presentation with myocardial infarction (all P < 0.01). CONCLUSIONS Elderly patients experienced sustained long-term improvement in quality of life comparable with younger patients after PCI. Our findings suggest that age per se should not deter against revascularization because of sustained benefit in HRQOL.
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Affiliation(s)
- Bryan P Yan
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital and Institute of Vascular Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong; Center of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia.
| | - Lally L Y Chan
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital and Institute of Vascular Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Vivian W Y Lee
- School of Pharmacy, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Cheuk-Man Yu
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital and Institute of Vascular Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Martin C S Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - John Sanderson
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital and Institute of Vascular Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Christopher M Reid
- Center of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia; School of Public Health, Curtin University, Perth, Australia
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Ivabradine in combination with beta-blocker reduces symptoms and improves quality of life in elderly patients with stable angina pectoris: Age-related results from the ADDITIONS study. Exp Gerontol 2014; 59:34-41. [DOI: 10.1016/j.exger.2014.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 08/26/2014] [Accepted: 09/02/2014] [Indexed: 12/19/2022]
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Shan L, Saxena A, McMahon R. A Systematic Review on the Quality of Life Benefits after Percutaneous Coronary Intervention in the Elderly. Cardiology 2014; 129:46-54. [DOI: 10.1159/000360603] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 02/12/2014] [Indexed: 11/19/2022]
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Soo Hoo SY, Gallagher R, Elliott D. Systematic review of health-related quality of life in older people following percutaneous coronary intervention. Nurs Health Sci 2014; 16:415-27. [PMID: 24779852 DOI: 10.1111/nhs.12121] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 11/10/2013] [Accepted: 11/25/2013] [Indexed: 11/29/2022]
Abstract
People aged over 60 years represent an increasingly high proportion of the population undergoing percutaneous coronary intervention. While risks are greater for older people in terms of major adverse cardiovascular events and higher mortality for this treatment, it is unclear if the benefits of health-related quality of life outcomes may outweigh risks. A search of the PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica, and Cochrane databases was conducted for the period from January 1999 to June 2012 using key words "percutaneous coronary intervention"/"angioplasty," "older," "elderly," and "quality of life"/"health-related quality of life." Using a systematic review approach, data from 18 studies were extracted for description and synthesis. Findings revealed that everyone regardless of age reported better health-related quality of life, primarily from the relief of angina and improved physical and mental function. Age itself did not have an independent predictive effect when other factors such as comorbid conditions were taken into account. Assessment of older peoples' health status following percutaneous coronary intervention by nurses and other health professionals is therefore important for the provision of quality care.
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Affiliation(s)
- Soon Yeng Soo Hoo
- Faculty of Health, University of Technology, Sydney, Australia; Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
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O'Driscoll JM, Marciniak A, Ray KK, Schmid K, Smith R, Sharma R. The safety and clinical usefulness of dobutamine stress echocardiography among octogenarians. Heart 2014; 100:1001-7. [DOI: 10.1136/heartjnl-2013-305229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Rittger H, Hochadel M, Behrens S, Hauptmann KE, Zahn R, Mudra H, Brachmann J, Zeymer U. Interventional treatment and outcome in elderly patients with stable coronary artery disease. Results from the German ALKK registry. Herz 2013; 39:212-8. [PMID: 23712825 DOI: 10.1007/s00059-013-3822-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 03/07/2013] [Accepted: 03/24/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND The number of elderly and very elderly patients undergoing percutaneous coronary interventions (PCI) is increasing. We therefore analyzed data from the German ALKK registry (Arbeitsgemeinschaft Leitende Krankenhausärzte; Working Group of Hospital Cardiologists) to determine differences in procedural features, antithrombotic treatment, and in-hospital outcome in patients with coronary artery disease (CAD) according to age in a large series of patients. METHODS AND RESULTS The present analysis was based on the data of 35,534 consecutive patients undergoing elective PCI who were enrolled in the ALKK registry. Of these 27,145 (76.4 %) were younger than 75 years, 7,645 (21.5 %) were aged between 75 and 84 years, and 744 (2.1 %) patients were older than 85 years. Mean age was 68.5 years (60.9-74.5 years), and 25,784 patients (72.6 %) were male. Overall intraprocedural events were very low (1.1 %) and there was no significant difference between the three age groups [< 75 years (1.1 %); 75-< 85 years (1.2 %); ≥ 85 years (0.5 %) (p = not significant)]. Rates of in-hospital death, stroke and transient ischemic attack (TIA), as well as the combined endpoint in-hospital major adverse cardiac and cerebrovascular events (MACCE) were also very low (0.6 % vs. 0.9 % vs. 0.9 %; p < 0.001) but significantly higher in elderly patients with no further increase in the very elderly patient group. CONCLUSION We found no differences in this registry in intraprocedural complications during elective PCI between younger and elderly patients. Although in-hospital MACCE were somewhat higher in the elderly, the overall event rate was low and thus elderly patients should not be deprived from this therapy because of age alone.
