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Singh M, El Sabbagh A, Lewis BR, Kanwar A, Terzic CM, Al-Hijji MA, Behfar A, Kirkland JL. Clinical Significance of Biological Age in Patients Undergoing Percutaneous Coronary Intervention. Mayo Clin Proc 2023; 98:1137-1152. [PMID: 37536804 DOI: 10.1016/j.mayocp.2023.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 03/08/2023] [Accepted: 03/28/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE To test whether biological age calculated using deficits, functional impairments, or their combination will provide improved estimation of long-term mortality among older adults undergoing percutaneous coronary intervention. PATIENTS AND METHODS Cardiovascular deficits, noncardiovascular deficits, and functional impairments were prospectively studied in 535 patients aged 55 years or older from August 1, 2014, to March 31, 2018. Models for biological age included deficits (acquired, increase with age, associated with worse prognosis, did not saturate early), functional impairments (subjective-help with daily activities, difficulty with sensory input, continence, weight, balance, mobility; or objective-timed up and go, functional reach), or their combination. RESULTS The mean ± SD age of the study patients was 72.1±9.5 years. For every 5-year increase in chronological age, the mean number of cardiovascular deficits increased from 2.36 among patients younger than 70 years to 3.44 in nonagenarians. The mean number of functional impairments increased from 2.15 for those younger than 70 years to 6.74 for nonagenarians. During a median follow-up of 2.05 years, 99 patients died. Significant improvement in the Harrell concordance index (C index) for prediction of long-term all-cause mortality was noted with biological age calculated from deficits and impairments compared with chronological age (0.77 vs 0.65; P<.001) and when estimating biological age via functional impairments alone vs chronological age (0.75 vs 0.65; P<.001) but not via deficits alone (0.71 vs 0.65; P=.08). Biological age estimates from subjective functional impairments captured most of the prognostic information related to all-cause and noncardiac mortality, whereas deficit-based estimation favored cardiovascular mortality. CONCLUSION The derivation of biological age from deficits and functional impairments provides a major improvement in the estimation of survival as estimated by chronological age.
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Affiliation(s)
- Mandeep Singh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| | | | - Bradley R Lewis
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Amrit Kanwar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Carmen M Terzic
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Atta Behfar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - James L Kirkland
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN
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Chang KY, Chiu N, Aggarwal R. In-Hospital Mortality for Inpatient Percutaneous Coronary Interventions in the United States. Am J Cardiol 2021; 159:30-35. [PMID: 34503823 DOI: 10.1016/j.amjcard.2021.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 11/18/2022]
Abstract
Cardiovascular mortality is substantially higher in rural communities compared with urban communities. Understanding if disparities in inpatient percutaneous coronary intervention (PCI) persist in the United States will help inform initiatives to improve cardiovascular health. Of the more than 7 million hospitalizations in the National Inpatient Sample (2016), we identified 80,793 unweighted hospitalizations for PCI using ICD-10 procedure codes. Using survey weights, these hospitalizations projected 371,040 US admissions for inpatient PCI. For the primary analysis, we determined the association between hospital urban-rural designation and in-hospital mortality after inpatient PCI. In the secondary analysis, we evaluated the association between teaching status and this outcome. Multivariable logistic regression models, adjusted for multiple risk factors and patient characteristics, were used. Of the 371,430 hospitalizations for inpatient PCI, there were 108.9 (±2.2) admissions per 100,000 US population from urban hospitals and 152.9 (±6.3) from rural hospitals. Of the urban hospitals, there were 77.7 (±1.9) admissions per 100,000 US population at teaching hospitals (71.7%) and 30.7 (±1.0) at urban nonteaching hospitals (28.3%). In-hospital mortality did not differ between urban and rural hospitals (1.8% urban vs 1.9% rural, adjusted odds ratio for rural compared with urban: 1.15 [95% confidence interval 0.98, 1.34], p = 0.08). In urban hospitals, however, in-hospital mortality was higher in nonteaching hospitals than in teaching hospitals (2.0% nonteaching vs 1.7% teaching, adjusted odds ratio for teaching compared with nonteaching: 1.17 [95% confidence interval 1.01, 1.36], p = 0.04). In conclusion, in-hospital mortality rates after inpatient PCI were similar between urban and rural hospitals in the United States. However, among urban hospitals, nonteaching hospitals had higher rates of in-hospital mortality after PCI. In conclusion, solutions to address disparities for inpatient PCI outcomes between teaching and nonteaching hospitals are needed.
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Affiliation(s)
- Katie Y Chang
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Nicholas Chiu
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Rahul Aggarwal
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
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Kanwar A, Roger VL, Lennon RJ, Gharacholou SM, Singh M. Poor quality of life in patients with and without frailty: co-prevalence and prognostic implications in patients undergoing percutaneous coronary interventions and cardiac catheterization. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 7:591-600. [PMID: 32821905 DOI: 10.1093/ehjqcco/qcaa065] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/29/2020] [Accepted: 08/17/2020] [Indexed: 11/14/2022]
Abstract
AIMS We hypothesize that poor quality of life (QOL) is highly prevalent in frail older adults and is associated with worse prognosis. METHODS AND RESULTS Predismissal standardized tests for frailty and QOL were prospectively administered to patients included in two cohorts. In Cohort 1, 629 patients ≥65 years who underwent percutaneous coronary intervention (PCI) from 2005 to 2008, frailty (Fried criteria), and QOL [SF-36 and Seattle Angina Questionnaires (SAQ)] were ascertained. Cohort 2 included 921 patients ≥55 years who underwent cardiac catheterization (535 had PCI) from 2014 to 2018 and frailty was determined by Rockwood criteria and QOL by single-item, self-reported health questionnaire. In Cohort 1, 19% were frail and 20% patients in Cohort 2 were frail with a frailty index >0.30. The median SAQ for physical limitation (58.9 vs. 82.2, P < 0.001), physical (29.5 vs. 43.9, P < 0.001), and mental (49.2 vs. 57.4, P < 0.001) component scores of SF-36 in Cohort 1 were lower and self-rating of fair/poor health (56% vs 18%, P < 0.001) in Cohort 2 was significantly higher in frail patients. As compared to patients without frailty, frail patients were five times more likely (59% vs. 11%, P < 0.001) in Cohort 1 and seven times more likely (56% vs. 8%) in Cohort 2 to be classified with poor QOL. Age- and gender-adjusted 3-year all-cause death and death or myocardial infarction (MI) was significantly higher for patients undergoing PCI with frailty; [hazard ratio (95% confidence interval) death, 4.20 (2.63-6.68, P < 0.001) and death or MI hazard ratio (HR) 2.72 (1.91-3.87, P < 0.001)] and with poor QOL [HR death 2.47 (1.59-3.84, P < 0.001)] and death or MI 1.61 (1.16-2.24, P < 0.001). There was no significant interaction between frailty and QOL (P = 0.64) and only modest attenuation was observed when considered together indicating their independent prognostic influence. CONCLUSION In elderly patients undergoing cardiac catheterization or PCI, poor QOL is seen more frequently in frail patients. Both frailty and poor QOL had significant and independent association with long-term survival.
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Affiliation(s)
- Amrit Kanwar
- Department of Internal Medicine, Loma Linda University, Loma Linda, California
| | - Veronique L Roger
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Ryan J Lennon
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | | | - Mandeep Singh
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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Darmoch F, Ullah W, Al-Khadra Y, Sattar Y, Pacha HM, Zghouzi M, Soud M, Bagur R, Naidu SS, Goldsweig AM, Mamas M, Brilakis ES, Alraies MC. Characteristics and hospital outcomes of coronary atherectomy within the United States: a multivariate and propensity-score matched analysis. Expert Rev Cardiovasc Ther 2021; 19:865-870. [PMID: 34330193 DOI: 10.1080/14779072.2021.1963233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Suboptimal stent delivery and deployment in calcified coronary lesions are associated with a poor clinical outcome. METHODS Using the National Inpatient Sample database, we identified patients undergoing percutaneous coronary intervention (PCI). Comparison between procedural and hospital outcomes between patients who underwent atherectomy and those who did not. RESULTS A total of 2,035,039 patients underwent PCI, of which 50,095 (2.4%) underwent lesion modification using atherectomy. After adjustment for baseline differences, patients who underwent atherectomy were found to have higher rates of in-hospital mortality (3.3% vs 2.2% adjusted Odds Ratio, aOR, 1.39; 95% confidence interval [CI], 1.31-1.46, P < 0.001), coronary artery dissection (1.7% vs 1.1%, aOR, 1.56; 95%, 1.45-1.67, P < 0.001) vascular complications (1.6% vs 1.0%, aOR, 1.52; 95%, 1.42-1.64, P < 0.001), major bleeding (6.3% vs 4.7%, aOR, 1.24; 95%, 1.18-1.28, P < 0.001), and acute kidney injury (AKI) (10.9%vs 9.1%, aOR, 1.07; 95%, 1.04-1.11, P < 0.001) when compared with non-atherectomy patients. Concomitant intravascular ultrasound (IVUS) imaging improved mortality, while other complication rates were not affected by imaging. CONCLUSION Coronary atherectomy was performed in patients with multiple comorbidities and was associated with higher in-hospital mortality and complications than the non-atherectomy group.
