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Mitsis A, Myrianthefs M. Fragile hearts: Unveiling the crucial layers of frailty in elderly patients undergoing percutaneous coronary interventions. World J Clin Cases 2024; 12:5998-6000. [DOI: 10.12998/wjcc.v12.i26.5998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 06/22/2024] [Accepted: 07/10/2024] [Indexed: 07/19/2024] Open
Abstract
Wang and Liu's systematic review of frailty among elderly patients undergoing percutaneous coronary intervention (PCI) revealed that patients with frailty have significantly higher risks of all-cause and in-hospital death, major undesirable cardiovascular events, and major haemorrhage. Frailty is associated with adverse events, prolonged hospital stays, increased complications, and elevated mortality risk due to diminished physiological reserves. Integrating frailty into risk assessment tools is crucial, and gait speed has emerged as a key predictor of frailty. Recognizing the impact of frailty leads to personalized and informed decision-making, and frailty assessments should be performed. This holistic approach can inform tailored interventions, thereby optimizing outcomes for this vulnerable population undergoing PCI.
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Affiliation(s)
- Andreas Mitsis
- Department of Cardiology, Nicosia General Hospital, Nicosia 2026, Cyprus
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2
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Pavasini R, Biscaglia S, Kunadian V, Hakeem A, Campo G. Coronary artery disease management in older adults: revascularization and exercise training. Eur Heart J 2024; 45:2811-2823. [PMID: 38985545 DOI: 10.1093/eurheartj/ehae435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/10/2024] [Accepted: 06/23/2024] [Indexed: 07/12/2024] Open
Abstract
The mean age of patients with coronary artery disease (CAD) is steadily increasing. In older patients, there is a tendency to underutilize invasive approach, coronary revascularization, up-to-date pharmacological therapies, and secondary prevention strategies, including cardiac rehabilitation. Older adults with CAD commonly exhibit atypical symptoms, multi-vessel disease involvement, complex coronary anatomy, and a higher presence of risk factors and comorbidities. Although both invasive procedures and medical treatments are characterized by a higher risk of complications, avoidance may result in a suboptimal outcome. Often, overlooked factors, such as coronary microvascular disease, malnutrition, and poor physical performance, play a key role in determining prognosis, yet they are not routinely assessed or addressed in older patients. Historically, clinicians have relied on sub-analyses or observational findings to make clinical decisions, as older adults were frequently excluded or under-represented in clinical studies. Recently, dedicated evidence through randomized clinical trials has become available for older CAD patients. Nevertheless, the management of older CAD patients still raises several important questions. This review aims to comprehensively summarize and critically evaluate this emerging evidence, focusing on invasive management and coronary revascularization. Furthermore, it seeks to contextualize these interventions within the framework of improved risk stratification tools for older CAD patients, through user-friendly scales along with emphasizing the importance of promoting physical activity and exercise training to enhance the outcomes of invasive and medical treatments. This comprehensive approach may represent the key to improving prognosis in the complex and growing patient population of older CAD patients.
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Affiliation(s)
- Rita Pavasini
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy
| | - Simone Biscaglia
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Newcastle University and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Abdul Hakeem
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy
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3
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Ko D, Evans PT, Lin KJ, Pande AN, Cervone A, Lee SB, Cheng S, Tsacogianis T, Glynn RJ, Kim DH. Frailty and Clinical Outcomes of Ticagrelor Versus Clopidogrel in Older Adults With Acute Myocardial Infarction. J Am Heart Assoc 2024; 13:e034529. [PMID: 39056329 DOI: 10.1161/jaha.124.034529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 07/02/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Ticagrelor is recommended over clopidogrel in acute coronary syndrome based on the results of the PLATO (Study of Platelet Inhibition and Patient Outcomes) trial. We aimed to emulate PLATO in older adults with and without frailty and with acute coronary syndrome treated with percutaneous coronary intervention. METHODS AND RESULTS We created a new-user cohort of Medicare fee-for-service beneficiaries aged ≥65 years hospitalized for acute coronary syndrome from 2014 to 2018 and initiated ticagrelor or clopidogrel following percutaneous coronary intervention. Frailty was defined using a validated claims-based frailty index ≥0.25. Coprimary outcomes were major adverse cardiovascular events and major bleeding. Follow-up began on the date of first outpatient prescription for ticagrelor or clopidogrel and ended on the earliest date for an outcome event, death, discontinuation of the index drug, or disenrollment from Medicare. The study included 42 843 older adults; 23% were frail. After propensity score matching, the rates of major adverse cardiovascular events per 100 person-years comparing ticagrelor versus clopidogrel groups were 7.8 and 7.3 in the frail cohort (hazard ratio [HR], 1.07 [95% CI, 0.84-1.36]) and 3.7 and 4.2 in the nonfrail cohort (HR, 0.87 [95% CI, 0.75-1.02]). The corresponding rates of major bleeding were 4.3 and 3.8 in the frail cohort (HR, 1.12 95% CI, [0.80-1.56]) and 2.2 and 1.8 in the nonfrail cohort (HR, 1.22 [95% CI, 0.98-1.51]). CONCLUSIONS There was a trend toward a modest reduction in risk of major adverse cardiovascular events and a trend toward a modest increase in risk of major bleeding with ticagrelor compared with clopidogrel in the nonfrail cohort. There was insufficient evidence for the benefit of ticagrelor in frail older adults.
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Affiliation(s)
- Darae Ko
- Hinda and Arthur Marcus Institute for Aging Research Hebrew SeniorLife Boston MA
- Section of Cardiovascular Medicine Boston Medical Center Boston MA
| | - Peter T Evans
- Section of Cardiovascular Medicine Boston Medical Center Boston MA
| | - Kueiyu Joshua Lin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital Boston MA
- Division of General Internal Medicine, Department of Medicine Massachusetts General Hospital Boston MA
| | - Ashvin N Pande
- Section of Cardiovascular Medicine Boston Medical Center Boston MA
| | - Alexander Cervone
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital Boston MA
| | - Su Been Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital Boston MA
| | - Susan Cheng
- Department of Cardiology Cedars-Sinai Medical Center Los Angeles CA
| | - Theodore Tsacogianis
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital Boston MA
| | - Robert J Glynn
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital Boston MA
| | - Dae Hyun Kim
- Hinda and Arthur Marcus Institute for Aging Research Hebrew SeniorLife Boston MA
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital Boston MA
- Division of Gerontology, Department of Medicine Beth Israel Deaconess Medical Center Boston MA
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4
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James K, Jamil Y, Kumar M, Kwak MJ, Nanna MG, Qazi S, Troy AL, Butt JH, Damluji AA, Forman DE, Orkaby AR. Frailty and Cardiovascular Health. J Am Heart Assoc 2024; 13:e031736. [PMID: 39056350 DOI: 10.1161/jaha.123.031736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
The incidence of frailty and cardiovascular disease (CVD) increases as the population ages. There is a bidirectional relationship between frailty and CVD, and both conditions share several risk factors and underlying biological mechanisms. Frailty has been established as an independent prognostic marker in patients with CVD. Moreover, its presence significantly influences both primary and secondary prevention strategies for adults with CVD while also posing a barrier to the inclusion of these patients in pivotal clinical trials and advanced cardiac interventions. This review discusses the current knowledge base on the relationship between frailty and CVD, how managing CVD risk factors can modify frailty, the influence of frailty on CVD management, and future directions for frailty detection and modification in patients with CVD.
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Affiliation(s)
- Kirstyn James
- Department of Geriatric Medicine Cork University Hospital Cork Ireland
| | - Yasser Jamil
- Department of Internal Medicine Yale University School of Medicine New Haven CT USA
| | | | - Min J Kwak
- University of Texas Health Science Center at Houston TX USA
| | - Michael G Nanna
- Department of Internal Medicine Yale University School of Medicine New Haven CT USA
| | | | - Aaron L Troy
- Department of Medicine Beth Israel Deaconess Medical Center Boston MA USA
| | - Jawad H Butt
- British Heart Foundation Cardiovascular Research Centre University of Glasgow UK
- Department of Cardiology Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
- Department of Cardiology Zealand University Hospital Roskilde Denmark
| | - Abdulla A Damluji
- Johns Hopkins University School of Medicine Baltimore MD USA
- The Inova Center of Outcomes Research Inova Heart and Vascular Institute Baltimore MD USA
| | - Daniel E Forman
- Department of Medicine (Geriatrics and Cardiology) University of Pittsburgh PA USA
- Pittsburgh GRECC (Geriatrics Research, Education and Clinical Center) VA Pittsburgh Healthcare System Pittsburgh PA USA
| | - Ariela R Orkaby
- VA Boston Healthcare System Boston MA USA
- Division of Aging, Brigham and Women's Hospital Harvard Medical School Boston MA USA
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5
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El Hajj M, Hadid B, Rosenzveig A, Hadid S, Frishman WH, Aronow WS. Managing the Intricacies of Coronary Revascularization: A Close Look at the Complete Versus Culprit-Only Approach and its Implications in Elderly Patients. Cardiol Rev 2024:00045415-990000000-00293. [PMID: 38970477 DOI: 10.1097/crd.0000000000000752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/08/2024]
Abstract
Coronary heart disease is the leading cause of mortality in the United States, and data indicates that 805,000 Americans will face a new or recurrent myocardial infarction (MI) attack every year. Frailty, a conceptual syndrome categorized by a functional decline that occurs with aging, has been linked to adverse health outcomes in cardiovascular disease and all cardiac-related procedures in general. It is therefore reasonable to deliberate that more conservative medical therapy or medical management should be considered in the frail population when managing acute coronary syndrome. This course of action has, in fact, been documented in clinical practice. However, the recent Functional Assessment in Elderly MI Patients with Multivessel Disease trial, in which all subjects were 75 years of age or above, indicated that the more invasive complete revascularization approach may be favorable over incomplete or culprit-only revascularization in patients with acute MI. In this review, we will discuss coronary heart disease and review guidelines and procedures for culprit lesion identification, including electrocardiogram procedures, coronary angiography, intravascular ultrasound, fractional flow reserve, and instantaneous fractional flow reserve. We then discuss the concept of complete vs culprit-only/incomplete coronary revascularization and staging. Following this, we will delve into recent trials discussing complete vs culprit-only revascularization, emphasizing the insights gleaned from this latest trial within this special frailty cohort which warrants special consideration.
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Affiliation(s)
- Mahmoud El Hajj
- From the Department of Internal Medicine, Montefiore St. Luke's Cornwall Hospital, Newburgh, NY
| | - Bana Hadid
- Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Akiva Rosenzveig
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | - Somar Hadid
- Department of Medicine, New York Medical College, Valhalla, NY
| | - William H Frishman
- Department of Medicine, New York Medical College, Valhalla, NY
- Department of Medicine, Westchester Medical Center, Valhalla, NY
- Department of Cardiology, Westchester Medical Center, Valhalla, NY
| | - Wilbert S Aronow
- Department of Medicine, New York Medical College, Valhalla, NY
- Department of Medicine, Westchester Medical Center, Valhalla, NY
- Department of Cardiology, Westchester Medical Center, Valhalla, NY
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Rakisheva A, Soloveva A, Shchendrygina A, Giverts I. Heart Failure With Preserved Ejection Fraction and Frailty: From Young to Superaged Coexisting HFpEF and Frailty. INTERNATIONAL JOURNAL OF HEART FAILURE 2024; 6:93-106. [PMID: 39081641 PMCID: PMC11284337 DOI: 10.36628/ijhf.2023.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/01/2024] [Accepted: 06/14/2024] [Indexed: 08/02/2024]
Abstract
Being commonly diagnosed in elderly women and associated with comorbidities as well as ageing-related cardio-vascular changes, heart failure with preserved ejection fraction (HFpEF) has been recently considered as a distinct cardiogeriatric syndrome. Frailty is another frequent geriatric syndrome. HFpEF and frailty share common underlying mechanisms, often co-exist, and represent each other's risk factors. A threshold of 65 years old is usually used to screen patients for both frailty and HFpEF in research and clinical settings. However, both HFpEF and frailty are very heterogenous conditions that may develop at younger ages. In this review we aim to provide a broader overview on the coexistence of HFpEF and frailty throughout the lifetime. We hypothesize that HFpEF and frailty patients' profiles (young, elderly, superaged) represent a continuum of the common ageing process modified by cumulative exposure to risk factors resulting to a presentation of HFpEF and frailty at different ages. We believe, that suggested approach might stimulate assessment of frailty in HFpEF assessment and vice versa regardless of age and early implementation of targeted interventions. Future studies of pathophysiology, clinical features, and outcomes of frailty in HFpEF by age are needed.