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Affiliation(s)
- H Rittger
- Medizinische Klinik 2, Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany,
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Blankenship JC, Marshall JJ, Pinto DS, Lange RA, Bates ER, Holper EM, Grines CL, Chambers CE. Effect of percutaneous coronary intervention on quality of life: A consensus statement from the society for cardiovascular angiography and interventions. Catheter Cardiovasc Interv 2012; 81:243-59. [DOI: 10.1002/ccd.24376] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 02/12/2012] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Duane S. Pinto
- Beth Israel Deaconess Medical Center; Boston; Massachusetts
| | - Richard A. Lange
- University of Texas Health Science Center at San Antonio; San Antonio; Texas
| | - Eric R. Bates
- University of Michigan Hospitals and Health Centers; Ann Arbor; Michigan
| | | | - Cindy L. Grines
- Detroit Medical Center Cardiovascular Institute; Detroit; Michigan
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Ivabradine for the treatment of stable angina pectoris in octogenarians. Clin Res Cardiol 2010; 100:121-8. [DOI: 10.1007/s00392-010-0220-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Accepted: 08/25/2010] [Indexed: 01/16/2023]
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Agarwal S, Schechter C, Zaman A. Assessment of functional status and quality of life after percutaneous coronary revascularisation in octogenarians. Age Ageing 2009; 38:748-51. [PMID: 19755713 DOI: 10.1093/ageing/afp174] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Teplitsky I, Assali A, Golovchiner G, Shor N, Weiss A, Battler A, Kornowski R. Acute and intermediate‐term results of percutaneous coronary stenting in octogenarian patients. ACTA ACUST UNITED AC 2009; 5:195-9. [PMID: 14630562 DOI: 10.1080/14628840310018167] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) in octogenarian patients has been associated with increased cardiovascular morbidity and mortality. This study aimed to assess acute and intermediate-term clinical outcomes among octogenarians undergoing PCI. METHODS The authors identified 97 consecutive patients aged > or =80 years who underwent PCI using stents between November 2000 and February 2002 at their institution. The patients were divided into three groups according to clinical presentation: (1) acute myocardial infarction (AMI, n = 31); (2) unstable angina pectoris (UAP, n = 28); and (3) stable angina pectoris (SAP, n = 38). Procedural data, and in-hospital and six-month clinical outcomes were obtained and adjudicated for all patients. RESULTS Overall mean age was 84 +/- 3 years, 67% of patients were males and 73% had multivessel coronary disease. In-hospital outcomes varied according to clinical presentation: procedural success was 78% in AMI patients (including shock patients), 93% in UAP, and 95% in SAP patients. Likewise, hospital mortality was 26% in AMI, 3.6% in UAP, and 0% in SAP patients (p = 0.0003). Among AMI patients, hospital mortality was extremely high in patients with cardiogenic shock (67% versus 4.6% in AMI without shock, p < 0.0001). Cumulative event rate at six months also varied according to clinical presentation: mortality/MI and target vessel revascularization (TVR) rates were 29%, 3.6%, and 0% in AMI, 7.1%, 7.4%, and 11% in UAP and 0%, 5.3%, and 7.9% in SAP patients. Multivariate analysis identified cardiogenic shock as the most powerful risk factor for predicting mortality (odds ratio = 42, p = 0.03). CONCLUSIONS These results show that clinically stable octogenarian patients undergoing PCI have favorable procedural and intermediate-term prognosis. In contrast, cardiogenic shock has a profound negative prognostic impact on octogenarians despite 'aggressive' PCI attempts.