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Affiliation(s)
- Fahed Darmoch
- Department of Cardiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Waqas Ullah
- Department of Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | - Yasser Al-Khadra
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Yasar Sattar
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Elmhurst Hospital New York, USA
| | - Homam Moussa Pacha
- Department ofCardiology, University of Texas Health Science Center, Houston, Texas, USA
| | - Mohamed Zghouzi
- Detroit Medical Center, Heart Hospital, Detroit, Michigan, USA
| | - Mohamad Soud
- Department of Cardiology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Rodrigo Bagur
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry Western University, London, Ontario, Canada
| | - Srihari S Naidu
- Department of Cardiology, Westchester Medical Center, Valhalla, NY, USA
| | - Andrew M Goldsweig
- Department of Cardiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Mamas Mamas
- Department of Cardiology, Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
| | - Emmanouil S Brilakis
- Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - M Chadi Alraies
- Detroit Medical Center, Heart Hospital, Detroit, Michigan, USA
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Ozmen C, Deniz A, Günay İ, Ünal İ, Celik AI, Çağlıyan ÇE, Deveci OS, Demir M, Kanadaşı M, Usal A. Frailty Significantly Associated with a Risk for Mid-term Outcomes in Elderly Chronic Coronary Syndrome Patients: a Prospective Study. Braz J Cardiovasc Surg 2020; 35:897-905. [PMID: 33306315 PMCID: PMC7731848 DOI: 10.21470/1678-9741-2019-0484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Frailty is a condition of elderly characterized by increased vulnerability to stressful events. Frail patients are more likely to have adverse events. The purposes of this study were to define frailty in patients aged ≥ 70 years with chronic coronary syndrome (CCS) and to evaluate mortality and prognostic significance of frailty in these patients. METHODS We included 99 patients, ≥ 70 years old (mean age 74±5.3 years), with diagnosis of CCS. They were followed-up for up to 12 months. The frailty score was evaluated according to the Canadian Study of Health and Aging (CSHA). All patients were divided as frail or non-frail. The groups were compared for their characteristics and clinical outcomes. RESULTS Fifty patients were classified as frail, and 49 patients as non-frail. The 12-month Major Adverse Cardiac Events (MACE) rate was 69.4% in frail patients and 20% in non-frail patients. Frailty increases the risk for MACE as much as 3.48 times. Two patients died in the non-frail group and 11 patients died in the frail group. Frailty increases the risk for death as much as 6.05 times. When we compared the aforementioned risk factors by multivariate analysis, higher CSHA frailty score was associated with increased MACE and death (relative risk [RR] = 22.94, 95% confidence interval [CI] 3.33-158.19, P=0.001, for MACE; RR = 7.41, 95% CI 1.44-38.03, P=0.016, for death). CONCLUSION Being a frail elderly CCS patient is associated with worse outcomes. Therefore, frailty score should be evaluated for elderly CCS patients as a prognostic marker.
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Affiliation(s)
- Caglar Ozmen
- Department of Cardiology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Ali Deniz
- Department of Cardiology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - İmam Günay
- Department of Cardiology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - İlker Ünal
- Department of Biostatistics, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Aziz Inan Celik
- Department of Cardiology, Gebze Fatih State Hospital, Kocaeli, Turkey
| | - Çağlar Emre Çağlıyan
- Department of Cardiology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Onur Sinan Deveci
- Department of Cardiology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Mesut Demir
- Department of Cardiology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Mehmet Kanadaşı
- Department of Cardiology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Ayhan Usal
- Department of Cardiology, Faculty of Medicine, Cukurova University, Adana, Turkey
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Zykov MV, D'yachenko NV, Trubnikova OA, Erlih AD, Kashtalap VV, Barbarash OL. [Comorbidity and Gender of Patients at Risk of Hospital Mortality After Emergency Percutaneous Coronary Intervention]. ACTA ACUST UNITED AC 2020; 60:38-45. [PMID: 33131473 DOI: 10.18087/cardio.2020.9.n1166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/16/2020] [Accepted: 07/29/2020] [Indexed: 11/18/2022]
Abstract
Aim To study gender aspects of comorbidity in evaluating the risk of in-hospital death for patients with acute coronary syndrome (ACS) after a percutaneous coronary intervention (PCI).Material and methods The presented results are based on data of two ACS registries, the city of Sochi and RECORD-3. 986 patients were included into this analysis by two additional criteria, age <70 years and PCI. 80% of the sample were men. Analysis of comorbidity severity was performed for all patients and included 9 indexes: type 2 diabetes mellitus, chronic kidney disease, atrial fibrillation, anemia, stroke, arterial hypertension, obesity, and peripheral atherosclerosis. Group 1 (minimum comorbidity) consisted of patients with not more than one disease (n=367); group 2 (moderate comorbidity) consisted of patients with 2 or 3 diseases (n=499), and group 3 (pronounced comorbidity) consisted of patients with 4 or more diseases (n=120). In-hospital mortality was 2.7 % (n=27).Results Significant data on the effect of comorbidity on the in-hospital prognosis were obtained only for men of the compared groups: 0.6, 1.8, and 8.8 %, respectively (χ2=21.6; р<0.0001). At the same time, among 44 women with minimum comorbidity, there were no cases of in-hospital death, and the presence of moderate (n=110) and pronounced comorbidity (n=40) was associated with a similar death rate (7.3 and 7.5 %, respectively). Noteworthy, in moderate comorbidity, the female gender was associated with a 4-fold increase in the risk of in-hospital death (odd ratio, OR 4.3 at 95 % confidence interval, CI from 1.5 to 12.1; р=0.003). In addition, both in men and women with minimum comorbidity, even a high risk by the GRACE scale (score ≥140) was not associated with increased in-hospital mortality, which was minimal (0 for women and 1 % for men). At the same time, in the patient subgroup with moderate and pronounced comorbidity, a GRACE score ≥140 resulted in a 6-fold increase in the risk of in-hospital death for men (OR 6.0 at 95 % CI from 1.7 to 21.9; р=0.002) and a 16-fold increase for women (OR 16.2 at 95 % CI from 2.0 to 130.4; р=0.0006).Conclusion This study identified gender-related features in predicting the risk of in-hospital death for ACS patients with comorbidities after PCI, which warrants reconsideration of existing approaches to risk stratification.
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Affiliation(s)
- M V Zykov
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo
| | - N V D'yachenko
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo
| | - O A Trubnikova
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo
| | - A D Erlih
- Pirogov Russian National Research Medical University, Moscow
| | - V V Kashtalap
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo
| | - O L Barbarash
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo
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Singh M, Spertus JA, Gharacholou SM, Arora RC, Widmer RJ, Kanwar A, Sanjanwala RM, Welle GA, Al-Hijji MA. Comprehensive Geriatric Assessment in the Management of Older Patients With Cardiovascular Disease. Mayo Clin Proc 2020; 95:1231-1252. [PMID: 32498778 DOI: 10.1016/j.mayocp.2019.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 08/29/2019] [Accepted: 09/04/2019] [Indexed: 12/30/2022]
Abstract
Cardiovascular disease (CVD) disproportionately affects older adults. It is expected that by 2030, one in five people in the United States will be older than 65 years. Individuals with CVD now live longer due, in part, to current prevention and treatment approaches. Addressing the needs of older individuals requires inclusion and assessment of frailty, multimorbidity, depression, quality of life, and cognition. Despite the conceptual relevance and prognostic importance of these factors, they are seldom formally evaluated in clinical practice. Further, although these constructs coexist with traditional cardiovascular risk factors, their exact prevalence and prognostic impact remain largely unknown. Development of the right decision tools, which include these variables, can facilitate patient-centered care for older adults. These gaps in knowledge hinder optimal care use and underscore the need to rigorously evaluate the optimal constructs for providing care to older adults. In this review, we describe available tools to examine the prognostic role of age-related factors in patients with CVD.