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Affiliation(s)
| | - Anzhela Soloveva
- Department of Cardiology, Almazov Almazov National Medical Research Centre, Saint Petersburg, Russia
| | | | - Ilya Giverts
- Maimonides Medical Center, Brooklyn, NY, USA
- Massachusetts General Hospital, Boston, MA, USA
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Moumneh MB, Jamil Y, Kalra K, Ijaz N, Campbell G, Kochar A, Nanna MG, van Diepen S, Damluji AA. Frailty in the cardiac intensive care unit: assessment and impact. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2024; 13:506-514. [PMID: 38525951 PMCID: PMC11214587 DOI: 10.1093/ehjacc/zuae039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 03/26/2024]
Abstract
Frailty, a clinical syndrome of increased vulnerability, due to diminished cognitive, physical, and physiological reserves is a growing concern in the cardiac intensive care unit (CICU). It contributes to morbidity, mortality, and complications and often exerts a bidirectional association with cardiovascular disease. Although it predominately affects older adults, frailty can also be observed in younger patients <65 years of age, with approximately 30% of those admitted in CICU are frail. Acute cardiovascular illness can also impair physical and cognitive functioning among survivors and these survivors often suffer from frailty and functional declines post-CICU discharge. Patients with frailty in the CICU often have higher comorbidity burden, and they are less likely to receive optimal therapy for their acute cardiovascular conditions. Given the significance of this geriatric syndrome, this review will focus on assessment, clinical outcomes, and interventions, in an attempt to establish appropriate assessment, management, and resource utilization in frail patients during and after CICU admission.
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Affiliation(s)
- Mohamad B Moumneh
- Inova Center of Outcomes Research, Inova Heart and Vascular, 3300 Gallows Road, Falls Church, VA 22042, USA
| | - Yasser Jamil
- Department of Medicine, Yale School of Medicine, 333 Cedar St., New Haven, CT 06510, USA
| | - Kriti Kalra
- Inova Center of Outcomes Research, Inova Heart and Vascular, 3300 Gallows Road, Falls Church, VA 22042, USA
| | - Naila Ijaz
- Inova Center of Outcomes Research, Inova Heart and Vascular, 3300 Gallows Road, Falls Church, VA 22042, USA
| | - Greta Campbell
- Department of Cardiovascular Medicine, Brigham and Women’s Hospital, 75 Francis St., Boston, MA 02115, USA
| | - Ajar Kochar
- Department of Cardiovascular Medicine, Brigham and Women’s Hospital, 75 Francis St., Boston, MA 02115, USA
| | - Michael G Nanna
- Department of Medicine, Division of Cardiology, Yale University School of Medicine, 333 Cedar St., New Haven, CT 06510, USA
| | - Sean van Diepen
- Division of Critical Care, University of Alberta, 116 St. and 85 Ave, Edmonton, AB T6G 2R3, CA
| | - Abdulla A Damluji
- Inova Center of Outcomes Research, Inova Heart and Vascular, 3300 Gallows Road, Falls Church, VA 22042, USA
- Division of Critical Care, University of Alberta, 116 St. and 85 Ave, Edmonton, AB T6G 2R3, CA
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, USA
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8
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Zhang P, Wang J, Wang X, Wang L, Xu S, Gong P. Protectin D1 Alleviates Myocardial Ischemia/Reperfusion Injury by Regulating PI3K/AKT Signaling Pathway. J Cardiovasc Transl Res 2024; 17:376-387. [PMID: 37580643 DOI: 10.1007/s12265-023-10426-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/03/2023] [Indexed: 08/16/2023]
Abstract
Myocardial ischemia/reperfusion (I/R) injury after the onset of acute myocardial infarction (AMI) can be life-threatening, and there is no effective strategy for therapeutic intervention. Here, we studied the potential of protectin D1 in protecting from I/R-induced cardiac damages and investigated the underlying mechanisms. An in vivo rat model of I/R after AMI induction was established through the ligation of the left anterior descending (LAD) artery to assess the cardiac functions and evaluate the protective effect of protectin D1. Protectin D1 protected against I/R-induced oxidative stress and inflammation in the rat model, improved the cardiac function, and reduced the infarct size in myocardial tissues. The beneficial effect of protectin D1 was associated with the up-regulation of miRNA-210 and the effects on PI3K/AKT signaling and HIF-1α expression. Together, our data suggest that protectin D1 could serve as a potential cardioprotective agent against I/R-associated cardiac defects.
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Affiliation(s)
- Peng Zhang
- Department of Cardiology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, 518020, Guangdong, China
| | - Jin Wang
- Emergency Department, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, 1017 Dongmen North Road, Luohu District, Shenzhen, 518020, Guangdong, China
| | - Xingsong Wang
- Department of Anesthesiology, Shouxian Chinese Medicine Hospital, Huainan, 232299, Anhui, China
| | - Li Wang
- Emergency Department, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, 1017 Dongmen North Road, Luohu District, Shenzhen, 518020, Guangdong, China
| | - Shihai Xu
- Emergency Department, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, 1017 Dongmen North Road, Luohu District, Shenzhen, 518020, Guangdong, China.
| | - Ping Gong
- Emergency Department, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, 1017 Dongmen North Road, Luohu District, Shenzhen, 518020, Guangdong, China.
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Álvarez-Zaballos S, Juárez-Fernández M, Martínez-Sellés M. Invasive Strategy in Octogenarians with Non-ST-Segment Elevation Acute Myocardial Infarction. Rev Cardiovasc Med 2024; 25:78. [PMID: 39076933 PMCID: PMC11263832 DOI: 10.31083/j.rcm2503078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/28/2023] [Accepted: 12/07/2023] [Indexed: 07/31/2024] Open
Abstract
With population aging and the subsequent accumulation of cardiovascular risk factors, a growing proportion of patients presenting with acute coronary syndrome (ACS) are octogenarian (aged between 80 and 89). The marked heterogeneity of this population is due to several factors like age, comorbidities, frailty, and other geriatric conditions. All these variables have a strong impact on outcomes. In addition, a high prevalence of multivessel disease, complex coronary anatomies, and peripheral arterial disease, increases the risk of invasive procedures in these patients. In advanced age, the type and duration of antithrombotic therapy need to be individualized according to bleeding risk. Although an invasive strategy for non-ST-segment elevation acute myocardial infarction (NSTEMI) is recommended for the general population, its need is not so clear in octogenarians. For instance, although frail patients could benefit from revascularization, their higher risk of complications might change the risk/benefit ratio. Age alone should not be the main factor to consider when deciding the type of strategy. The risk of futility needs to be taken into account and identification of risk factors for adverse outcomes, such as renal impairment, could help in the decision-making process. Finally, an initially selected conservative strategy should be open to a change to invasive management depending on the clinical course (recurrent angina, ventricular arrhythmias, heart failure). Further evidence, ideally from prospective randomized clinical trials is urgent, as the population keeps growing.
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Affiliation(s)
- Sara Álvarez-Zaballos
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Miriam Juárez-Fernández
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Manuel Martínez-Sellés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- Medicine Department, Universidad Europea, 28670 Madrid, Spain
- Medicine Department, Universidad Complutense, 28005 Madrid, Spain
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10
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McDonagh J. When age is not a barrier, but frailty is. Eur J Cardiovasc Nurs 2024:zvae022. [PMID: 38415790 DOI: 10.1093/eurjcn/zvae022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 02/09/2024] [Indexed: 02/29/2024]
Affiliation(s)
- Julee McDonagh
- Faculty of Science, Medicine, and Health, School of Nursing, University of Wollongong, 33 Moore Street, Liverpool 2170, New South Wales, Australia
- Centre for Chronic and Complex Care Research, Western Sydney Local Health District, Blacktown Hospital, 18 Blacktown Road, 2148 New South Wales, Australia
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Wang SS, Liu WH. Impact of frailty on outcomes of elderly patients undergoing percutaneous coronary intervention: A systematic review and meta-analysis. World J Clin Cases 2024; 12:107-118. [PMID: 38292628 PMCID: PMC10824195 DOI: 10.12998/wjcc.v12.i1.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/30/2023] [Accepted: 12/15/2023] [Indexed: 01/02/2024] Open
Abstract
BACKGROUND Frailty is a common condition in elderly patients who receive percutaneous coronary intervention (PCI). However, how frailty affects clinical outcomes in this group is unclear. AIM To assess the link between frailty and the outcomes, such as in-hospital complications, post-procedural complications, and mortality, in elderly patients post-PCI. METHODS The PubMed/MEDLINE, EMBASE, Cochrane Library, and Web of Science databases were screened for publications up to August 2023. The primary outcomes assessed were in-hospital and all-cause mortality, major adverse cardiovascular events (MACEs), and major bleeding. The Newcastle-Ottawa Scale was used for quality assessment. RESULTS Twenty-one studies with 739693 elderly patients undergoing PCI were included. Frailty was consistently associated with adverse outcomes. Frail patients had significantly higher risks of in-hospital mortality [risk ratio: 3.45, 95% confidence interval (95%CI): 1.90-6.25], all-cause mortality [hazard ratio (HR): 2.08, 95%CI: 1.78-2.43], MACEs (HR: 2.92, 95%CI: 1.85-4.60), and major bleeding (HR: 4.60, 95%CI: 2.89-7.32) compared to non-frail patients. CONCLUSION Frailty is a pivotal determinant in the prediction of risk of mortality, development of MACEs, and major bleeding in elderly individuals undergoing percutaneous coronary intervention.
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Affiliation(s)
- Shi-Shi Wang
- Department of Emergency Medicine, Huzhou Third Municipal Hospital, The Affiliated Hospital of Huzhou University, Huzhou 313000, Zhejiang Province, China
| | - Wang-Hao Liu
- Department of Geriatrics, Huzhou Third Municipal Hospital, the Affiliated Hospital of Huzhou University, Huzhou 313000, Zhejiang Province, China
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12
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Zong M, Guan X, Huang W, Chang J, Zhang J. Effect of Frailty on the Long-Term Prognosis of Elderly Patients with Acute Myocardial Infarction. Clin Interv Aging 2023; 18:2021-2029. [PMID: 38058549 PMCID: PMC10697082 DOI: 10.2147/cia.s433221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/18/2023] [Indexed: 12/08/2023] Open
Abstract
Background To investigate the effect of frailty on the long-term prognosis of elderly patients with acute myocardial infarction (AMI). Methods The data of 238 AMI patients (aged ≥75 years) were retrospectively reviewed. They were divided into two groups according to the Modified Frailty Index (mFI): frailty group (mFI≥0.27, n=143) and non-frailty group (mFI<0.27, n=95). The major adverse cardiovascular and cerebrovascular events (MACEs) and Kaplan-Meier survival curves of the two groups were compared. Multivariate Cox regression analysis was used to identify the risk factors for MACEs. Results The frailty group showed a significantly older age as well as a higher N-terminal proB-type natriuretic peptide level, Global Registry of Acute Coronary Events score, and CRUSADE bleeding score compared with the non-frailty group (P<0.05). A significantly greater proportion of patients with combined heart failure, atrial fibrillation, comorbidity, and activities of daily living score of <60 was also observed in the frailty group compared with the non-frailty group (P<0.05). At 36 months after AMI, the frailty group vs the non-frailty group showed a significantly poorer survival (log-rank P=0.005), higher incidence of MACEs (50.35 vs 29.47, P=0.001), higher overall mortality rate (20.98% vs 7.37%, P=0.006), higher 30-day mortality rate (13.99% vs 5.26%, P=0.033), higher major bleeding rate (14.69% vs 5.26, P=0.018), and lower repeat revascularization rate (2.10% vs 8.42%, P=0.03). Frailty, type 2 diabetes, and N-terminal proB-type natriuretic peptide ≥1800 pg/mL were independent risk factors for MACEs. Conclusion Frailty is an independent risk factor affecting the long-term prognosis of elderly patients with AMI.