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Affiliation(s)
- Igal Teplitsky
- Cardiology Department, Rabin Medical Center, Petch-Tivka, Israel
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Günal A, Aengevaeren WRM, Gehlmann HR, Luijten JE, Bos JS, Verheugt FWA. Outcome and quality of life one year after percutaneous coronary interventions in octogenarians. Neth Heart J 2008; 16:117-22. [PMID: 18427635 PMCID: PMC2300464 DOI: 10.1007/bf03086129] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND While percutaneous coronary intervention (PCI) is increasingly being performed in octogenarians, little is known about the quality of life (QOL) one year after PCI. We assessed the one-year outcome and QOL after PCI. METHODS Outcome and QOL at one year were assessed in patients of 80 years and older who underwent PCI at our institution. We used the RAND-36 Health Survey to assess health-related QOL at follow-up. The EuroSCORE was used for reference risk assessment. RESULTS Ninety-eight patients (mean age 82.7+/-2.9 years; 60% female) underwent PCI. Acute PCI was performed in 36% of the patients. Canadian Cardiovascular Society (CCS) angina class before the procedure was class III for 28% and class IV for 64%. Of the patients, 98% were in the highest-risk group (additive EuroSCORE 6+). The overall PCI success rate was 94%. Mortality at one year was 19% (38% acute vs. 12% elective PCI). At followup, general health was rated as fairly good and better then before PCI (CCS I and II: 77%). RAND-36 scores for the mental component were better than scores for the physical component. Physical functioning (41+/-28) and role limitations caused by physical health problems (32+/-37) had the worst scores. The mental component vitality had the lowest (55+/-20) and mental health the highest (70+/-21) score. Social functioning was in general good (67+/-26). CONCLUSION Octogenarians have a high mortality risk following PCI, especially in acute PCI. In survivors QOL is acceptable with a better mental than physical score. In general, PCI in octogenarians has a positive effect on health perception, with less symptoms of angina pectoris. (Neth Heart J 2008;16:117-22.).
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Affiliation(s)
- A Günal
- Department of Cardiology, Heartlung Centre, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
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Abstract
As surgery has been extended into the elderly population, health-related quality of life (HRQOL) has been appropriately added as a parameter to evaluate surgical success. Surgery remains of significant risk in older patients, and an estimate of the type of outcome, including morbidity, mortality, and HRQOL can aid in that decision. New techniques, such as laparoscopic or minimally invasive surgery show great promise for reduction in perioperative stress and improved HRQOL in younger patients, but have not been extensively used in the older and frail patients for whom the benefits potentially may be greater.
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Affiliation(s)
- Thomas R Hornick
- Case Western Reserve University, VISN 10 Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA.
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Affiliation(s)
- Jan Kaehler
- Department of Cardiology, University Hospital Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
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Maziarz DM, Koutlas TC. Cost considerations in selecting coronary artery revascularization therapy in the elderly. Am J Cardiovasc Drugs 2004; 4:219-25. [PMID: 15285697 DOI: 10.2165/00129784-200404040-00003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
This article presents some of the cost factors involved in selecting coronary artery revascularization therapy in an elderly patient. With the percentage of gross national product allocated to healthcare continuing to rise in the US, resource allocation has become an issue. Percutaneous coronary intervention continues to be a viable option for many patients, with lower initial costs. However, long-term angina-free results often require further interventions or eventual surgery. Once coronary artery revascularization therapy is selected, it is worthwhile to evaluate the cost considerations inherent to various techniques. Off-pump coronary artery bypass graft surgery has seen a resurgence, with improved technology and lower hospital costs than on-pump bypass surgery. Numerous factors contributing to cost in coronary surgery have been studied and several are documented here, including the potential benefits of early extubation and the use of standardized optimal care pathways. A wide range of hospital-level cost variation has been noted, and standardization issues remain. With the advent of advanced computer-assisted robotic techniques, a push toward totally endoscopic bypass surgery has begun, with the eventual hope of reducing hospital stays to a minimum while maximizing outcomes, thus reducing intensive care unit and stepdown care times, which contribute a great deal toward overall cost. At the present time, these techniques add a significant premium to hospital charges, outweighing any potential length-of-stay benefits from a cost standpoint. As our elderly population continues to grow, use of healthcare resource dollars will continue to be heavily scrutinized. Although the clinical outcome remains the ultimate benchmark, cost containment and optimization of resources will take on a larger role in the future.