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Affiliation(s)
- Mandeep Singh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, MO
| | | | - Rakesh C Arora
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Amrit Kanwar
- University of Iowa Carver College of Medicine, Iowa City, IA
| | - Rohan M Sanjanwala
- Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, Manitoba, Canada
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Abdullah AS, Salama A, Ibrahim H, Eigbire G, Hoefen R, Alweis R. Palliative Care in Myocardial Infarction: Patient Characteristics and Trends of Service Utilization in a National Inpatient Sample. Am J Hosp Palliat Care 2019; 36:722-726. [PMID: 30803244 DOI: 10.1177/1049909119832818] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Myocardial infarction (MI) remains a leading cause of mortality. Palliative care (PC) has recently expanded in scope to include noncancer-related conditions. There is little data available regarding the use of PC in critical MI patients. METHODS We used discharge data from the National Inpatient Sample for the years 2012 to 2014. We examined discharges with a primary diagnosis of MI. We measured the rate of PC referral, trend in utilization during the study period and possible predictors of PC utilization. RESULTS Among 1 667 520 discharges of those patients ≥18 years of age and with a primary diagnosis of MI, use of PC was seen in 2.5% of all patients and in 24% of patients who died. In a multivariable logistic regression, we found the presence of cancer, cardiogenic shock, dementia, stroke, hemiplegia, the use of circulatory support, and mechanical ventilation were associated with higher likelihood of PC referral. Palliative care referral increased during the study period, odds ratio of 1.18 per year (95% confidence interval: 1.14-1.21; P value <.001). Palliative care was not associated with prolonged length of stay. CONCLUSION Several comorbidities were associated with the use of PC, most notably the use of mechanical ventilation and the presence of metastatic cancer. There was a trend of increasing use of PC during the study period.
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Affiliation(s)
| | - Amr Salama
- 1 Department of Medicine-Unity Hospital, Rochester Regional Health, Rochester, NY, USA
| | - Hisham Ibrahim
- 2 Department of Cardiology-University of Iowa Hospital and Clinics, Iowa city, IA, USA
| | - George Eigbire
- 1 Department of Medicine-Unity Hospital, Rochester Regional Health, Rochester, NY, USA
| | - Ryan Hoefen
- 3 Sands-Constellation Heart Institute, Rochester Regional health, Rochester, NY, USA
| | - Richard Alweis
- 1 Department of Medicine-Unity Hospital, Rochester Regional Health, Rochester, NY, USA.,4 Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.,5 School of Health Sciences, Rochester Institute of Technology, Rochester, NY, USA
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Karabağ T, Altuntaş E, Kalaycı B, Şahіn B, Somuncu MU, Çakır MO. The relationship of Charlson comorbidity index with stent restenosis and extent of coronary artery disease. Interv Med Appl Sci 2018; 10:70-75. [PMID: 30363352 PMCID: PMC6167624 DOI: 10.1556/1646.10.2018.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objectives The objective of this study is to investigate the effect of comorbid conditions [Charlson comorbidity index (CCI)] on stent restenosis who underwent coronary angioplasty earlier. Methods Patients were divided into two groups; patients with critical restenosis [recurrent diameter stenosis >50% at the stent segment or its edges (5-mm segments adjacent to the stent) (Group 1; n = 53, mean age: 63.8 ± 9.9 years)] and patients with no critical restenosis [<50% obstruction (Group 2; n = 94, mean age: 62.1 ± 9.1 years)]. The CCI and modified CCI were used for the presence of comorbid conditions. The Gensini scoring system was used to assess the extent of coronary artery disease (CAD). Results Group 1 had a significantly greater CCI and modified CCI score compared to Group 2 (7.1 ± 3.7 vs. 5.6 ± 1.6, p = 0.006; 6.9 ± 3.6 vs. 4.5 ± 1.5, p = 0.008, respectively). There was a weak correlation, albeit significant, between the modified CCI score and restenosis percentage (r = 0.29, p < 0.001; r = 0.25, p = 0.003, respectively). Conclusions In conclusion, the CCI score is greater among patients with stent restenosis than those without. CCI score is higher among patients with a more diffuse CAD than with a milder disease extent.
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Affiliation(s)
- Turgut Karabağ
- Faculty of Medicine, Department of Cardiology, Bulent Ecevit University, Zonguldak, Turkey
| | - Emіne Altuntaş
- Department of Cardiology, Ataturk State Hospital, Zonguldak, Turkey
| | - Belma Kalaycı
- Faculty of Medicine, Department of Cardiology, Bulent Ecevit University, Zonguldak, Turkey
| | - Bahar Şahіn
- Faculty of Medicine, Department of Cardiology, Bulent Ecevit University, Zonguldak, Turkey
| | - Mustafa Umut Somuncu
- Faculty of Medicine, Department of Cardiology, Bulent Ecevit University, Zonguldak, Turkey
| | - Mustafa Ozan Çakır
- Faculty of Medicine, Department of Cardiology, Bulent Ecevit University, Zonguldak, Turkey
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Al-Hijji MA, Gulati R, Lennon RJ, Bell M, El Sabbagh A, Park JY, Slusser J, Sandhu GS, Reeder GS, Rihal CS, Singh M. Outcomes of Percutaneous Coronary Interventions in Patients With Anemia Presenting With Acute Coronary Syndrome. Mayo Clin Proc 2018; 93:1448-1461. [PMID: 30286831 DOI: 10.1016/j.mayocp.2018.03.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/22/2018] [Accepted: 03/28/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To study the influence of anemia on long-term outcomes of patients with acute coronary syndrome undergoing percutaneous coronary intervention (PCI). PATIENTS AND METHODS The study included 5668 consecutive unique patients with acute coronary syndrome who underwent PCI at Mayo Clinic from January 1, 2004, through December 31, 2014. The patients were stratified on the basis of the presence (hemoglobin [Hgb] level, <13 g/dL in men and <12 g/dL in women) and severity (moderate to severe Hgb level, <11 g/dL in men and women) of pre-PCI anemia and compared with patients without anemia. The primary outcomes were in-hospital and long-term all-cause mortality after balancing baseline comorbidities using the inverse propensity weighting method. RESULTS Unadjusted all-cause in-hospital mortality (4.6% [84 of 1831] vs 2.0% [75 of 3837]) and 5-year follow-up mortality (44.4% [509] vs 15.4% [323]) were higher in patients with anemia than in those without anemia (P<.001 for both). After applying inverse propensity weighting analysis, the all-cause in-hospital mortality (2.0% [37] vs 2.0% [75]; P=.85) and 5-year mortality (17.8% [203] vs 15.4% [323]; P=.05) were not significantly different between patients with and without anemia; however, there were higher rates of all-cause 5-year mortality in patients with moderate to severe anemia (22.3% [113] vs 15.4% [323]; P<.001) compared with patients without anemia. The trend in 5-year mortality was driven by increased noncardiac mortality in patients with anemia (10.2% [91] vs 7.1% [148]; P=.04) and moderate to severe anemia (10.4% [52] vs 7.1% [148]; P=.006) when compared with nonanemic patients. CONCLUSION After accounting for differences in risk profiles of anemic and nonanemic patients, anemia appeared to be an independent risk factor for increased long-term all-cause and noncardiac mortality.
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Affiliation(s)
| | - Rajiv Gulati
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Ryan J Lennon
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Malcolm Bell
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | - Jae Yoon Park
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Joshua Slusser
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | | | - Guy S Reeder
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | - Mandeep Singh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
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Kwok CS, Martinez SC, Pancholy S, Ahmed W, Al-Shaibi K, Potts J, Mohamed M, Kontopantelis E, Curzen N, Mamas MA. Effect of Comorbidity On Unplanned Readmissions After Percutaneous Coronary Intervention (From The Nationwide Readmission Database). Sci Rep 2018; 8:11156. [PMID: 30042466 PMCID: PMC6057975 DOI: 10.1038/s41598-018-29303-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 07/02/2018] [Indexed: 12/18/2022] Open
Abstract
It is unclear how comorbidity influences rates and causes of unplanned readmissions following percutaneous coronary intervention (PCI). We analyzed patients in the Nationwide Readmission Database who were admitted to hospital between 2010 and 2014. The comorbidity burden as defined by the Charlson Comorbidity Index (CCI). Primary outcomes were 30-day readmission rates and causes of readmission according to comorbidity burden. A total of 2,294,346 PCI procedures were included the analysis. The patients in CCI = 0, 1, 2 and ≥3 were 842,272(36.7%), 701,476(30.6%), 347,537(15.1%) and 403,061(17.6%), respectively. 219,227(9.6%) had an unplanned readmission within 30 days and rates by CCI group were 6.6%, 8.6%, 11.4% and 15.9% for CCI groups 0, 1, 2 and ≥3, respectively. The CCI score was also associated with greater cost (cost of index PCI for not readmitted vs readmitted was CCI = 0 $21,257 vs $19,764 and CCI ≥ 3 $26,736 vs $27,723). Compared to patients with CCI = 0, greater CCI score was associated with greater independent odds of readmission (CCI = 1 OR 1.25(1.22–1.28), p < 0.001, CCI ≥ 3 OR 2.08(2.03–2.14), p < 0.001). Rates of non-cardiac causes for readmissions increased with increasing CCI group from 49.4% in CCI = 0 to 57.1% in CCI ≥ 3. Rates of early unplanned readmission increase with greater comorbidity burden and non-cardiac readmissions are higher among more comorbid patients.