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Affiliation(s)
- Min Zong
- Department of Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Xiaonan Guan
- Department of Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Wen Huang
- Department of Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Jing Chang
- Department of Internal Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Jianjun Zhang
- Department of Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
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Kovacevic M, Pompei G, Kunadian V. Tailoring antiplatelet therapy in older patients with coronary artery disease. Platelets 2023; 34:2285446. [PMID: 38050696 DOI: 10.1080/09537104.2023.2285446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/14/2023] [Indexed: 12/06/2023]
Abstract
The older population represents a unique subset of patients due to a higher rate of comorbidities and risk factors, which can lead to a higher rate of ischemic and bleeding events. As a result, older adults are mainly underrepresented or excluded from randomized trials. Although the advancement in the percutaneous coronary intervention field with the development of new technologies, techniques, and potent antiplatelet therapy led to a reduction of ischemic risk, there is still a concern regarding bleeding hazards. Apart from the global utilization of less invasive trans-radial approach and proton pump inhibitors to reduce bleeding risk, proper tailoring of antiplatelet therapy in the older person is imperative. So far, several antiplatelet drugs have been introduced in different clinical scenarios, with dual antiplatelet therapy (combination of acetylsalicylic acid and P2Y12 inhibitor) recommended after percutaneous coronary intervention. The decision on the choice of antiplatelet drug and the DAPT duration is challenging and should be based on the relationship between ischemia and bleeding with the purpose of reducing ischemic events but not at the expense of increased bleeding complications. This is particularly important in the older population, where the evidence is obscure. The main objective of this review is to summarize the available evidence on contemporary antiplatelet therapy and different approaches of de-escalation strategies in older patients after percutaneous coronary intervention.
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Affiliation(s)
- Mila Kovacevic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Graziella Pompei
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK and
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK and
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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14
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Zhang H, Wei X, Chen X, Sun X. Mortality from all-cause and cause-specific in the elderly: Joint implications of anemia and frailty. Arch Gerontol Geriatr 2023; 115:105213. [PMID: 37783022 DOI: 10.1016/j.archger.2023.105213] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/30/2023] [Accepted: 09/23/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Anemia is prevalent among older adults, and it contributes to the incidence of frailty. In turn, the frail elderly may be deficient in nutrients, including iron, vitamin B-12, and folate, that can be materials for human blood, as a result of their limited nutrient intake, resulting in anemia. Both anemia and frailty are associated with an increased risk of mortality in elderly adults. However, the combined influence of anemia and frailty on mortality is unclear. METHODS Data obtained from NHANES 2007-2014 were analyzed in this study. Frailty status was determined using a modified Fried Phenotype, and anemia was defined according to the criteria set by the World Health Organization. Public-use Linked Mortality files until December 31, 2019 were available. The weighted Cox proportional hazard regression models were used to estimate separate effects and joint effects of frailty and anemia on all-cause and cause-specific mortality. RESULTS This study analyzed 6,406 participants aged 60 years or older. Over a 13-year follow-up period, considering participants with no anemia and no frailty as reference, participants with both anemia and frailty had nearly fourfold the all-cause (HR (95% CI): 4.03 (2.95,5.52)), more than four-time the cardiovascular (HR (95% CI): 4.24(2.46,7.32)) mortality risk, and above five-time the non-CVD/non-cancer (HR (95% CI): 5.17 (3.58,7.46)) mortality risk. CONCLUSIONS The study indicated that older adults who exhibit low levels of hemoglobin and frailty are at the greatest risk for all-cause, cardiovascular, cancer, and non-cancer/non-cardiovascular mortality, with the exception of cancer mortality, which was only increased by anemia.
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Affiliation(s)
- HuanRui Zhang
- Department of Geriatric, The First Hospital of China Medical University, NO.155 Nanjing North Street, Heping Ward, Shenyang 110001, China
| | - Xuejiao Wei
- Department of health services and policy research, Queen's University, Kingston, ON, Canada
| | - XiTao Chen
- Department of Thoracic Surgery, The First Hospital of China Medical University, NO.155 Nanjing North Street, Heping Ward, Shenyang 110001, China.
| | - XiaoDi Sun
- Department of Geriatric, The First Hospital of China Medical University, NO.155 Nanjing North Street, Heping Ward, Shenyang 110001, China.
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Kalra K, Moumneh MB, Nanna MG, Damluji AA. Beyond MACE: a multidimensional approach to outcomes in clinical trials for older adults with stable ischemic heart disease. Front Cardiovasc Med 2023; 10:1276370. [PMID: 38045910 PMCID: PMC10690830 DOI: 10.3389/fcvm.2023.1276370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/02/2023] [Indexed: 12/05/2023] Open
Abstract
The global population of older adults is expanding rapidly resulting in a shift towards managing multiple chronic diseases that coexist and may be exacerbated by cardiovascular illness. Stable ischemic heart disease (SIHD) is a predominant contributor to morbidity and mortality in the older adult population. Although results from clinical trials demonstrate that chronological age is a predictor of poor health outcomes, the current management approach remains suboptimal due to insufficient representation of older adults in randomized trials and the inadequate consideration for the interaction between biological aging, concurrent geriatric syndromes, and patient preferences. A shift towards a more patient-centered approach is necessary for appropriately and effectively managing SIHD in the older adult population. In this review, we aim to demonstrate the distinctive needs of older adults who prioritize holistic health outcomes like functional capacity, cognitive abilities, mental health, and quality of life alongside the prevention of major adverse cardiovascular outcomes reported in cardiovascular clinical trials. An individualized, patient-centered approach that involves shared decision-making regarding outcome prioritization is needed when any treatment strategy is being considered. By prioritizing patients and addressing their unique needs for successful aging, we can provide more effective care to a patient population that exhibits the highest cardiovascular risks.
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Affiliation(s)
- Kriti Kalra
- Inova Center of Outcomes Research, Inova Heart and Vascular, Fairfax, VA, United States
| | - Mohamad B. Moumneh
- Inova Center of Outcomes Research, Inova Heart and Vascular, Fairfax, VA, United States
| | - Michael G. Nanna
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Abdulla A. Damluji
- Inova Center of Outcomes Research, Inova Heart and Vascular, Fairfax, VA, United States
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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16
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Ko D, Pande A, Lin KJ, Cervone A, Bessette LG, Lee SB, Cheng S, Glynn RJ, Kim DH. Utilization of P2Y 12 Inhibitors in Older Adults With ST-Elevation Myocardial Infarction and Frailty. Am J Cardiol 2023; 207:245-252. [PMID: 37757521 PMCID: PMC10840744 DOI: 10.1016/j.amjcard.2023.08.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/06/2023] [Accepted: 08/13/2023] [Indexed: 09/29/2023]
Abstract
Choosing optimal P2Y12 inhibitor in frail older adults is challenging because they are at increased risk of both ischemic and bleeding events. We conducted a retrospective cohort study of Medicare Advantage Plan beneficiaries who were prescribed clopidogrel, prasugrel, or ticagrelor after percutaneous coronary intervention-treated ST-elevation myocardial infarction from January 1, 2010 to December 31, 2020. Frailty was defined using claims-based frailty index ≥0.25. We conducted multivariable logistic regression to identify factors associated with using potent P2Y12 inhibitors and multivariable-adjusted competing risk analyses to compare the rate of discontinuation of potent P2Y12 inhibitors in frail versus non-frail patients. There were 11,239 patients (mean age 74 years, 39% women). The prevalence of cardiovascular and geriatric co-morbidities was as follows: 32% chronic kidney disease, 28% heart failure, 10% previous myocardial infarction, 6% dementia, 20% anemia, and 12% frailty. The proportion of patients receiving clopidogrel decreased from 78.3% in 2010 to 2013 to 42.1% in 2018 to 2020, with a concurrent increase in those receiving potent P2Y12 inhibitors (mostly ticagrelor) from 21.7% to 57.9%. Frailty was independently associated with reduced odds of initiation (odds ratio 0.78, 95% confidence interval 0.67 to 0.90) but not with discontinuation of potent P2Y12 inhibitors (subdistribution hazard ratio 1.09, 95% confidence interval 0.98 to 1.22). In conclusion, frail older adults are less likely to receive potent P2Y12 inhibitors after percutaneous coronary intervention-treated ST-elevation myocardial infarction, but they are as likely as non-frail patients to continue with the prescribed P2Y12 inhibitor.
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Affiliation(s)
- Darae Ko
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts; Section of Cardiovascular Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Ashvin Pande
- Section of Cardiovascular Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Kueiyu Joshua Lin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Alexander Cervone
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lily G Bessette
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Su Been Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Susan Cheng
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Robert J Glynn
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Dae Hyun Kim
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
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Guo R, Zhang S, Yu S, Li X, Liu X, Shen Y, Wei J, Wu Y. Inclusion of frailty improved performance of delirium prediction for elderly patients in the cardiac intensive care unit (D-FRAIL): A prospective derivation and external validation study. Int J Nurs Stud 2023; 147:104582. [PMID: 37672971 DOI: 10.1016/j.ijnurstu.2023.104582] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 07/29/2023] [Accepted: 07/30/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND The elderly patients admitted to cardiac intensive care unit (CICU) are at relatively high risk for developing delirium. A simple and reliable predictive model can benefit them from early recognition of delirium followed by timely and appropriate preventive strategies. OBJECTIVE To explore the role of frailty in delirium prediction and develop and validate a delirium predictive model including frailty for elderly patients in CICU. DESIGN A prospective, observational cohort study. SETTINGS CICU at China-Japan Friendship Hospital from March 1, 2022 to August 25, 2022 (derivation cohort); CICU at Beijing Anzhen Hospital affiliated to Capital Medical University from March 14, 2023 to May 8, 2023 (external validation cohort). PARTICIPANTS A total of 236 and 90 participants were enrolled in the derivation and external validation cohorts, respectively. Participants in the derivation cohort were assigned into either the delirium (n = 70) or non-delirium group (n = 166) based on the occurrence of delirium. METHODS The simplified Chinese version of the Confusion Assessment Method for the Diagnosis of Delirium in the Intensive Care Unit was used to assess delirium twice a day at 8:00-10:00 and 18:00-20:00 until the onset of delirium or discharge from the CICU. Frailty was assessed using the FRAIL scale during the first 24 h in the CICU. Other possible risk factors were collected prospectively through patient interviews and medical records review. After processing missing data via multiple imputations, univariate analysis and bootstrapped forward stepwise logistic regression were performed to select optimal predictors and develop the models. The models were internally validated using bootstrapping and evaluated comprehensively via discrimination, calibration, and clinical utility in both the derivation and external validation cohorts. RESULTS The study developed D-FRAIL predictive model using FRAIL score, hearing impairment, Acute Physiology and Chronic Health Evaluation-II score, and fibrinogen. The area under the receiver operating characteristic curve (AUC) was 0.937 (95% confidence interval [CI]: 0.907-0.967) and 0.889 (95%CI: 0.840-0.938) even after bootstrapping in the derivation cohort. Inclusion of frailty was demonstrated to improve the model performance greatly with the AUC increased from 0.851 to 0.937 (p < 0.001). In the external validation cohort, the AUC of D-FRAIL model was 0.866 (95%CI: 0.782-0.907). Calibration plots and decision curve analysis suggested good calibration and clinical utility of the D-FRAIL model in both the derivation and external validation cohorts. CONCLUSIONS For elderly patients in the CICU, FRAIL score is an independent delirium predictor and the D-FRAIL model demonstrates superior performance in predicting delirium.