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Affiliation(s)
- David M Maziarz
- Brody School of Medicine at East Carolina University, Greenville, North Carolina 27834-4354, USA
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Halon DA, Adawi S, Dobrecky-Mery I, Lewis BS. Importance of increasing age on the presentation and outcome of acute coronary syndromes in elderly patients. J Am Coll Cardiol 2004; 43:346-52. [PMID: 15013113 DOI: 10.1016/j.jacc.2003.08.044] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2003] [Revised: 08/06/2003] [Accepted: 08/18/2003] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The study examined differences in presentation and outcome between elderly (> or =70 years) and very elderly (> or =80 years) patients hospitalized for acute coronary syndromes (ACS). BACKGROUND The elderly constitute an increasingly important sector of patients with ACS but have been underrepresented in many therapeutic trials. METHODS We compiled a registry of 449 consecutive patients, 251 elderly (70 to 79 years) (septuagenarians, group 1) and 198 very elderly (> or =80 years) (group 2), to examine outcomes in relation to baseline characteristics and treatment. We recorded survival over a period of 24 +/- 4 months and rehospitalization and symptomatic status at 16 +/- 4 months. RESULTS At index hospitalization, the older cohort (group 2) more often had acute myocardial infarction (35% vs. 9.7%, p < 0.0001), heart failure (33.3% vs. 19.4%, p < 0.001), and renal dysfunction (21.6% vs. 12.3%, p = 0.01). They were less likely to undergo coronary angiography (29.3% vs. 43.8%, p = 0.002), but those selected for angiography more often underwent revascularization so that revascularization rates were similar (22.7% group 2 vs. 24.3% group 1, p = NS). Two-year survival rate was poorer in group 2 (67.4 +/- 3.5% vs. 83.5 +/- 2.5% in group 1, p < 0.0001). Repeat rehospitalization was similar (53.0% vs. 48.2%, respectively, p = 0.31), but improvement in well-being of survivors was greater (60.0% vs. 46.3%, p = 0.01). CONCLUSIONS The study demonstrated important differences between elderly (70 to 79 years) and very elderly (> or =80 years) patients hospitalized with ACS. The older cohort was sicker on admission and had poorer outcome, but a subgroup selected for angiography and possible intervention had two-year outcomes similar to the younger cohort.
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Affiliation(s)
- David A Halon
- Department of Cardiology, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa 34362, Israel.
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Weintraub WS, Veledar E, Thompson T, Burnette J, Jurkovitz C, Mahoney E. Percutaneous coronary intervention outcomes in octogenarians during the stent era (National Cardiovascular Network). Am J Cardiol 2001; 88:1407-10, A6. [PMID: 11741560 DOI: 10.1016/s0002-9149(01)02120-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- W S Weintraub
- Emory Center for Outcomes Research, Division of Cardiology, School of Medicine, Emory University, Atlanta, Georgia 30306, USA.
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Torre Hernández JMDL, Fernández-Valls M, Royuela N, Gómez González I, Enríquez SG, Zueco J, Figueroa Á, Colman T. Angina inestable en el paciente octogenario: ¿es factible y eficaz el abordaje invasivo? Rev Esp Cardiol (Engl Ed) 2001. [DOI: 10.1016/s0300-8932(01)76382-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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