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Affiliation(s)
- Chun Shing Kwok
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK. .,Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK.
| | - Sara C Martinez
- Division of Cardiology, Providence St. Peter Hospital, Olympia, Washington, USA
| | - Samir Pancholy
- The Wright Center for Graduate Medical Education, The Commonwealth Medical College, Scranton, PA, USA
| | - Waqar Ahmed
- Department of Cardiology, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Khaled Al-Shaibi
- Department of Cardiology, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Jessica Potts
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK
| | - Mohamed Mohamed
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK.,Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | | | - Nick Curzen
- University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Faculty of Medicine, University of Southampton, Southampton, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK.,Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
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12
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Walker DM, Gale CP, Lip G, Martin-Sanchez FJ, McIntyre HF, Mueller C, Price S, Sanchis J, Vidan MT, Wilkinson C, Zeymer U, Bueno H. Editor's Choice - Frailty and the management of patients with acute cardiovascular disease: A position paper from the Acute Cardiovascular Care Association. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2018; 7:176-193. [PMID: 29451402 DOI: 10.1177/2048872618758931] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Frailty is increasingly seen among patients with acute cardiovascular disease. A combination of an ageing population, improved disease survival, treatable long-term conditions as well as a greater recognition of the syndrome has accelerated the prevalence of frailty in the modern world. Yet, this has not been matched by an expansion of research. National and international bodies have identified acute cardiovascular disease in the frail as a priority area for care and an entity that requires careful clinical decisions, but there remains a paucity of guidance on treatment efficacy and safety, and how to manage this complex group. This position paper from the Acute Cardiovascular Care Association presents the latest evidence about frailty and the management of frail patients with acute cardiovascular disease, and suggests avenues for future research.
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Affiliation(s)
| | - C P Gale
- 2 Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK
| | - G Lip
- 3 Institute for Cardiovascular Sciences, University of Birmingham, UK.,4 Aalborg Thrombosis Research Unit, Aalborg University, Denmark
| | | | | | - C Mueller
- 6 Cardiovascular Research Institute Basel, University of Basel, Switzerland
| | - S Price
- 7 Royal Brompton Hospital, UK
| | - J Sanchis
- 8 Department of Cardiology, University of Valencia, Spain.,9 University of Valencia, CIBER CV, Spain
| | - M T Vidan
- 10 Department of Geriatrics, Universidad Complutense de Madrid Dr Esquerdo, Spain
| | - C Wilkinson
- 2 Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK
| | - U Zeymer
- 11 Klinikum Ludwigshafen und Institut for Herzinfarktforschung, Germany
| | - H Bueno
- 12 National Centre for Cardiovascular Research, Spain
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13
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Abstract
Frailty has become more frequently recognized as an indicator of predisability. It has been shown to have an association with cardiovascular disease (CVD), just as CVD has an association with frailty, and is a predictor of hospitalization and mortality. The ability to identify this population provides a measure to more accurately assess risk and prognosis which can help the early detection of disease and dictate intervention. This has become even more critical over time with the advent of various therapeutic interventions that are geared toward patients who are poor candidates for aggressive surgical measures, such as transcatheter aortic valve replacement. The American Heart Association has called for a better understanding of frailty as it relates to CVD in the elderly.
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14
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van Boven N, van Domburg RT, Kardys I, Umans VA, Akkerhuis KM, Lenzen MJ, Valgimigli M, Daemen J, Zijlstra F, Boersma E, van Geuns RJ. Development and validation of a risk model for long-term mortality after percutaneous coronary intervention: The IDEA-BIO Study. Catheter Cardiovasc Interv 2017; 91:686-695. [PMID: 28707322 DOI: 10.1002/ccd.27182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 06/08/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVES We aimed to develop a model to predict long-term mortality after percutaneous coronary intervention (PCI), to aid in selecting patients with sufficient life expectancy to benefit from bioabsorbable scaffolds. BACKGROUND Clinical trials are currently designed to demonstrate superiority of bioabsorbable scaffolds over metal devices up to 5 years after implantation. METHODS From 2000 to 2011, 19.532 consecutive patients underwent PCI in a tertiary referral hospital. Patients were randomly (2:1) divided into a training (N = 13,090) and validation (N = 6,442) set. Cox regression was used to identify determinants of long-term mortality in the training set and used to develop a risk model. Model performance was studied in the training and validation dataset. RESULTS Median age was 63 years (IQR 54-72) and 72% were men. Median follow-up was 3.6 years (interquartile range [IQR] 2.4-6.8). The ratio elective vs. non-elective PCIs was 42/58. During 88,620 patient-years of follow-up, 3,156 deaths occurred, implying an incidence rate of 35.6 per 1,000. Estimated 5-year mortality was 12.9%.Regression analysis revealed age, body mass index, diabetes mellitus, renal insufficiency, prior myocardial infarction, PCI indication, lesion location, number of diseased vessels and cardiogenic shock at presentation as determinants of mortality. The long-term risk model showed good discrimination in the training and validation sets (c-indices 0.76 and 0.74), whereas calibration was appropriate. CONCLUSIONS A simple risk model, containing 9 baseline clinical and angiographic variables effectively predicts long-term mortality after PCI and may possibly be used to select suitable patients for bioabsorbable scaffolds.
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Affiliation(s)
- Nick van Boven
- Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands.,Department of Cardiology and Cardiovascular Research School COEUR, Erasmus MC, Rotterdam, The Netherlands
| | - Ron T van Domburg
- Department of Cardiology and Cardiovascular Research School COEUR, Erasmus MC, Rotterdam, The Netherlands
| | - Isabella Kardys
- Department of Cardiology and Cardiovascular Research School COEUR, Erasmus MC, Rotterdam, The Netherlands
| | - Victor A Umans
- Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - K Martijn Akkerhuis
- Department of Cardiology and Cardiovascular Research School COEUR, Erasmus MC, Rotterdam, The Netherlands
| | - Mattie J Lenzen
- Department of Cardiology and Cardiovascular Research School COEUR, Erasmus MC, Rotterdam, The Netherlands
| | - Marco Valgimigli
- Department of Cardiology and Cardiovascular Research School COEUR, Erasmus MC, Rotterdam, The Netherlands
| | - Joost Daemen
- Department of Cardiology and Cardiovascular Research School COEUR, Erasmus MC, Rotterdam, The Netherlands
| | - Felix Zijlstra
- Department of Cardiology and Cardiovascular Research School COEUR, Erasmus MC, Rotterdam, The Netherlands
| | - Eric Boersma
- Department of Cardiology and Cardiovascular Research School COEUR, Erasmus MC, Rotterdam, The Netherlands
| | - Robert-Jan van Geuns
- Department of Cardiology and Cardiovascular Research School COEUR, Erasmus MC, Rotterdam, The Netherlands
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15
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Sacha J, Sacha M, Soboń J, Borysiuk Z, Feusette P. Is It Time to Begin a Public Campaign Concerning Frailty and Pre-frailty? A Review Article. Front Physiol 2017; 8:484. [PMID: 28744225 PMCID: PMC5504234 DOI: 10.3389/fphys.2017.00484] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 06/23/2017] [Indexed: 01/06/2023] Open
Abstract
Frailty is a state that encompasses losses in physical, psychological or social domains. Therefore, frail people demonstrate a reduced potential to manage external stressors and to respond to life incidents. Consequently, such persons are prone to various adverse consequences such as falls, cognitive decline, infections, hospitalization, disability, institutionalization, and death. Pre-frailty is a condition predisposing and usually preceding the frailty state. Early detection of frailty (i.e., pre-frailty) may present an opportunity to introduce effective management to improve outcomes. Exercise training appears to be the basis of such management in addition to periodic monitoring of food intake and body weight. However, various nutritional supplements and other probable interventions, such as treatment with vitamin D or androgen, require further investigation. Notably, many societies are not conscious of frailty as a health problem. In fact, people generally do not realize that they can change this unfavorable trajectory to senility. As populations age, it is reasonable to begin treating frailty similarly to other population-affecting disorders (e.g., obesity, diabetes or cardiovascular diseases) and implement appropriate preventative measures. Social campaigns should inform societies about age-related frailty and pre-frailty and suggest appropriate lifestyles to avoid or delay these conditions. In this article, we review current information concerning therapeutic interventions in frailty and pre-frailty and discuss whether a greater public awareness of such conditions and some preventative and therapeutic measures may decrease their prevalence.