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Affiliation(s)
- Rongrong Guo
- School of Nursing, Capital Medical University, Beijing 100069, China
| | - Shan Zhang
- School of Nursing, Capital Medical University, Beijing 100069, China
| | - Saiying Yu
- School of Nursing, Capital Medical University, Beijing 100069, China
| | - Xiangyu Li
- School of Nursing, Capital Medical University, Beijing 100069, China
| | - Xinju Liu
- Cardiac Intensive Care Unit, China-Japan Friendship Hospital, Beijing 100029, China
| | - Yanling Shen
- Surgical Intensive Care Unit, China-Japan Friendship Hospital, Beijing 100029, China
| | - Jinling Wei
- Cardiac Intensive Care Unit, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing 100029, China
| | - Ying Wu
- School of Nursing, Capital Medical University, Beijing 100069, China.
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Christensen DM, Strange JE, Falkentoft AC, El-Chouli M, Ravn PB, Ruwald AC, Fosbøl E, Køber L, Gislason G, Sehested TSG, Schou M. Frailty, Treatments, and Outcomes in Older Patients With Myocardial Infarction: A Nationwide Registry-Based Study. J Am Heart Assoc 2023:e030561. [PMID: 37421279 PMCID: PMC10382124 DOI: 10.1161/jaha.123.030561] [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: 04/12/2023] [Accepted: 05/30/2023] [Indexed: 07/10/2023]
Abstract
Background Guidelines recommend that patients with myocardial infarction (MI) receive equal care regardless of age. However, withholding treatment may be justified in elderly and frail patients. This study aimed to investigate trends in treatments and outcomes of older patients with MI according to frailty. Methods and Results All patients aged ≥75 years with first-time MI during 2002 to 2021 were identified through Danish nationwide registries. Frailty was categorized using the Hospital Frailty Risk Score. One-year risk and hazard ratios (HRs) for days 0 to 28 and 29 to 365 were calculated for all-cause death. A total of 51 022 patients with MI were included (median, 82 years; 50.2% women). Intermediate/high frailty increased from 26.7% in 2002 to 2006 to 37.1% in 2017 to 2021. Use of treatment increased substantially regardless of frailty: for example, 28.1% to 48.0% (statins), 21.8% to 33.7% (dual antiplatelet therapy), and 7.6% to 28.0% (percutaneous coronary intervention) for high frailty (all P-trend <0.001). One-year death decreased for low frailty (35.1%-17.9%), intermediate frailty (49.8%-31.0%), and high frailty (62.8%-45.6%), all P-trend <0.001. Age- and sex-adjusted 29- to 365-day HRs (2017-2021 versus 2002-2006) were 0.53 (0.48-0.59), 0.62 (0.55-0.70), and 0.62 (0.46-0.83) for low, intermediate, and high frailty, respectively (P-interaction=0.23). When additionally adjusted for treatment, HRs attenuated to 0.74 (0.67-0.83), 0.83 (0.74-0.94), and 0.78 (0.58-1.05), respectively, indicating that increased use of treatment may account partially for the observed improvements. Conclusions Use of guideline-based treatments and outcomes improved concomitantly in older patients with MI, irrespective of frailty. These results indicate that guideline-based management of MI may be reasonable in the elderly and frail.
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Affiliation(s)
| | - Jarl Emanuel Strange
- Department of Cardiology Herlev and Gentofte University Hospital Copenhagen Denmark
- Department of Cardiology Rigshospitalet Copenhagen Denmark
| | | | | | - Pauline B Ravn
- Department of Cardiology Zealand University Hospital Roskilde Roskilde Denmark
| | | | - Emil Fosbøl
- Department of Cardiology Rigshospitalet Copenhagen Denmark
| | - Lars Køber
- Department of Cardiology Rigshospitalet Copenhagen Denmark
| | - Gunnar Gislason
- Danish Heart Foundation Copenhagen Denmark
- Department of Cardiology Herlev and Gentofte University Hospital Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
- The National Institute of Public Health University of Southern Denmark Copenhagen Denmark
| | - Thomas S G Sehested
- Danish Heart Foundation Copenhagen Denmark
- Department of Cardiology Zealand University Hospital Roskilde Roskilde Denmark
| | - Morten Schou
- Department of Cardiology Herlev and Gentofte University Hospital Copenhagen Denmark
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19
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Pham HM, Nguyen AP, Nguyen HTT, Nguyen TN, Nguyen TX, Nguyen TTH, Nguyen HTT, Nguyen AT, Nguyen QN, Tran GS, Vu HTT. The Frail Scale - A Risk Stratification in Older Patients with Acute Coronary Syndrome. J Multidiscip Healthc 2023; 16:1521-1529. [PMID: 37274424 PMCID: PMC10239255 DOI: 10.2147/jmdh.s409535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/22/2023] [Indexed: 06/06/2023] Open
Abstract
Purpose The aim of this study was to explore the impact of frailty on in-hospital adverse outcomes and net adverse clinical events (NACE) in older patients with acute coronary syndrome. Patients and Methods This observational study included elderly patients (≥60 years old), diagnosed with acute coronary syndrome (ACS) at admission from February 2021 to August 2021. The primary outcome was net adverse clinical events (NACE) defined as a composite of all-cause mortality, stroke, and major bleeding. Secondary outcome was in-hospital adverse outcomes including arrhythmia, acquired pneumonia, stroke, major bleeding, and all-cause mortality. Frailty was assessed using the Frail scale (FS). Data about socio-demographics, comorbidities, body mass index, ACS type, coronary angiography, left ventricular ejection fraction, and length of hospital stay were also collected. Univariate and multivariate logistic regressions were employed to identify the potential association between frailty and outcomes. Results Of the 116 ACS patients, 38 patients were frail (32.76%). Frail subjects were more often female (50%) and older (p < 0.01) and had higher rates of in-hospital adverse outcomes (OR = 2.37, p = 0.05) and NACE (OR = 7.12; p < 0.01). In univariate analysis, the increased frail score was significantly associated with increased odds of NACE (unadjusted OR = 1.98, 95% CI 1.17-3.35 for each score increase in Frail Score). In multivariable logistic regression, models controlling for age, gender, PCI, LVEF, and coronary angiography (adjusted OR 2.19, 95% CI 1.12-4.29 for each score increase in Frail Score). Conclusion This study revealed the reference data of frailty assessment in older patients with ACS in Vietnam. Our result indicated that over 30% of ACS older patients presented with frailty which was associated with an increased risk of in-hospital adverse outcomes and NACE. This study also provided promising information about the simple FRAIL scale's potential role in the risk stratification of older patients with ACS.
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Affiliation(s)
- Hung Manh Pham
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, 100000, Vietnam
- Department of Cardiology, Hanoi Medical University, Hanoi, 100000, Vietnam
| | - Anh Phuong Nguyen
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, 100000, Vietnam
- Department of Cardiology, Hanoi Medical University, Hanoi, 100000, Vietnam
| | - Huong Thi Thu Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, 100000, Vietnam
| | - Tam Ngoc Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, 100000, Vietnam
| | - Thanh Xuan Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, 100000, Vietnam
| | - Thu Thi Hoai Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, 100000, Vietnam
| | - Huong Thi Thanh Nguyen
- Physiology Department, Hanoi Medical University, Hanoi, 100000, Vietnam
- Dinh Tien Hoang Institute of Medicine, Hanoi, 100000, Vietnam
| | - Anh Trung Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, 100000, Vietnam
| | - Quang Ngoc Nguyen
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, 100000, Vietnam
- Department of Cardiology, Hanoi Medical University, Hanoi, 100000, Vietnam
| | - Giang Song Tran
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, 100000, Vietnam
| | - Huyen Thi Thanh Vu
- Department of Geriatrics, Hanoi Medical University, Hanoi, 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, 100000, Vietnam
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Association of Frailty Status on the Causes and Outcomes of Patients Admitted With Cardiovascular Disease. Am J Cardiol 2023; 192:7-15. [PMID: 36702048 DOI: 10.1016/j.amjcard.2022.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/17/2022] [Accepted: 12/26/2022] [Indexed: 01/25/2023]
Abstract
Data are limited about the contemporary association between frailty and the causes and outcomes of patients admitted with cardiovascular diseases (CVD). Using the US National Inpatient Sample, CVD admissions of interest (acute myocardial infarction, ischemic stroke, atrial fibrillation (AF), heart failure, pulmonary embolism, cardiac arrest, and hemorrhagic stroke) were stratified by Hospital Frailty Risk Score (HFRS). Logistic regression was used to determine adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of in-hospital mortality among different groups with frailty. The study included 9,317,398 hospitalizations. Of these, 5,573,033 (59.8%) had a low HFRS (<5); 3,422,700 (36.7%) had an intermediate HFRS (5 to 15); and 321,665 (3.5%) had a high HFRS (>15). Ischemic stroke was the most common admission for the groups with high risk (75.4%), whereas acute myocardial infarction was the most common admission for the group with low risk (36.9%). Compared with the group with low risk, patients with high risk had increased mortality across the most CVD admissions, except in patients admitted for cardiac arrest and hemorrhagic stroke (p <0.001). The strongest association with all-cause mortality was shown among patients with high risk admitted for AF (aOR 6.75, 95% CI 6.51 to 7.00, and aOR 17.69, 95% CI 16.08 to 19.45) compared with their counterparts with low risk. In conclusion, patients with CVD admissions have varying frailty risk according to cardiovascular cause of admission, with ischemic stroke being the most common among groups with frailty and high risk. Increased frailty is associated with all-cause mortality in patients with most CVD admissions, except for cardiac arrest and hemorrhagic stroke, with the strongest association seen in patients admitted with AF.
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21
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Ko D, Bostrom JA, Qazi S, Kramer DB, Kim DH, Orkaby AR. Frailty and Cardiovascular Mortality: A Narrative Review. Curr Cardiol Rep 2023; 25:249-259. [PMID: 36795307 PMCID: PMC10130976 DOI: 10.1007/s11886-023-01847-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE OF REVIEW The goal of the narrative review is to provide an overview of the epidemiology of frailty in cardiovascular disease and cardiovascular mortality and discuss applications of frailty in cardiovascular care of older adults. RECENT FINDINGS Frailty is highly prevalent in older adults with cardiovascular disease and is a robust, independent predictor of cardiovascular death. There is a growing interest in using frailty to inform management of cardiovascular disease either through pre- or post-treatment prognostication or by delineating treatment heterogeneity in which frailty serves to distinguish patients with differential harms or benefits from a given therapy. Frailty can enable more individualized treatment in older adults with cardiovascular disease. Future studies are needed to standardize frailty assessment across cardiovascular trials and enable implementation of frailty assessment in cardiovascular clinical practice.
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Affiliation(s)
- Darae Ko
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Section of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, USA
| | - John A Bostrom
- Section of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, USA
| | - Saadia Qazi
- Department of Medicine, VA Boston Healthcare System, Boston, MA, USA
- Division of Cardiology, Brigham and Women's Hospital, Boston, MA, USA
- Division of Aging, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel B Kramer
- Richart A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Dae Hyun Kim
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA
| | - Ariela R Orkaby
- Department of Medicine, VA Boston Healthcare System, Boston, MA, USA.
- Division of Aging, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA.
- New England GRECC (Geriatric Research, Education, and Clinical Center) VA Boston Healthcare System, 150 South Huntington, 02130, Boston, MA, USA.
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22
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Boyraz B, Peker T, Akgümüş A, Balun A. Interventional therapy of acute coronary syndromes in very old patient population and results of 2 years follow-up. Egypt Heart J 2023; 75:14. [PMID: 36811731 PMCID: PMC9947199 DOI: 10.1186/s43044-023-00340-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/17/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Research on cardiovascular treatment options and prognosis in very old age groups of patients is warranted. In our study, we evaluated and followed up on clinical conditions on admission and comorbidities of patients older than 80 years who were admitted to our hospital with acute myocardial infarction and shared our findings. RESULTS A total of 144 patients were included in the study, with a mean age of 84.56 ± 5.01 years. No complications resulting in death or requiring surgery were observed in the patients. All-cause mortality was found to be related to heart failure, chronic pulmonary disease shock, and C-reactive protein levels. Cardiovascular mortality was correlated to heart failure, shock on admission, and C-reactive protein levels. No significant difference in mortality was observed between Non-ST elevated myocardial infarction and ST-elevation myocardial infarction. CONCLUSIONS Percutaneous coronary intervention is a safe treatment option with low complication and mortality rates in very old patients with acute coronary syndromes.