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Affiliation(s)
- Jerzy Sacha
- Faculty of Physical Education and Physiotherapy, Opole University of TechnologyOpole, Poland
- Department of Cardiology, University Hospital of the University of OpoleOpole, Poland
| | | | - Jacek Soboń
- Faculty of Physical Education and Physiotherapy, Opole University of TechnologyOpole, Poland
| | - Zbigniew Borysiuk
- Faculty of Physical Education and Physiotherapy, Opole University of TechnologyOpole, Poland
| | - Piotr Feusette
- Department of Cardiology, University Hospital of the University of OpoleOpole, Poland
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16
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Mlynarska A, Mlynarski R, Golba KS. Frailty syndrome in patients with heart rhythm disorders. Geriatr Gerontol Int 2016; 17:1313-1318. [DOI: 10.1111/ggi.12868] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 05/30/2016] [Accepted: 06/14/2016] [Indexed: 12/30/2022]
Affiliation(s)
- Agnieszka Mlynarska
- Department of Internal Nursing, Chair of Internal Medicine, School of Health Sciences; Medical University of Silesia; Katowice Poland
- Department of Electrocardiology; Upper Silesian Heart Center; Katowice Poland
| | - Rafal Mlynarski
- Department of Electrocardiology; Upper Silesian Heart Center; Katowice Poland
| | - Krzysztof S Golba
- Department of Electrocardiology; Upper Silesian Heart Center; Katowice Poland
- Department of Electrocardiology and Heart Failure, School of Health Sciences; Medical University of Silesia; Katowice Poland
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17
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Singh M, Stewart R, White H. Importance of frailty in patients with cardiovascular disease. Eur Heart J 2014; 35:1726-31. [PMID: 24864078 PMCID: PMC4565652 DOI: 10.1093/eurheartj/ehu197] [Citation(s) in RCA: 222] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 03/20/2014] [Accepted: 04/23/2014] [Indexed: 12/16/2022] Open
Abstract
Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality. With the ageing population, the prognostic determinants among others include frailty, health status, disability, and cognition. These constructs are seldom measured and factored into clinical decision-making or evaluation of the prognosis of these at-risk older adults, especially as it relates to high-risk interventions. Addressing this need effectively requires increased awareness and their recognition by the treating cardiologists, their incorporation into risk prediction models when treating an elderly patient with underlying complex CVD, and timely referral for comprehensive geriatric management. Simple measures such as gait speed, the Fried score, or the Rockwood Clinical Frailty Scale can be used to assess frailty as part of routine care of elderly patients with CVD. This review examines the prevalence and outcomes associated with frailty with special emphasis in patients with CVD.
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Affiliation(s)
- Mandeep Singh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA
| | - Ralph Stewart
- Green Lane Cardiovascular Service, Auckland City Hospital, and University of Auckland, Auckland, New Zealand
| | - Harvey White
- Green Lane Cardiovascular Service, Auckland City Hospital, and University of Auckland, Auckland, New Zealand
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18
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Routine Assessment of On-Clopidogrel Platelet Reactivity and Gene Polymorphisms in Predicting Clinical Outcome Following Drug-Eluting Stent Implantation in Patients With Stable Coronary Artery Disease. JACC Cardiovasc Interv 2013; 6:1166-75. [DOI: 10.1016/j.jcin.2013.06.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 06/07/2013] [Accepted: 06/20/2013] [Indexed: 11/23/2022]
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19
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Kanwar A, Singh M, Lennon R, Ghanta K, McNallan SM, Roger VL. Frailty and health-related quality of life among residents of long-term care facilities. J Aging Health 2013; 25:792-802. [PMID: 23801154 PMCID: PMC3927409 DOI: 10.1177/0898264313493003] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To determine the prevalence and relationship of frailty and health-related quality of life (HRQOL) among residents of long-term care [nursing homes (NH) and assisted living (AL)] facilities. METHODS Residents of NH and AL facilities in La Crosse County, Wisconsin, were recruited 1/2009-6/2010 and assessed for frailty (gait speed, unintended weight loss, grip strength), comorbidity (Charlson index), and HRQOL [Short Form (SF)-36]. RESULTS Among 137 participants, 85% were frail. Frail residents were older, had more comorbidities (2.0 vs. 0, p < .001) and lower mean SF-36 Physical Component Score (PCS, 32 vs. 48, p < .001). Following adjustments for age, sex, and comorbidities, compared to nonfrail residents, frail residents had lower SF-36 PCS (mean difference -14.7, 95% CI. -19.3,-10.1, p < .001). Frailty, comorbidity, and HRQOL did not differ between NH and AL facilities. DISCUSSION Frail residents had lower HRQOL, suggesting that preventing frailty may lead to better HRQOL among residents of long-term care facilities.
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Affiliation(s)
| | - Mandeep Singh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Ryan Lennon
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | | | - Véronique L. Roger
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
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20
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Ekerstad N, Swahn E, Janzon M, Alfredsson J, Löfmark R, Lindenberger M, Andersson D, Carlsson P. Frailty is independently associated with 1-year mortality for elderly patients with non-ST-segment elevation myocardial infarction. Eur J Prev Cardiol 2013; 21:1216-24. [PMID: 23644488 DOI: 10.1177/2047487313490257] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND For the large population of elderly patients with cardiovascular disease, it is crucial to identify clinically relevant measures of biological age and their contribution to risk. Frailty is denoting decreased physiological reserves and increased vulnerability. We analysed the manner in which the variable frailty is associated with 1-year outcomes for elderly non-ST-segment elevation myocardial infarction (NSTEMI) patients. METHODS AND RESULTS Patients aged 75 years or older, with diagnosed NSTEMI were included at three centres, and clinical data including judgment of frailty were collected prospectively. Frailty was defined according to the Canadian Study of Health and Aging Clinical Frailty Scale. Of 307 patients, 149 (48.5%) were considered frail. By Cox regression analyses, frailty was found to be independently associated with 1-year mortality after adjusting for cardiovascular risk and comorbid conditions (hazard ratio 4.3, 95% CI 2.4-7.8). The time to the first event was significantly shorter for frail patients than for nonfrail (34 days, 95% CI 10-58, p = 0.005). CONCLUSIONS Frailty is strongly and independently associated with 1-year mortality. The combined use of frailty and comorbidity may constitute an important risk prediction concept in regard to cardiovascular patients with complex needs.
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Affiliation(s)
- Niklas Ekerstad
- Linköping University, Linköping, Sweden NU County Hospital, Trollhättan-Vänersborg-Uddevalla, Sweden
| | - Eva Swahn
- Linköping University, Linköping, Sweden
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21
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Singh M, Holmes DR, Gersh BJ, Frye RL, Lennon RJ, Rihal CS. Thirty-year trends in outcomes of percutaneous coronary interventions in diabetic patients. Mayo Clin Proc 2013; 88:22-30. [PMID: 23274017 DOI: 10.1016/j.mayocp.2012.09.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 08/08/2012] [Accepted: 09/14/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To characterize in-hospital and long-term outcomes after percutaneous coronary interventions (PCIs) in patients with diabetes mellitus (DM). PATIENTS AND METHODS Patients who underwent PCIs were grouped by era: group 1, October 9, 1979, to December 31, 1989 (408 with DM and 2684 without DM); group 2, January 1, 1990, to December 31, 1996 (1170 and 4664); group 3, January 1, 1997, to December 31, 2003 (2032 and 6584); and group 4, January 1, 2004, to December 31, 2008 (1412 and 4141). The main outcome measures were in-hospital mortality, major adverse cardiovascular events, long-term mortality, composites of mortality with revascularization, and ischemic events. RESULTS Patients with DM had significant declines in in-hospital adverse outcomes over time. These declines were similar to those observed in patients without DM. After adjusting for baseline risk, there was no significant change in the association between DM and in-hospital death or in-hospital major adverse cardiovascular events over time. The use of aspirin, β-blockers, angiotensin-converting enzyme inhibitors, lipid-lowering drugs, and thienopyridines all increased over time. The effect of DM on long-term survival and survival free of revascularization did not change significantly from group 2 to group 4. However, the effect of DM on survival free of myocardial infarction and stroke was reduced significantly, from a hazard ratio (95% CI) of 1.71 (1.51-1.92) in group 2 to 1.39 (1.20-1.60) in group 4 (P=.04). CONCLUSION Over 30 years, the improving outcomes in patients with diabetes who underwent PCIs have been similar to improvements in patients without DM. However, the risk-adjusted association of DM with long-term death, myocardial infarction, and stroke has decreased in the current era (group 4) compared with the bailout stent era (group 2).
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Affiliation(s)
- Mandeep Singh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA.
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22
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Comparison of frail patients versus nonfrail patients ≥65 years of age undergoing percutaneous coronary intervention. Am J Cardiol 2012; 109:1569-75. [PMID: 22440119 DOI: 10.1016/j.amjcard.2012.01.384] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 01/30/2012] [Accepted: 01/30/2012] [Indexed: 11/21/2022]
Abstract
Frailty is a geriatric syndrome characterized by functional impairments and is associated with poor outcomes; however, the prevalence of frailty and its association with health status in patients treated with percutaneous coronary intervention (PCI) are unknown. To assess the prevalence of frailty and its association with health status in PCI-treated patients, we studied 629 patients ≥65 years old undergoing PCI from October 2005 through September 2008. Frailty was characterized using the Fried criteria: weight loss >10 lbs. in previous 1 year, exhaustion, low physical activity, poor gait speed, and poor grip strength (3 features = frail; 1 feature to 2 features = intermediate frailty; 0 feature = not frail). Health status was assessed using the Short-Form 36 and the Seattle Angina Questionnaire (SAQ). Multivariable linear regression models were used to estimate the independent association between frailty and health status. Complete data on 545 patients demonstrated that 19% (n = 117) were frail, 47% (n = 298) had intermediate frailty, and 21% (n = 130) were not frail. Frail patients had more co-morbidities and more frequent left main coronary artery or multivessel disease after adjusting for age and gender (p <0.05 across groups). Multivariable linear regression demonstrated poorer health status in frail patients compared to nonfrail patients as evidenced by lower Short-Form 36 scores, lower SAQ scores for physical limitation, and lower SAQ scores for quality of life (p <0.001 for each health status domain). In conclusion, 1/5 of older patients are frail at the time of PCI and have greater comorbid burden, angiographic disease severity, and poorer health status than nonfrail adults.
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23
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Ekerstad N, Swahn E, Janzon M, Alfredsson J, Löfmark R, Lindenberger M, Carlsson P. Frailty is independently associated with short-term outcomes for elderly patients with non-ST-segment elevation myocardial infarction. Circulation 2011; 124:2397-404. [PMID: 22064593 DOI: 10.1161/circulationaha.111.025452] [Citation(s) in RCA: 242] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND For the large and growing population of elderly patients with cardiovascular disease, it is important to identify clinically relevant measures of biological age and their contribution to risk. Frailty is an emerging concept in medicine denoting increased vulnerability and decreased physiological reserves. We analyzed the manner in which the variable frailty predicts short-term outcomes for elderly non-ST-segment elevation myocardial infarction patients. METHODS AND RESULTS Patients aged ≥ 75 years, with diagnosed non-ST-segment elevation myocardial infarction were included at 3 centers, and clinical data including judgment of frailty were collected prospectively. Frailty was defined according to the Canadian Study of Health and Aging Clinical Frailty Scale. The impact of the comorbid conditions on risk was quantified by the coronary artery disease-specific index. Of 307 patients, 149 (48.5%) were considered frail. By multiple logistic regression, frailty was found to be strongly and independently associated with risk for the primary composite outcome (death from any cause, myocardial reinfarction, revascularization due to ischemia, hospitalization for any cause, major bleeding, stroke/transient ischemic attack, and need for dialysis up to 1 month after inclusion) (odds ratio, 2.2; 95% confidence interval, 1.3-3.7), in-hospital mortality (odds ratio, 4.6; 95% confidence interval, 1.3-16.8), and 1-month mortality (odds ratio, 4.7; 95% confidence interval, 1.7-13.0). CONCLUSIONS Frailty is strongly and independently associated with in-hospital mortality, 1-month mortality, prolonged hospital care, and the primary composite outcome. The combined use of frailty and comorbidity may constitute an ultimate risk prediction concept in regard to cardiovascular patients with complex needs.
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Affiliation(s)
- Niklas Ekerstad
- Center for Medical Technology Assessment/IMH, Linköping University, Sandbäcksgatan 7, 58183 Linköping, Sweden.
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24
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Singh M, Rihal CS, Lennon RJ, Spertus JA, Nair KS, Roger VL. Influence of frailty and health status on outcomes in patients with coronary disease undergoing percutaneous revascularization. Circ Cardiovasc Qual Outcomes 2011; 4:496-502. [PMID: 21878670 DOI: 10.1161/circoutcomes.111.961375] [Citation(s) in RCA: 190] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND- Although older patients frequently undergo percutaneous coronary interventions (PCI), frailty, comorbidity, and quality of life are seldom part of risk prediction approaches. We assessed their incremental prognostic value over and above the risk factors in the Mayo Clinic risk score. METHODS AND RESULTS- Patients ≥65 years who underwent PCI were assessed for frailty (Fried criteria), comorbidity (Charlson index), and quality of life [SF-36]. Of the 628 discharged [median follow-up of 35.0 months (interquartile range, 22.7 to 42.9)], 78 died and 72 had a myocardial infarction (MI). Three-year mortality was 28% for frail patients, 6% for nonfrail patients. The respective 3-year rates of death or MI were 41% and 17%. After adjustment, frailty [hazard ratio (HR), 4.19 [95% confidence interval (CI), 1.85, 9.51], physical component score of the SF-36 (HR, 1.59; 95% CI, 1.24 to 2.02), and comorbidity, (HR, 1.10; 95% CI, 1.05, 1.16) were associated with mortality. Frailty was associated with mortality/MI (HR, 2.61, 1.52, 4.50). Models with conventional Mayo Clinic risk score had C-statistics of 0.628, 0.573 for mortality and mortality/MI, respectively. Adding frailty, quality of life, and comorbidity, the C-statistic was (0.675, 0.694, 0.671) for mortality and (0.607, 0.587, 0.576) for mortality/MI, respectively. Including frailty, comorbidities and SF-36, conferred a discernible improvement to predict death and death/MI (integrated discrimination improvement, 0.027 and 0.016, and net reclassification improvement of 43% and 18%, respectively). CONCLUSIONS- After PCI, frailty, comorbidity and poor quality of life are prevalent and are associated with adverse long-term outcomes. Their inclusion improves the discriminatory ability of the Mayo Clinic risk score derived from the routine cardiovascular risk factors.
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Affiliation(s)
- Mandeep Singh
- Divisions of Cardiovascular Diseases and Department of Health Sciences Research, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, and the Mayo Clinic and Mid America Heart Institute, Rochester, MN 55905, USA.
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Sanchis J, Núñez J, Bodí V, Núñez E, García-Alvarez A, Bonanad C, Regueiro A, Bosch X, Heras M, Sala J, Bielsa O, Llácer A. Influence of comorbid conditions on one-year outcomes in non-ST-segment elevation acute coronary syndrome. Mayo Clin Proc 2011; 86:291-6. [PMID: 21346247 PMCID: PMC3068888 DOI: 10.4065/mcp.2010.0702] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To investigate comorbid conditions with prognostic influence in non-ST-segment elevation acute coronary syndrome (NSTEACS). PATIENTS AND METHODS The study group consisted of a derivation cohort of 1017 patients (admitted from October 1, 2002, through October 1, 2008) and an external validation cohort of 652 patients (admitted from February 1, 2006, through September 30, 2009). Comorbid conditions, including risk factors and components of the Charlson comorbidity index (ChCI) and coronary artery disease-specific index, were recorded. The main outcome was one-year mortality. RESULTS During follow-up, 103 patients died. After adjusting for variables associated with NSTEACS characteristics (base model), 5 comorbid conditions predicted mortality: severe or mild renal failure (hazard ratio [HR], 2.9 and HR, 1.6, respectively), dementia (HR, 3.1), peripheral artery disease (HR, 2.0), previous heart failure (HR, 2.6), and previous myocardial infarction (HR, 1.4). A simple comorbidity index (SCI) was developed using these variables, (per point: HR, 1.6; 95% confidence interval, 1.4-1.8; P = .0001). Adding the SCI, Charlson comorbidity index, or coronary artery disease-specific index to the base model resulted in a gain of 6.58%, 5.00%, and 4.04%, respectively, in discriminative ability (P = .001), without significant differences among the 3 indices. In patients with comorbid conditions, the highest risk period was in the first weeks after NSTEACS. The strength of the association between SCI and mortality rate was similar in the external validation cohort (HR, 1.3; 95% confidence interval, 1.1-1.6; P = .001). CONCLUSION Renal dysfunction, dementia, peripheral artery disease, previous heart failure, and previous myocardial infarction are the comorbid conditions that predict mortality in NSTEACS. A simple index using these variables proved to be as accurate as the more complex comorbidity indices for risk stratification. In-hospital management of patients with comorbid conditions merits further investigation.
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Affiliation(s)
- Juan Sanchis
- Cardiology Department, University Clinic Hospital, Medicine Department, University of València, Blasco Ibáñez 17, 46010 València, Spain.
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Wang Y, Guo T, Cai HY, Ma TK, Tao SM, Sun S, Chen MQ, Gu Y, Pang JH, Xiao JM, Yang XY, Yang C. Cardiac shock wave therapy reduces angina and improves myocardial function in patients with refractory coronary artery disease. Clin Cardiol 2011; 33:693-9. [PMID: 21089114 DOI: 10.1002/clc.20811] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Safe and effective therapeutic management of refractory coronary artery disease (CAD) in heart patients is critical to enhance cardiovascular function and improve quality of life. Current therapies for refractory CAD are inadequate in ameliorating angina and promoting revascularization of ischemic myocardium. HYPOTHESIS Cardiac shock wave therapy (CSWT) is a safe and effective noninvasive intervention in the management of patients with refractory CAD. METHODS The study enrolled 9 male patients age 50 to 70 years (5.11 ± 5.46 years) with a diagnosis of CAD and stent implantation (3.00 ± 2.24 stents). CSWT was carried out for 3 months at 3 intervals during the first week of each month (first, third, and fifth day), for a total of 9 therapies per patient. Dobutamine stress echocardiography and radionuclide angiography identified the myocardial ischemic segments. The effects of CSWT on myocardial perfusion and systolic function were examined. Other outcome measures included myocardial injury enzyme markers, angina scale, nitroglycerin dosage, and cardiopulmonary fitness assessments. RESULTS Improved myocardial blood flow and regional systolic function (stress peak systolic strain rate - 1.10 to - 1.60 s(-1), P = 0.002) were detected in patients following CSWT. Reductions in creatine kinase (87.89 ± 36.69 to 86.22 ± 35.96 IU/L, P = 0.046), creatine kinase MB (10.89 ± 5.73 to 10.11 ± 5.93 IU/L, P = 0.008), aspartate transaminase (interquartile range [IQR], 28.00 to 27.00 IU/L, P = 0.034) were also found. Angina (Canadian Cardiovascular Society scale IQR 3.0 to 2.0, P = 0.035) and nitroglycerin dose reduction (IQR 3.0 to 1.0 times/wk, P = 0.038) were reported. CONCLUSIONS This study is a preliminary assessment of CSWT in patients with refractory CAD. We report that CSWT is a noninvasive, effective, and safe intervention in the treatment of refractory CAD.