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Affiliation(s)
- Bedrettin Boyraz
- Cardiology Department, Medicalpark Hospital, Mudanya University, Kırcaali, Fevzi Çakmak Cd. No:76, 16220, Osmangazi, Bursa, Turkey.
| | - Tezcan Peker
- Cardiology Department, Medicalpark Hospital, Mudanya University, Kırcaali, Fevzi Çakmak Cd. No:76, 16220 Osmangazi, Bursa Turkey
| | - Alkame Akgümüş
- grid.484167.80000 0004 5896 227XCardiology Department, Medical Faculty, Bandırma Onyedi Eylül University, Balıkesir, Turkey
| | - Ahmet Balun
- grid.484167.80000 0004 5896 227XCardiology Department, Medical Faculty, Bandırma Onyedi Eylül University, Balıkesir, Turkey
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Damluji AA, Forman DE, Wang TY, Chikwe J, Kunadian V, Rich MW, Young BA, Page RL, DeVon HA, Alexander KP. Management of Acute Coronary Syndrome in the Older Adult Population: A Scientific Statement From the American Heart Association. Circulation 2023; 147:e32-e62. [PMID: 36503287 DOI: 10.1161/cir.0000000000001112] [Citation(s) in RCA: 62] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Diagnostic and therapeutic advances during the past decades have substantially improved health outcomes for patients with acute coronary syndrome. Both age-related physiological changes and accumulated cardiovascular risk factors increase the susceptibility to acute coronary syndrome over a lifetime. Compared with younger patients, outcomes for acute coronary syndrome in the large and growing demographic of older adults are relatively worse. Increased atherosclerotic plaque burden and complexity of anatomic disease, compounded by age-related cardiovascular and noncardiovascular comorbid conditions, contribute to the worse prognosis observed in older individuals. Geriatric syndromes, including frailty, multimorbidity, impaired cognitive and physical function, polypharmacy, and other complexities of care, can undermine the therapeutic efficacy of guidelines-based treatments and the resiliency of older adults to survive and recover, as well. In this American Heart Association scientific statement, we (1) review age-related physiological changes that predispose to acute coronary syndrome and management complexity; (2) describe the influence of commonly encountered geriatric syndromes on cardiovascular disease outcomes; and (3) recommend age-appropriate and guideline-concordant revascularization and acute coronary syndrome management strategies, including transitions of care, the use of cardiac rehabilitation, palliative care services, and holistic approaches. The primacy of individualized risk assessment and patient-centered care decision-making is highlighted throughout.
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Malchikova SV, Trushnikova NS, Kazakovtseva MV, Maksimchuk-Kolobova NS. Cardiovascular risk factors, clinical manifestations and management of myocardial infarction in elderly and longliving patients depending on geriatric status. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2023. [DOI: 10.15829/1728-8800-2023-3376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Aim. To study cardiovascular risk factors, clinical manifestations and management of myocardial infarction (MI) in elderly and longliving patients depending on geriatric status.Material and methods. Out of 92 patients with MI (mean age, 81,6±4,2), 3 following groups were formed: "frailty" — 35 (38,0%), "prefrailty" — 16 (17,4%), and "no frailty" — 41 (44,6%). The following questionnaires were used: Age Is Not a Hindrance, Mini Nutritional Assessment (MNA), Barthel Index for Activities of Daily Living, Lawton Instrumental Activities of Daily Living Scale, balance test, Gait Speed Test, Timed Up and Go test, grip test, Mini Mental State Examination (MMSE), Clock Drawing Test, Geriatric Depression Scale.Results. Frailty probability in patients is higher in the presence of obesity, type 2 diabetes, a decrease in glomerular filtration rate (GFR) <60 ml/min/1,73 m2, a stroke, and heart failure. In the event of clinical manifestations of acute coronary syndrome (ACS), patients without frailty sought medical assistance earlier (in the first 2 hours — 26,8% of patients (χ2=7,8, p=0,005). Most patients with prefrailty and frailty called an ambulance later, but in the first 12 hours — 68,8 and 74,3%, respectively (χ2=15,6, p=0,012). The prevalence of thrombolysis is 23,2%, percutaneous coronary intervention — 30,4% and did not depend on geriatric status. The probability of multivessel disease is higher in patients with or at risk of malnutrition. The main hemodynamic parameters, echocardiography, laboratory parameters in patients with MI did not depend on geriatric status. According to the STOPP/START criteria, frail patients with more often received nonrecommended inhospital medicines.Conclusion. Frailty in patients with MI was associated with multiple cardiovascular risk factors, later medical assistance, and more frequent non-recommended treatment.
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Huang BT, Cheng YH, Yang BS, Zhang YK, Huang FY, Peng Y, Pu XB, Chen M. The influence of pressure injury risk on the association between left ventricular ejection fraction and all-cause mortality in patients with acute myocardial infarction 80 years or older. World J Emerg Med 2023; 14:112-121. [PMID: 36911061 PMCID: PMC9999128 DOI: 10.5847/wjem.j.1920-8642.2023.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 10/21/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND We aimed to investigate whether the pressure injury risk mediates the association of left ventricular ejection fraction (LVEF) with all-cause death in patients with acute myocardial infarction (AMI) aged 80 years or older. METHODS This retrospective cohort study included 677 patients with AMI aged 80 years or older from a tertiary-level hospital. Pressure injury risk was assessed using the Braden scale at admission, and three risk groups (low/minimal, intermediate, high) were defined according to the overall score of six different variables. LVEF was measured during the index hospitalization for AMI. All-cause death after hospital discharge was the primary outcome. RESULTS Over a median follow-up period of 1,176 d (interquartile range [IQR], 722-1,900 d), 226 (33.4%) patients died. Multivariate Cox regression analysis showed that reduced LVEF was associated with an increased risk of all-cause death only in the high-risk group of pressure injury (adjusted hazard ratios [HR]=1.81, 95% confidence interval [CI]: 1.03-3.20; P=0.040), but not in the low/minimal- (adjusted HR=1.29, 95%CI: 0.80-2.11; P=0.299) or intermediate-risk groups (adjusted HR=1.14, 95%CI: 0.65-2.02; P=0.651). Significant interactions were detected between pressure injury risk and LVEF (adjusted P=0.003). The cubic spline with hazard ratio plot revealed a distinct shaped curve relation between LVEF and all-cause death among different pressure injury risk groups. CONCLUSIONS In older patients with AMI, the risk of pressure injury mediated the association between LVEF and all-cause death. The classification of older patients for both therapy and prognosis assessment appears to be improved by the incorporation of pressure injury risk assessment into AMI care management.
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Affiliation(s)
- Bao-Tao Huang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yi-Heng Cheng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Bo-Sen Yang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yi-Ke Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Fang-Yang Huang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yong Peng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xiao-Bo Pu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China
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Nanna MG, Abdullah A, Mortensen MB, Navar AM. Primary prevention statin therapy in older adults. Curr Opin Cardiol 2023; 38:11-20. [PMID: 36598445 PMCID: PMC9830552 DOI: 10.1097/hco.0000000000001003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to assess the evidence for primary prevention statin treatment in older adults, within the context of the most recent guideline recommendations, while also highlighting important considerations for shared decision-making. RECENT FINDINGS As the average lifespan increases and the older adult population grows, the opportunity for prevention of morbidity and mortality from cardiovascular disease is magnified. Randomized trials and meta-analyses have demonstrated a clear benefit for primary prevention statin use through age 75, with uncertainty beyond that age. Despite these data supporting their use, current guidelines conflict in their statin treatment recommendations in those aged 70-75 years. Reflecting the paucity of evidence, the same guidelines are equivocal around primary prevention statins in those beyond age 75. Two large ongoing randomized trials (STAREE and PREVENTABLE) will provide additional insights into the treatment benefits and risks of primary prevention statins in the older adult population. In the meantime, a holistic approach in treatment decisions remains paramount for older patients. SUMMARY The benefits of primary prevention statin treatment are apparent through age 75, which is reflected in the current ACC/AHA and USPSTF recommendations. Ongoing trials will clarify the utility in those beyond age 75.
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Affiliation(s)
- Michael G Nanna
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ahmed Abdullah
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Ann Marie Navar
- Division of Cardiology, UT Southwestern Medical Center, Dallas, Texas, USA
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Ashikawa H, Adachi T, Iwatsu K, Kamisaka K, Kamiya K, Uchiyama Y, Yamada S. Physical Frailty May Predict 2-Year Prognosis in Elderly Patients With Acute Myocardial Infarction - A Report From the FLAGSHIP Study. Circ J 2022; 87:490-497. [PMID: 36567107 DOI: 10.1253/circj.cj-22-0515] [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] [Indexed: 12/24/2022]
Abstract
BACKGROUND Elderly patients with acute myocardial infarction (AMI) are a high-risk population for heart failure (HF), but the association between physical frailty and worsening prognosis, including HF development, has not been documented extensively.Methods and Results: As part of the FLAGSHIP study, we enrolled 524 patients aged ≥70 years hospitalized for AMI and capable of walking at discharge. Physical frailty was assessed using the FLAGSHIP frailty score. The primary outcome was a composite outcome of all-cause death and HF rehospitalization within 2 years after discharge. The secondary outcome was all-cause death and HF rehospitalization. After adjusting for confounders, physical frailty showed a significant association with an increased risk of the composite outcome (hazard ratio [HR]=2.09, 95% confidence interval [CI]: 1.03-4.22, P=0.040). The risk of HF rehospitalization increased with physical frailty, but the association was not statistically significant (HR=2.14, 95% CI: 0.84-5.44, P=0.110). Physical frailty was not associated with an increased risk of all-cause death (HR=1.45, 95% CI: 0.49-4.26, P=0.501). CONCLUSIONS The findings suggest that physical frailty assessment serves as a stratifying tool to identify high-risk populations for post-discharge clinical events among ambulant elderly patients with AMI.
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Affiliation(s)
- Hironobu Ashikawa
- Program in Physical and Occupational Therapy, Nagoya University Graduate School of Medicine
| | - Takuji Adachi
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine
| | - Kotaro Iwatsu
- Department of Rehabilitation, Hirakata Kohsai Hospital
| | - Kenta Kamisaka
- Department of Rehabilitation, Tazuke Kofukai Medical Institute Kitano Hospital
| | - Kuniyasu Kamiya
- Department of Hygiene & Public Health, Osaka Medical and Pharmaceutical University
| | - Yasushi Uchiyama
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine
| | - Sumio Yamada
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine.,Department of Cardiology, Aichi Medical University
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Wang JL, He XQ, Guo CY, Chen H, Li HW, Zhao SM. Sex-related differences in clinical outcomes and predictive factors in the very elderly patients with ACS undergoing PCI. Front Cardiovasc Med 2022; 9:950165. [PMID: 36247454 PMCID: PMC9554146 DOI: 10.3389/fcvm.2022.950165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background As shown in previous studies, there may be sex-related differences in clinical outcomes in patients with acute coronary syndromes (ACS) after percutaneous coronary intervention (PCI). However, the benefits of PCI in very elderly ACS patients and the gender differences were poorly described and understood. We investigated the clinical characteristics and outcomes after PCI by sex stratification, and the predictive factors of major adverse cardiovascular and cerebrovascular events (MACCE) in this very elderly ACS cohort. Methods A total of 1,676 consecutive ACS patients (50.2% women) aged ≥80 years old between January 2013 and May 2020 were recruited in this study. All patients were divided into four groups according to gender and treatment: male PCI (n = 321) and conservative management groups (n = 513), and female PCI (n = 283) and conservative management groups (n = 559). Clinical and coronary lesion characteristics were compared among four groups, also the clinical outcomes. MACCE and their predictive factors were assessed using Kaplan–Meier curve and Cox regression analysis. Results PCI procedures were conducted in 604 patients, and 1,072 were conservative management. Men were most likely to present with prior myocardial infarction (MI), peripheral artery disease, and chronic total occlusion (CTO); women had a higher prevalence of hypertension and dyslipidemia. The proportion of men receiving PCI procedures was significantly higher than that of women (38.5 vs. 33.6%, p = 0.038). Compared to conservative management, successful PCI significantly improved composite MACCE in both men (33.9 vs. 18.4%, p < 0.001) and women (27.9 vs. 20.8%, p = 0.026). There were no differences between sex in the improvement of clinical outcomes after PCI. In addition, age, ST-segment elevation myocardial infarction (STEMI), log N-terminal pro-brain natriuretic peptide (NT-proBNP), P2Y12 receptor antagonist, and β-blocker were independently associated with the incidence of MACCE after PCI tested by the Cox regression model, but not gender (male: hazard ratio (HR) 1.275, 95% confidence interval (CI) 0.853–1.905, p = 0.236). Conclusion In this very elderly ACS cohort, men presented with more complex clinical conditions, and women were less likely to receive PCI treatment. Both women and men had similar benefits from the PCI procedure in the decrease of MACCE.