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Affiliation(s)
- Yu Wang
- Department of Cardiology, 1st Hospital of Kumming Medical College, Kumming, Yunnan, China
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de Mulder M, Gitt A, van Domburg R, Hochadel M, Seabra-Gomes R, Serruys PW, Silber S, Weidinger F, Wijns W, Zeymer U, Hamm C, Boersma E. EuroHeart score for the evaluation of in-hospital mortality in patients undergoing percutaneous coronary intervention. Eur Heart J 2011; 32:1398-408. [PMID: 21345854 DOI: 10.1093/eurheartj/ehr034] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
AIMS The applicability of currently available risk prediction models for patients undergoing percutaneous coronary interventions (PCIs) is limited. We aimed to develop a model for the prediction of in-hospital mortality after PCI that is based on contemporary and representative data from a European perspective. METHODS AND RESULTS Our analyses are based on the Euro Heart Survey of PCIs, which contains information on 46 064 consecutive patients who underwent PCI for different indications in 176 participating European centres during 2005-08. Patients were randomly divided into a training (n = 23 032) and a validation (n = 23 032) set with similar characteristics. In these sets, 339 (1.5%) and 305 (1.3%) patients died during hospitalization, respectively. On the basis of the training set, a logistic model was constructed that related 16 independent patient or lesion characteristics with mortality, including PCI indication, advanced age, haemodynamic instability, multivessel disease, and proximal LAD disease. In both the training and validation data sets, the model had a good performance in terms of discrimination (C-index 0.91 and 0.90, respectively) and calibration (Hosmer-Lemeshow P-value 0.39 and 0.18, respectively). CONCLUSION In-hospital mortality in PCI patients was well predicted by a risk score that contains 16 factors. The score has strong applicability for European practices.
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Lu KJ, Yan BP, Ajani AE, Wilson WM, Duffy SJ, Gurvitch R, Clark DJ, Brennan A, Reid C, Andrianopoulos N, Krum H. Impact of concomitant heart failure on outcomes in patients undergoing percutaneous coronary interventions: analysis of the Melbourne Interventional Group registry. Eur J Heart Fail 2011; 13:416-22. [PMID: 21307036 DOI: 10.1093/eurjhf/hfr003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS The presence of heart failure (HF) is an established risk factor for adverse outcomes in patients undergoing percutaneous coronary intervention (PCI). The aim of this study was to determine the prevalence and impact of concomitant HF on major outcomes in contemporary PCI practice. METHODS AND RESULTS We analysed 5006 consecutive PCIs (2004-2006) enrolled in the Melbourne Interventional Group registry. Baseline characteristics, in-hospital, 30-day, and 12-month outcomes of patients with a history of HF (n = 189, 3.8%) were compared with patients without HF (n = 4817, 96.2%). Patients with a history of HF were older (mean age 72.9 ± 9.8 vs. 64.3 ± 12 years, P < 0.01) and had higher rates of diabetes (37.0 vs. 23.5%, P < 0.01), renal dysfunction (Cr > 200 μmol/L; 16.5 vs. 3.9%, P < 0.01), multi-vessel disease (79.8 vs. 58.7%, P < 0.01), and presentation with cardiogenic shock (4.8 vs. 2.1%, P = 0.02). At 12 months, patients with HF had higher overall mortality (13.7 vs. 3.5%, P < 0.01) and rates of HF admission (10.4 vs. 2.0%, P < 0.01). Independent predictors of recurrent HF admission included history of HF [odds ratio (OR) 2.2, 95% confidence interval (CI) 1.2-4.2, P < 0.01] and renal dysfunction (OR 2.5, 95% CI 1.4-4.4, P < 0.01). At 12 months, patients with HF had lower rates of statin (73.9 vs. 89.2%, P < 0.01) and beta-blocker use (55.6 vs. 59.0%, P < 0.01). Angiotensin-converting enzyme-inhibitor/angiotensin receptor blocker use was also relatively low in HF patients (79.6%). CONCLUSION While the overall incidence of HF in patients undergoing PCI is low, underutilization of HF therapies may contribute to an increased likelihood of subsequent re-admission and increased mortality.
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Affiliation(s)
- Ken J Lu
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Singh M, Holmes DR, Lennon RJ, Rihal CS. Development and Validation of Risk Adjustment Models for Long-Term Mortality and Myocardial Infarction Following Percutaneous Coronary Interventions. Circ Cardiovasc Interv 2010; 3:423-30. [DOI: 10.1161/circinterventions.109.924308] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Existing models for outcome after percutaneous coronary interventions (PCIs) lack assessment of long-term prognosis. Our goal was to derive 1- and 5-year mortality and mortality/myocardial infarction (MI) risk models for PCI outcomes from simple, easily obtainable clinical and laboratory variables.
Methods and Results—
Using the Mayo Clinic registry, we analyzed long-term mortality and mortality/MI following PCIs on 9165 unique patients from January 1, 2001, through December 31, 2007. Cox proportional hazards regression was used to model the calculated risk score and major procedural complications. A total of 1243 patients died, and 696 had MI. Separate risk models derived from clinical, procedural, and laboratory characteristics were made for mortality and mortality/MI. Older age, comorbid conditions, low ejection fraction, acute MI, history of smoking, heart failure, hyperlipidemia, 3-vessel disease, procedural failure, ventricular arrhythmia during PCI, and low medication score were predictors of long-term mortality and mortality/MI. Simple integer scores stratified patients into low, moderate, high, and very high risk for subsequent events. Models had adequate goodness of fit, and areas under the receiver operating characteristic curve were 0.786 and 0.728 for mortality and mortality/MI, respectively, indicating good overall discrimination. Bootstrap analysis indicated that the model was not overfit to the available data set.
Conclusions—
Easily obtainable variables can be combined into a convenient risk scoring system at the time of patient dismissal following PCI to accurately predict long-term mortality and mortality/MI. This model may be useful for providing patients with individualized, evidence-based estimates of long-term risk.
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Affiliation(s)
- Mandeep Singh
- From the Division of Cardiovascular Diseases (M.S., C.S.R., D.R.H.), the Division of Biostatistics (R.J.L.), Mayo Clinic, Rochester, Minn
| | - David R. Holmes
- From the Division of Cardiovascular Diseases (M.S., C.S.R., D.R.H.), the Division of Biostatistics (R.J.L.), Mayo Clinic, Rochester, Minn
| | - Ryan J. Lennon
- From the Division of Cardiovascular Diseases (M.S., C.S.R., D.R.H.), the Division of Biostatistics (R.J.L.), Mayo Clinic, Rochester, Minn
| | - Charanjit S. Rihal
- From the Division of Cardiovascular Diseases (M.S., C.S.R., D.R.H.), the Division of Biostatistics (R.J.L.), Mayo Clinic, Rochester, Minn
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Peterson ED, Dai D, DeLong ER, Brennan JM, Singh M, Rao SV, Shaw RE, Roe MT, Ho KKL, Klein LW, Krone RJ, Weintraub WS, Brindis RG, Rumsfeld JS, Spertus JA. Contemporary mortality risk prediction for percutaneous coronary intervention: results from 588,398 procedures in the National Cardiovascular Data Registry. J Am Coll Cardiol 2010; 55:1923-32. [PMID: 20430263 PMCID: PMC3925678 DOI: 10.1016/j.jacc.2010.02.005] [Citation(s) in RCA: 347] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Revised: 02/08/2010] [Accepted: 02/09/2010] [Indexed: 12/14/2022]
Abstract
OBJECTIVES We sought to create contemporary models for predicting mortality risk following percutaneous coronary intervention (PCI). BACKGROUND There is a need to identify PCI risk factors and accurately quantify procedural risks to facilitate comparative effectiveness research, provider comparisons, and informed patient decision making. METHODS Data from 181,775 procedures performed from January 2004 to March 2006 were used to develop risk models based on pre-procedural and/or angiographic factors using logistic regression. These models were independently evaluated in 2 validation cohorts: contemporary (n = 121,183, January 2004 to March 2006) and prospective (n = 285,440, March 2006 to March 2007). RESULTS Overall, PCI in-hospital mortality was 1.27%, ranging from 0.65% in elective PCI to 4.81% in ST-segment elevation myocardial infarction patients. Multiple pre-procedural clinical factors were significantly associated with in-hospital mortality. Angiographic variables provided only modest incremental information to pre-procedural risk assessments. The overall National Cardiovascular Data Registry (NCDR) model, as well as a simplified NCDR risk score (based on 8 key pre-procedure factors), had excellent discrimination (c-index: 0.93 and 0.91, respectively). Discrimination and calibration of both risk tools were retained among specific patient subgroups, in the validation samples, and when used to estimate 30-day mortality rates among Medicare patients. CONCLUSIONS Risks for early mortality following PCI can be accurately predicted in contemporary practice. Incorporation of such risk tools should facilitate research, clinical decisions, and policy applications.