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Affiliation(s)
- Jia-li Wang
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiao-quan He
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Chun-yan Guo
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hui Chen
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hong-wei Li
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Department of Internal Medical, Medical Health Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular Disease, Beijing, China
| | - Shu-mei Zhao
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- *Correspondence: Shu-mei Zhao
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Yu Q, Guo D, Peng J, Wu Q, Yao Y, Ding M, Wang J. Prevalence and adverse outcomes of frailty in older patients with acute myocardial infarction after percutaneous coronary interventions: A systematic review and meta-analysis. Clin Cardiol 2022; 46:5-12. [PMID: 36168782 PMCID: PMC9849439 DOI: 10.1002/clc.23929] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 09/09/2022] [Accepted: 09/15/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The association between frailty and older patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) is unclear. Therefore, we conducted a systematic review and meta-analysis to investigate the prevalence of frailty in older patients with AMI following PCI, and determine the relationship between frailty and adverse outcomes in these patients. HYPOTHESIS Older patients with AMI have a higher prevalence of frailty after PCI, and the frailty in these patients increases the risk of adverse outcomes. METHODS A comprehensive search of the PubMed, Cochrane, Ovid (Medline), Ovid (Embase), and Web of Science databases was performed for articles published until October 2021. A meta-analysis was performed using stata12.0 software. A random-effects model was used when I2 was greater than 50%; otherwise, a fixed-effects model was used. RESULTS There were a total of 274,976 older patients in the included studies. Nine studies investigated the prevalence of frailty in older patients with AMI after PCI, with an overall prevalence of 39% (95% confidence interval [CI]: 18%-60%, p < .001). Six studies included adverse outcomes of frailty in older patients with AMI after PCI, including all-cause mortality (hazard ratio [HR] = 2.29, 95% CI: 1.65-3.16, p = .285), rehospitalization (HR = 2.53, 95% CI: 1.38-4.63), and in-hospital major bleeding (HR = 1.93, 95% CI: 1.29-2.90, p = .825). CONCLUSION The frailty prevalence is increased in older patients with AMI after PCI, especially in ST-segment elevation myocardial infarction (STEMI). AMI with frailty after PCI is more likely to be associated with worse clinical outcomes, such as death, bleeding, and rehospitalization.
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Affiliation(s)
- Qian Yu
- College of NursingGannan Medical UniversityGanzhouJiangxiChina
| | - Dawei Guo
- Department of MedicineJingGangshan UniversityJi'anJiangxiChina
| | - Jianan Peng
- Department of MedicineJingGangshan UniversityJi'anJiangxiChina
| | - Qifei Wu
- College of NursingGannan Medical UniversityGanzhouJiangxiChina
| | - Yonghuan Yao
- College of NursingGannan Medical UniversityGanzhouJiangxiChina
| | - Mei Ding
- College of NursingGannan Medical UniversityGanzhouJiangxiChina
| | - Jiang Wang
- Department of MedicineJingGangshan UniversityJi'anJiangxiChina
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30
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van Wyk GW, Berkovsky S, Fraile Navarro D, Coiera E. Comparing health outcomes between coronary interventions in frail patients aged 75 years or older with acute coronary syndrome: a systematic review. Eur Geriatr Med 2022; 13:1057-1069. [PMID: 35908241 PMCID: PMC9553773 DOI: 10.1007/s41999-022-00667-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 06/01/2022] [Indexed: 11/29/2022]
Abstract
Aim To assess the current evidence comparing the health outcomes of coronary interventions in frail patients aged 75 years or older with acute coronary syndrome. Findings Available studies are observational and limited by incomplete statistical adjustment required for robust causal analysis. There may be a signal for improved outcomes in acute coronary syndrome patients treated invasively vs conservatively. Message Robust studies are needed to inform the optimal selection of coronary interventions in frail older patients with acute coronary syndrome. Purpose To assess current evidence comparing the impact of available coronary interventions in frail patients aged 75 years or older with different subtypes of acute coronary syndrome (ACS) on health outcomes. Methods Scopus, Embase and PubMed were systematically searched in May 2022 for studies comparing outcomes between coronary interventions in frail older patients with ACS. Studies were excluded if they provided no objective assessment of frailty during the index admission, under-represented patients aged 75 years or older, or included patients with non-ACS coronary disease without presenting results for the ACS subgroup. Following data extraction from the included studies, a qualitative synthesis of results was undertaken. Results Nine studies met all eligibility criteria. All eligible studies were observational. Substantial heterogeneity was observed across study designs regarding ACS subtypes included, frailty assessments used, coronary interventions compared, and outcomes studied. All studies were assessed to be at high risk of bias. Notably, adjustment for confounders was limited or not adequately reported in all studies. The comparative assessment suggested a possible efficacy signal for invasive treatment relative to conservative treatment but possibly at the risk of increased bleeding events. Conclusions There is a paucity of evidence comparing health outcomes between different coronary interventions in frail patients aged 75 years or older with ACS. Available evidence is at high risk of bias. Given the growing importance of ACS in frail patients aged 75 years or older, new studies are needed to inform optimal ACS care for this population. Future studies should rigorously adjust for confounders.
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Affiliation(s)
- Gregory W van Wyk
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, 75 Talavera Rd, Macquarie Park, NSW, 2113, Australia.
| | - Shlomo Berkovsky
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, 75 Talavera Rd, Macquarie Park, NSW, 2113, Australia
| | - David Fraile Navarro
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, 75 Talavera Rd, Macquarie Park, NSW, 2113, Australia
| | - Enrico Coiera
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, 75 Talavera Rd, Macquarie Park, NSW, 2113, Australia
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Rubens M, Ramamoorthy V, Saxena A, Zevallos JC, Pelaez JGR, Chaparro S, Jimenez Carcamo J. Management and Outcomes of ST-Segment Elevation Myocardial Infarction in Hospitalized Frail Patients in the United States. Am J Cardiol 2022; 175:1-7. [PMID: 35599189 DOI: 10.1016/j.amjcard.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/23/2022] [Accepted: 04/05/2022] [Indexed: 11/19/2022]
Abstract
Cardiovascular diseases and frailty are common conditions of aging populations and often coexist. In this study, we examined the in-hospital management, outcomes, and resource use of frail patients hospitalized for ST-segment elevation myocardial infarction (STEMI). This was a retrospective analysis of the 2005-2014 data from the Nationwide Inpatient Sample. Patients were classified into to versus 'nonfrail' using the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator. The primary outcome was STEMI management, whereas secondary outcomes were in-hospital mortality, length of stay, and cost. Outcomes were compared between frail and nonfrail patients using propensity score-matched analysis. There were 1,360,597 STEMI hospitalizations, of which 36,316 (2.7%) were frail. Propensity score-matched analysis showed that in in-hospital management options for STEMI, the odds of overall revascularization (odds ratio [OR], 0.60; 95% confidence interval [CI], 0.55 to 0.65), percutaneous coronary intervention (OR, 0.53; 95% CI, 0.49 to 0.57), and coronary angiography (OR, 0.59; 95% CI, 0.55 to 0.64) were significantly lower for frail patients. The odds of receiving coronary artery bypass grafting (OR, 1.66; 95% CI, 1.48 to 1.86) and overall hemodynamic support (OR, 1.26; 95% CI, 1.15 to 1.39) were significantly higher for frail patients. In-hospital mortality (18.7% vs 8.2%, p <0.001), length of stay (7.7 vs 3.7 days, p <0.001) and costs ($90,060 vs $63,507, p <0.001) were significantly higher in frail patients. Our findings suggest that collaborative efforts by cardiologists and cardiovascular surgeons for identifying frailty in patients with STEMI and incorporating frailty in risk estimation measures may improve management strategies, resource use and optimize patient outcomes.
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Affiliation(s)
- Muni Rubens
- Miami Cancer Institute, Baptist Health South Florida, Miami
| | | | - Anshul Saxena
- Center for Advanced Analytics, Baptist Health South Florida, Miami
| | - Juan Carlos Zevallos
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, Florida
| | | | - Sandra Chaparro
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, Florida; Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Javier Jimenez Carcamo
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, Florida; Herbert Wertheim College of Medicine, Florida International University, Miami, Florida.
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A Newly Defined CHA 2DS 2-VA Score for Predicting Obstructive Coronary Artery Disease in Patients with Atrial Fibrillation-A Cross-Sectional Study of Older Persons Referred for Elective Coronary Angiography. J Clin Med 2022; 11:jcm11123462. [PMID: 35743532 PMCID: PMC9224727 DOI: 10.3390/jcm11123462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/05/2022] [Accepted: 06/13/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose: Atrial fibrillation (AF) can be a valuable indicator of non-obstructive coronary artery disease (CAD) among older patients indicated for elective coronary angiography (CAG). Appropriate stratification of AF patients is crucial for avoiding unnecessary complications. The objective of this study was to identify independent predictors that can allow diagnosing obstructive CAD in AF patients over 65 years who were indicated to undergo elective CAG. Patients and methods: This cross-sectional study included 452 (23.9%) AF patients over 65 years old who were directed to the Department of Invasive Cardiology at the Medical University of Bialystok for elective CAG during 2014−2016. The participants had CAD and were receiving optimal therapy (median age: 73 years, interquartile range: 69−77 years; 54.6% men). The prevalence and health correlates of obstructive CAD were determined, and a multivariate logistic regression model was generated with predictors (p < 0.1). Predictive performance was analyzed using a receiver-operating characteristic (ROC) curve analysis. Results: Stenosis (affecting ≥ 50% of the diameter of the left coronary artery stem or ≥70% of that of the other important epicardial vessels) was significant in 184 (40.7%) cases. Multivariate regression analysis revealed that only the male sex (odds ratio [OR]: 1.80, 95% confidence interval [CI]: 1.14−2.84, p = 0.01) and the newly created CHA2DS2-VA score (OR: 3.96, 95% CI: 2.96−5.31, p < 0.001) significantly increased the chance of obstructive CAD, while controlling for chronic kidney disease and anemia. The ROC curve analysis indicated that the CHA2DS2-VA scale may be a useful screening tool for the diagnosis of obstructive CAD (area under the ROC curve: 0.79, 95% CI: 0.75−0.84, p < 0.001), with ≥4 being the optimal cutoff value. Conclusions: Our study has proven that several older AF patients who are advised to undergo elective CAG have nonobstructive CAD. The CHA2DS2-VA score can contribute to improving the selection of patients for invasive diagnosis of CAD, but further investigation is required.
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Arshad S, Khan S, Karim A, Gupta VA. The burden of malnutrition & frailty in patients with coronary artery disease: An under-recognized problem. JRSM Cardiovasc Dis 2022; 11:20480040221102741. [PMID: 35651591 PMCID: PMC9149616 DOI: 10.1177/20480040221102741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 04/08/2022] [Accepted: 05/08/2022] [Indexed: 12/03/2022] Open
Abstract
Elderly patients with coronary artery disease have a high prevalence of frailty
and malnutrition. Frailty syndrome is associated with poor outcomes in patients
with myocardial infarction. There is a known overlap between frailty and
malnutrition, yet these are two different entities. Fried Frailty Phenotype,
Frail Scale, timed up and go test, and gait speed are rapid screening tests that
may identify patients with frailty in everyday clinical setting. Short Form MNA
is a sensitive tool to screen for malnutrition. Despite the availability of
several tools for screening for both these conditions, the screening rates
remain low. We aim to create awareness about the impacts of frailty and
malnutrition, provide a brief overview of tools available and highlight the
importance of screening in this high-risk population.
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Affiliation(s)
- Samiullah Arshad
- Department of Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington Kentucky, USA
| | - Samina Khan
- Department of Medicine, Royal Alexandra Hospital, Alberta Health Services, Alberta, Canada
| | - Adham Karim
- Department of Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington Kentucky, USA
| | - Vedant A. Gupta
- Department of Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington Kentucky, USA
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Węgiel M, Kleczyński P, Dziewierz A, Rzeszutko Ł, Surdacki A, Bartuś S, Rakowski T. Frailty as a Predictor of In-Hospital Outcome in Patients with Myocardial Infarction. J Cardiovasc Dev Dis 2022; 9:jcdd9050145. [PMID: 35621856 PMCID: PMC9145424 DOI: 10.3390/jcdd9050145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/30/2022] [Accepted: 05/02/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Frailty is a condition associated with aging, co-morbidity, and disability. We aimed to investigate the relationship between frailty and in-hospital outcome in patients with myocardial infarction (MI), including the occurrence of delirium, hospital-acquired pneumonia (HAP), and length of hospital stay. (2) Methods: We analyzed 55 patients ≥ 75 years old with ST-elevation and non-ST-elevation MI. Assessment with Abbreviated Mental Test Score (AMTS), Activity of Daily Living (ADL), Instrumental Activity of Daily Living (IADL) and Clinical Frailty Scale (CFS) was performed. (3) Results: In ROC analysis, IADL and CFS presented good predictive values for the occurrence of delirium (AUC = 0.81, p = 0.023, and AUC = 0.86, p = 0.009, respectively). For predicting HAP, only AMTS showed a significant value (AUC = 0.69, p = 0.036). In regression analyses, all tests presented significant predictive values for delirium. For predicting HAP, only IADL and CFS presented significant values (in an analysis adjusted for age, gender and type of MI). Frail patients (≥5 points in CFS) had longer hospital stays (10 days IQR: 8–17 vs. 8 days IQR: 7–10; p = 0.03). (4) Conclusions: While recognizing the limitations of our study associated with the relatively low sample size, we believe that our analysis shows that frailty is a predictor of poorer in-hospital outcomes in patients with MI, including higher rates of delirium, HAP and longer hospital stay.
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Affiliation(s)
- Michał Węgiel
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland;
| | - Paweł Kleczyński
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 31-202 Krakow, Poland;
| | - Artur Dziewierz
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland; (A.D.); (Ł.R.); (A.S.); (S.B.)
| | - Łukasz Rzeszutko
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland; (A.D.); (Ł.R.); (A.S.); (S.B.)
| | - Andrzej Surdacki
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland; (A.D.); (Ł.R.); (A.S.); (S.B.)
| | - Stanisław Bartuś
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland; (A.D.); (Ł.R.); (A.S.); (S.B.)
| | - Tomasz Rakowski
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland; (A.D.); (Ł.R.); (A.S.); (S.B.)
- Correspondence: ; Tel.: +48-12-4002200
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Ratcovich H, Beska B, Mills G, Holmvang L, Adams-Hall J, Stevenson H, Veerasamy M, Wilkinson C, Kunadian V. Five-year clinical outcomes in patients with frailty aged ≥75 years with non-ST elevation acute coronary syndrome undergoing invasive management. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac035. [PMID: 35919345 PMCID: PMC9242041 DOI: 10.1093/ehjopen/oeac035] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/27/2022] [Accepted: 05/12/2022] [Indexed: 01/05/2023]
Abstract
Aim Frailty is associated with adverse outcomes in older patients with acute coronary syndrome (ACS). The impact of frailty on long-term clinical outcomes following invasive management of non-ST elevation ACS (NSTEACS) is unknown. Methods and results The multi-centre Improve Clinical Outcomes in high-risk patieNts with ACS 1 (ICON-1) prospective cohort study consisted of patients aged >75 years undergoing coronary angiography following NSTEACS. Patients were categorized by frailty assessed by Canadian Study of Health and Ageing Clinical Frailty Scale (CFS) and Fried criteria. The primary composite endpoint was all-cause mortality, unplanned revascularization, myocardial infarction, stroke, and bleeding. Of 263 patients, 33 (12.5%) were frail, 152 (57.8%) were pre-frail, and 78 (29.7%) were robust according to CFS. By Fried criteria, 70 patients (26.6%, mean age 82.1 years) were frail, 147 (55.9%, mean age 81.3 years) were pre-frail, and 46 (17.5%, mean age 79.9 years) were robust. The composite endpoint was more common at 5 years among patients with frailty according to CFS (frail: 22, 66.7%; pre-frail: 81, 53.3%; robust: 27, 34.6%, P = 0.003), with a similar trend when using Fried criteria (frail: 39, 55.7%; pre-frail: 72, 49.0%; robust: 16, 34.8%, P = 0.085). Frailty measured with both CFS and Fried criteria was associated with the primary endpoint [age and sex-adjusted hazard ratio (HR) compared with robust groups. CFS: 2.22, 95% confidence interval (CI) 1.23–4.02, P = 0.008; Fried: HR 1.81, 95% CI 1.00–3.27, P = 0.048]. Conclusion In older patients who underwent angiography following NSTEACS, frailty is associated with an increased risk of the primary composite endpoint at 5 years. Registration: Clinicaltrials.gov NCT01933581
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Affiliation(s)
- Hanna Ratcovich
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, 4th Floor William Leech Building Newcastle upon Tyne, UK
| | - Benjamin Beska
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, 4th Floor William Leech Building Newcastle upon Tyne, UK
| | - Greg Mills
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, 4th Floor William Leech Building Newcastle upon Tyne, UK
| | - Lene Holmvang
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jennifer Adams-Hall
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Hannah Stevenson
- Cardiovascular and Transplant Research, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Murugapathy Veerasamy
- Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Chris Wilkinson
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, 4th Floor William Leech Building Newcastle upon Tyne, UK
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Tashiro H, Tanaka A, Takagi K, Uemura Y, Inoue Y, Umemoto N, Negishi Y, Shibata N, Yoshioka N, Shimizu K, Morishima I, Watarai M, Asano H, Ishii H, Murohara T. Incidence and Predictors of Frailty Progression among Octogenarians with ST-elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Arch Gerontol Geriatr 2022; 102:104737. [PMID: 35671551 DOI: 10.1016/j.archger.2022.104737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/15/2022] [Accepted: 05/26/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Frailty is one of the most serious health problems in older individuals with cardiovascular disease. Moreover, frailty progression is associated with subsequent adverse outcomes; therefore, the prevention of frailty progression is an important clinical issue. However, the incidence and predictors of frailty progression following acute myocardial infarction have not yet been fully elucidated. METHODS The present study is a sub-analysis of an observational multicenter registry retrospectively evaluating clinical outcomes of 288 octogenarians who underwent primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) between January 2014 and December 2016 at five hospitals. We identified 244 patients who survived until discharge and evaluated frailty at baseline and discharge using the Clinical Frailty Scale (CFS). We defined frailty progression as an increase of at least one level in the CFS score at discharge from baseline and assessed the predictors of frailty progression. RESULTS Frailty progression was observed in 29.5% of patients. Patients with frailty progression were older, had more severe conditions with a higher prevalence of Killip 4 status and mechanical circulatory support use, more frequently experienced in-hospital events such as stroke (4/72, 6% vs. 0/172, 0%, p = 0.007), and had longer hospital stays than those without frailty progression [19 (11-35) vs. 13 (9-19) days, p<0.01]. Multivariate analysis showed that age (odds ratio 1.08, 95% confidence interval 1.00-1.17, p = 0.046) and Killip 4 status at baseline (odds ratio 3.34, 95% confidence interval 1.26-8.85, p = 0.01) were significant predictors of frailty progression. CONCLUSIONS In-hospital frailty progression was commonly observed in octogenarians with STEMI who underwent primary PCI and survived until discharge, and was associated with more severe clinical conditions.
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Affiliation(s)
- Hiroshi Tashiro
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan; Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yusuke Uemura
- Cardiovascular Center, Anjo Kosei Hospital, Anjo, Japan
| | - Yosuke Inoue
- Department of Cardiology, Tosei General Hospital, Seto, Japan
| | - Norio Umemoto
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Yosuke Negishi
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Shibata
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan; Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Yoshioka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Kiyokazu Shimizu
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | | | - Hiroshi Asano
- Department of Cardiology, Tosei General Hospital, Seto, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Cardiology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Pasala S, Cooper LB, Psotka MA, Sinha SS, deFilippi CR, Tran H, Tehrani B, Sherwood M, Epps K, Batchelor W, Damluji AA. The influence of heart failure on clinical and economic outcomes among older adults ≥75 years of age with acute myocardial infarction. Am Heart J 2022; 246:65-73. [PMID: 34922928 DOI: 10.1016/j.ahj.2021.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 11/08/2021] [Accepted: 11/20/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND We aimed to evaluate the influence of heart failure (HF) on clinical and economic outcomes among older adults ≥75 years of age during their acute myocardial infarction (AMI) admission in large population-based study from the United States. We also evaluated the clinical characteristics associated with the presence of HF and the predictors of mortality, healthcare utilization, and cost among older adults with AMI. METHODS From January 1, 2000, to December 31, 2016, AMI admission was identified using the primary diagnosis and concomitant HF was identified using any non-primary diagnoses in the Premier Healthcare Database. RESULTS Of the 468,654 patients examined, 42,946 (9%) had concomitant HF during their AMI admission. These patients were older, more often female, and were more likely to be White. Patients with concomitant HF were more likely to be frail than non-HF patients (59% vs 15%, P < .001). The mean (SD) Elixhauser comorbidity index was 2.6 (2.5) vs 0.4 (1.1), P < .001 in the AMI with HF vs AMI only group. The use of percutaneous coronary intervention in those with AMI and HF was lower than those with AMI only (15% vs 31%, P < .001). The overall mortality rate for those with HF was 12%, the median [IQR] hospital length of stay was 5 [3,9] days, and only 25% of patients were discharged home. A higher proportion of patients were discharged to rehabilitation or hospice if they had AMI and HF (Rehabilitation: 33% vs 20%, P < .001; Hospice: 5% vs 3%, P < .001). The mean unadjusted cost of an AMI hospitalization in patients with concomitant HF was lower ($12,411 ± $14,860) than in those without HF ($15,828 ± $19,330). After adjusting for age, gender, race, hypertension, frailty, revascularization strategy, and death, the average cost of hospitalization attributed to concomitant HF was +$1,075 (95% CI +876 to $1,274) when compared to AMI patients without HF. CONCLUSION In patients ≥75 years of age, AMI with concomitant HF carries higher risk of death, but at ages ≥85 years, the risk difference diminishes due to other competing risks. HF was also associated with longer hospital length of stay and higher likelihood of referral to hospice and rehabilitation facilities when compared to older patients without HF. Care for these older adults is associated with increased hospitalization costs. Measures to identify HF in older adults during their AMI admission are necessary to optimize health outcomes, care delivery, and costs.
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Affiliation(s)
- Swetha Pasala
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Fairfax, VA
| | - Lauren B Cooper
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Fairfax, VA
| | - Mitchell A Psotka
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Fairfax, VA
| | - Shashank S Sinha
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Fairfax, VA
| | | | - Henry Tran
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Fairfax, VA
| | - Behnam Tehrani
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Fairfax, VA
| | - Matthew Sherwood
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Fairfax, VA
| | - Kelly Epps
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Fairfax, VA
| | - Wayne Batchelor
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Fairfax, VA
| | - Abdulla A Damluji
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Fairfax, VA; Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD.