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Affiliation(s)
- Eric D Peterson
- Duke Clinical Research Institute, Durham, North Carolina 27715, USA.
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Prophylactic use of intra-aortic balloon pump for high-risk percutaneous coronary intervention: will the Impella LP 2.5 device show superiority in a clinical randomized study? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2010; 11:91-7. [DOI: 10.1016/j.carrev.2009.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Accepted: 07/21/2009] [Indexed: 11/24/2022]
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Singh M, Peterson ED, Roe MT, Ou FS, Spertus JA, Rumsfeld JS, Anderson HV, Klein LW, Ho KK, Holmes DR. Trends in the Association Between Age and In-Hospital Mortality After Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2009; 2:20-6. [DOI: 10.1161/circinterventions.108.826172] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background—
Temporal trends and contemporary data characterizing the impact of patient age on in-hospital outcomes of percutaneous coronary interventions are lacking. We sought to determine the importance of age by assessing the in-hospital mortality of stratified age groups in the National Cardiovascular Data Registry.
Methods and Results—
In-hospital mortality after percutaneous coronary intervention on 1 410 069 patients was age stratified into 4 groups—group 1 (age <40, n=25 679), group 2 (40 to 59, n=496 204), group 3 (60 to 79, n=732 574), and group 4 (≥80, n=155 612)—admitted from January 1, 2001, to December 31, 2006. Overall in-hospital mortality was 1.22%; in-hospital mortality was 0.60%, 0.59%, 1.26%, and 3.16% in groups 1 to 4, respectively,
P
<0.0001. Overall temporal improvement per calendar year in the adjusted in-hospital mortality after percutaneous coronary intervention was noted in most groups; however, this finding was significant only in the 2 older age groups, group 3 (odds ratio, 0.94; 95% CI, 0.92 to 0.96) and group 4 (odds ratio, 0.95; 95% CI, 0.92 to 0.97). The absolute mortality reduction was greatest in the most elderly group, those over the age of 80 years.
Conclusions—
In-hospital mortality after percutaneous coronary intervention has fallen for all age groups over the past 6 years. However, the largest absolute reduction was seen among patients 80 years of age or older.
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Affiliation(s)
- Mandeep Singh
- From the Division of Cardiovascular Diseases (M.S., D.R.H), Mayo Clinic, Rochester, Minn; Duke Clinical Research Institute (M.T.R., F.-S.O., E.D.P.), Durham, NC; Mid America Heart Institute/UMKC (J.A.S.), Kansas City, Mo; Denver VA Medical Center (J.S.R.), Denver, Colo; University of Texas Health Science Center (H.V.A), Houston, Tex; Rush University Medical Center (L.W.K.), Chicago, Ill; and Beth Israel Deaconess Medical Center (K.K.L.H.), Boston, Mass
| | - Eric D. Peterson
- From the Division of Cardiovascular Diseases (M.S., D.R.H), Mayo Clinic, Rochester, Minn; Duke Clinical Research Institute (M.T.R., F.-S.O., E.D.P.), Durham, NC; Mid America Heart Institute/UMKC (J.A.S.), Kansas City, Mo; Denver VA Medical Center (J.S.R.), Denver, Colo; University of Texas Health Science Center (H.V.A), Houston, Tex; Rush University Medical Center (L.W.K.), Chicago, Ill; and Beth Israel Deaconess Medical Center (K.K.L.H.), Boston, Mass
| | - Matthew T. Roe
- From the Division of Cardiovascular Diseases (M.S., D.R.H), Mayo Clinic, Rochester, Minn; Duke Clinical Research Institute (M.T.R., F.-S.O., E.D.P.), Durham, NC; Mid America Heart Institute/UMKC (J.A.S.), Kansas City, Mo; Denver VA Medical Center (J.S.R.), Denver, Colo; University of Texas Health Science Center (H.V.A), Houston, Tex; Rush University Medical Center (L.W.K.), Chicago, Ill; and Beth Israel Deaconess Medical Center (K.K.L.H.), Boston, Mass
| | - Fang-Shu Ou
- From the Division of Cardiovascular Diseases (M.S., D.R.H), Mayo Clinic, Rochester, Minn; Duke Clinical Research Institute (M.T.R., F.-S.O., E.D.P.), Durham, NC; Mid America Heart Institute/UMKC (J.A.S.), Kansas City, Mo; Denver VA Medical Center (J.S.R.), Denver, Colo; University of Texas Health Science Center (H.V.A), Houston, Tex; Rush University Medical Center (L.W.K.), Chicago, Ill; and Beth Israel Deaconess Medical Center (K.K.L.H.), Boston, Mass
| | - John A. Spertus
- From the Division of Cardiovascular Diseases (M.S., D.R.H), Mayo Clinic, Rochester, Minn; Duke Clinical Research Institute (M.T.R., F.-S.O., E.D.P.), Durham, NC; Mid America Heart Institute/UMKC (J.A.S.), Kansas City, Mo; Denver VA Medical Center (J.S.R.), Denver, Colo; University of Texas Health Science Center (H.V.A), Houston, Tex; Rush University Medical Center (L.W.K.), Chicago, Ill; and Beth Israel Deaconess Medical Center (K.K.L.H.), Boston, Mass
| | - John S. Rumsfeld
- From the Division of Cardiovascular Diseases (M.S., D.R.H), Mayo Clinic, Rochester, Minn; Duke Clinical Research Institute (M.T.R., F.-S.O., E.D.P.), Durham, NC; Mid America Heart Institute/UMKC (J.A.S.), Kansas City, Mo; Denver VA Medical Center (J.S.R.), Denver, Colo; University of Texas Health Science Center (H.V.A), Houston, Tex; Rush University Medical Center (L.W.K.), Chicago, Ill; and Beth Israel Deaconess Medical Center (K.K.L.H.), Boston, Mass
| | - H. Vernon Anderson
- From the Division of Cardiovascular Diseases (M.S., D.R.H), Mayo Clinic, Rochester, Minn; Duke Clinical Research Institute (M.T.R., F.-S.O., E.D.P.), Durham, NC; Mid America Heart Institute/UMKC (J.A.S.), Kansas City, Mo; Denver VA Medical Center (J.S.R.), Denver, Colo; University of Texas Health Science Center (H.V.A), Houston, Tex; Rush University Medical Center (L.W.K.), Chicago, Ill; and Beth Israel Deaconess Medical Center (K.K.L.H.), Boston, Mass
| | - Lloyd W. Klein
- From the Division of Cardiovascular Diseases (M.S., D.R.H), Mayo Clinic, Rochester, Minn; Duke Clinical Research Institute (M.T.R., F.-S.O., E.D.P.), Durham, NC; Mid America Heart Institute/UMKC (J.A.S.), Kansas City, Mo; Denver VA Medical Center (J.S.R.), Denver, Colo; University of Texas Health Science Center (H.V.A), Houston, Tex; Rush University Medical Center (L.W.K.), Chicago, Ill; and Beth Israel Deaconess Medical Center (K.K.L.H.), Boston, Mass
| | - Kalon K.L. Ho
- From the Division of Cardiovascular Diseases (M.S., D.R.H), Mayo Clinic, Rochester, Minn; Duke Clinical Research Institute (M.T.R., F.-S.O., E.D.P.), Durham, NC; Mid America Heart Institute/UMKC (J.A.S.), Kansas City, Mo; Denver VA Medical Center (J.S.R.), Denver, Colo; University of Texas Health Science Center (H.V.A), Houston, Tex; Rush University Medical Center (L.W.K.), Chicago, Ill; and Beth Israel Deaconess Medical Center (K.K.L.H.), Boston, Mass
| | - David R. Holmes
- From the Division of Cardiovascular Diseases (M.S., D.R.H), Mayo Clinic, Rochester, Minn; Duke Clinical Research Institute (M.T.R., F.-S.O., E.D.P.), Durham, NC; Mid America Heart Institute/UMKC (J.A.S.), Kansas City, Mo; Denver VA Medical Center (J.S.R.), Denver, Colo; University of Texas Health Science Center (H.V.A), Houston, Tex; Rush University Medical Center (L.W.K.), Chicago, Ill; and Beth Israel Deaconess Medical Center (K.K.L.H.), Boston, Mass
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