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A heart team approach to assessing frailty in the cardiac catheterization laboratory. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 43:38-42. [DOI: 10.1016/j.carrev.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/02/2022] [Accepted: 04/05/2022] [Indexed: 11/19/2022]
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39
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Orkaby AR, Forman DE. Applying frailty to guide myocardial infarction management: an important step towards precision medicine and personalized care for older adults. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2022; 11:99-101. [DOI: 10.1093/ehjacc/zuab126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 12/23/2021] [Indexed: 04/08/2023]
Affiliation(s)
- Ariela R Orkaby
- New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA 02130, USA
- Division of Aging, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Daniel E Forman
- Section of Geriatric Cardiology, University of Pittsburgh Medical Center, 3471 Fifth Ave, Ste 500, Pittsburgh, PA 15213, USA
- Geriatric Research, Education, and Clinical Center (GRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA 15240, USA
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40
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Haghighat L, Reinhardt SW, Saly DL, Lu D, Matsouaka RA, Wang TY, Desai NR. Comfort Measures Only in Myocardial Infarction: Prevalence of This Status, Change Over Time, and Predictors From a Nationwide Study. Circ Cardiovasc Qual Outcomes 2022; 15:e007610. [PMID: 35041476 DOI: 10.1161/circoutcomes.120.007610] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients hospitalized with acute myocardial infarction (AMI) have a high mortality rate. Despite increasing recognition of the role for comfort focused care, little is known about the prevalence of comfort measures only (CMO) care among patients with AMI. The objective of this study was to investigate patient- and hospital-level patterns and predictors of CMO care among patients admitted with AMI. METHODS This retrospective cohort study used the National Cardiovascular Data Registry Chest Pain-MI Registry, which contains data on patients admitted with AMI. Data were analyzed in 6-month increments from January 2015 to June 2018. RESULTS Among 483 696 patients with AMI across 827 hospitals, 13 955 (2.9%) had CMO status at discharge (2.6% non-ST-segment-elevation myocardial infarction and 3.4% ST-segment-elevation myocardial infarction). There was a modest decline in CMO rates over time (3.0% to 2.8%). Independent patient characteristics associated with CMO status included male gender, White race, nonprivate insurance, frailty, and higher estimated bleeding and mortality risks. There was substantial variation in CMO rates across hospitals, with the proportion of CMO patients ranging from 0% to 17.1% and a median odds ratio of 1.59 (95% CI, 1.56-1.62). Among the 13 955 patients who were CMO by discharge, 8134 (58.3%) underwent diagnostic catheterization. This is despite significantly elevated risks predicted using precatheterization models, specifically the ACTION Registry GWTG in-hospital major bleeding and mortality risk scores. Patients who were initially managed invasively but later made CMO experienced high rates of procedural complications, including cardiogenic shock (38.3%), dialysis (10.1%), and bleeding (33.3%). CONCLUSIONS Most patients with AMI who were CMO by discharge had aggressive initial management and became CMO following in-hospital complications of their care. Early identification of high-risk patients and appropriate transition of such patients to CMO, if aligned with their values, remain important areas for future quality programs in AMI.
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Affiliation(s)
- Leila Haghighat
- Division of Cardiology, University of California, San Francisco (UCSF), CA (L.H.)
| | - Samuel W Reinhardt
- Section of Cardiovascular Medicine, Department of Internal Medicine (S.W.R., N.R.D.), Yale New Haven Hospital, New Haven, CT
| | - Danielle L Saly
- Department of Nephrology, Brigham and Women's Hospital, Boston, MA (D.L.S.)
| | - Di Lu
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (D.L., T.Y.W.)
| | - Roland A Matsouaka
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC (R.A.M.)
| | - Tracy Y Wang
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (D.L., T.Y.W.)
| | - Nihar R Desai
- Section of Cardiovascular Medicine, Department of Internal Medicine (S.W.R., N.R.D.), Yale New Haven Hospital, New Haven, CT.,Center for Outcomes Research and Evaluation (N.R.D.), Yale New Haven Hospital, New Haven, CT
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Rogalska E, Kuźma Ł, Wojszel ZB, Kurasz A, Napalkov D, Sokolova A, Tomaszuk-Kazberuk A. Atrial fibrillation is a predictor of nonobstructive coronary artery disease in elective angiography in old age: a cross-sectional study in Poland and Russia. Aging Clin Exp Res 2022; 34:175-183. [PMID: 34117626 PMCID: PMC8794909 DOI: 10.1007/s40520-021-01895-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 05/26/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Significant changes in the coronary vessels are not confirmed in a large proportion of patients undergoing cardiac catheterization. AIMS The present study aimed to determine correlates and independent predictors of nonobstructive coronary artery disease (CAD) in older adults referred for elective coronary angiography. METHODS A cross-sectional study was conducted involving 2,214 patients referred to two medical centers (in Poland and Russia) between 2014 and 2016 for elective coronary angiography due to exacerbated angina, despite undergoing optimal therapy for CAD. The median age was 72 years (IQR: 68-76), and 49.5% patients were women. RESULTS Significant stenosis (defined as stenosis of 50% or more of the diameter of the left main coronary artery stem or stenosis of 70% or more of the diameter of the remaining major epicardial vessels) was diagnosed only in 1135 (51.3%) patients. Female sex (odds ratio [OR], 3.01; 95% confidence interval [CI], 2.44-3.72; p < 0.001) and atrial fibrillation (OR, 1.87; 95% CI 1.45-2.40; p < 0.001) were the main independent predictors of nonobstructive CAD. Significantly lower ORs were observed for diabetes (OR, 0.75; 95% CI 0.59-0.95; p = 0.02), chronic kidney disease (OR, 0.76; 95% CI 0.61-0.96; p = 0.02), and anemia (OR, 0.69; 95% CI 0.50-0.95; p = 0.02) after controlling for age, chronic heart failure, BMI, and study center. DISCUSSION AND CONCLUSIONS The results confirmed that nonobstructive CAD occurs in a high percentage of older patients referred for elective coronary angiography. This suggests the need to improve patient stratification for invasive diagnosis of CAD, especially for older women and patients with atrial fibrillation. Trial registration number and date of registration: NCT04537507, September 3, 2020.
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Affiliation(s)
- Ewelina Rogalska
- Department of Cardiology, Medical University of Bialystok, M. Sklodowska-Curie Str. 24A, 15-276, Bialystok, Poland
| | - Łukasz Kuźma
- Department of Invasive Cardiology, Medical University of Bialystok, M. Sklodowska-Curie Str. 24A, 15-276, Bialystok, Poland.
| | - Zyta B Wojszel
- Department of Geriatrics, Medical University of Bialystok, Fabryczna Str. 27, 15-369, Bialystok, Poland
| | - Anna Kurasz
- Department of Invasive Cardiology, Medical University of Bialystok, M. Sklodowska-Curie Str. 24A, 15-276, Bialystok, Poland
| | - Dmitry Napalkov
- Department of Internal Diseases, I.M. Sechenov First Moscow State Medical University, Bol'shaya Pirogovskaya Ulitsa, 19c1, Moscow, Russia, 119146
| | - Anastasiya Sokolova
- Department of Internal Diseases, I.M. Sechenov First Moscow State Medical University, Bol'shaya Pirogovskaya Ulitsa, 19c1, Moscow, Russia, 119146
| | - Anna Tomaszuk-Kazberuk
- Department of Cardiology, Medical University of Bialystok, M. Sklodowska-Curie Str. 24A, 15-276, Bialystok, Poland
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42
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Tehrani BN, Damluji AA, Batchelor WB. Acute Myocardial Infarction and Cardiogenic Shock Interventional Approach to Management in the Cardiac Catheterization Laboratories. Curr Cardiol Rev 2022; 18:e251121198293. [PMID: 34823461 PMCID: PMC9413732 DOI: 10.2174/1573403x17666211125090929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 07/07/2021] [Accepted: 07/28/2021] [Indexed: 11/22/2022] Open
Abstract
Despite advances in early reperfusion and a technologic renaissance in the space of Mechanical Circulatory Support (MCS), Cardiogenic Shock (CS) remains the leading cause of in-hospital mortality following Acute Myocardial Infarction (AMI). Given the challenges inherent to conducting adequately powered randomized controlled trials in this time-sensitive, hemodynamically complex, and highly lethal syndrome, treatment recommendations have been derived from AMI patients without shock. In this review, we aimed to (1) examine the pathophysiology and the new classification system for CS; (2) provide a comprehensive, evidence-based review for best practices for interventional management of AMI-CS in the cardiac catheterization laboratory; and (3) highlight the concept of how frailty and geriatric syndromes can be integrated into the decision process and where medical futility lies in the spectrum of AMI-CS care. Management strategies in the cardiac catheterization laboratory for CS include optimal vascular access, periprocedural antithrombotic therapy, culprit lesion versus multi-vessel revascularization, selective utilization of hemodynamic MCS tailored to individual shock hemometabolic profiles, and management of cardiac arrest. Efforts to advance clinical evidence for patients with CS should be concentrated on (1) the coordination of multi-center registries; (2) development of pragmatic clinical trials designed to evaluate innovative therapies; (3) establishment of multidisciplinary care models that will inform quality care and improve clinical outcomes.
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Affiliation(s)
- Behnam N Tehrani
- Interventional Cardiology, INOVA Heart and Vascular Institute, Virginia, VA 22042, United States
| | - Abdulla A Damluji
- Interventional Cardiology, INOVA Heart and Vascular Institute, Virginia, VA 22042, United States.,Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Wayne B Batchelor
- Interventional Cardiology, INOVA Heart and Vascular Institute, Virginia, VA 22042, United States
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He YY, Chang J, Wang XJ. Frailty as a predictor of all-cause mortality in elderly patients undergoing percutaneous coronary intervention: A systematic review and meta-analysis. Arch Gerontol Geriatr 2022; 98:104544. [DOI: 10.1016/j.archger.2021.104544] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/27/2021] [Accepted: 09/30/2021] [Indexed: 12/14/2022]
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44
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Thompson W, Morin L, Jarbøl DE, Andersen JH, Ernst MT, Nielsen JB, Haastrup P, Schmidt M, Pottegård A. Statin Discontinuation and Cardiovascular Events Among Older People in Denmark. JAMA Netw Open 2021; 4:e2136802. [PMID: 34854906 PMCID: PMC8640890 DOI: 10.1001/jamanetworkopen.2021.36802] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE Statin use is common in older persons. Given uncertainties in ongoing benefit, changes in health status, and shifting goals of care and preferences, statin discontinuation may be considered in some older persons, although there is currently little evidence to guide this decision. OBJECTIVE To evaluate the association between statin discontinuation and the rate of major adverse cardiovascular events (MACE) among people aged 75 years or older who receive long-term statin treatment. DESIGN, SETTING, AND PARTICIPANTS This cohort study included all persons in Denmark aged 75 years or older who were treated with statins for at least 5 consecutive years as of January 1, 2011. Participants were followed up until December 31, 2016. Data were analyzed from July to November, 2020. EXPOSURE Statin discontinuation. MAIN OUTCOMES AND MEASURES Rate of occurrence of MACE and its components (myocardial infarction, ischemic stroke or transient ischemic attack, coronary revascularization, and death due to myocardial infarction or ischemic stroke) in persons continuing statins compared with those discontinuing statins. Confounding adjustment was done using inverse probability of treatment weighting. Analyses were conducted separately for primary prevention (no history of cardiovascular disease) and secondary prevention (history of cardiovascular disease). RESULTS The study included 67 418 long-term statin users, including 27 463 in the primary prevention analysis (median age, 79 years [IQR, 77-83 years]; 18 134 [66%] female) and 39 955 in the secondary prevention analysis (median age, 80 years [IQR, 77-84 years]; 18 717 [47%] female). In both primary and secondary prevention analyses, the rate of MACE was higher among persons who discontinued statins compared with those who continued statins. In the primary prevention cohort, the weighted rate difference was 9 per 1000 person-years (95% CI, 5-12 per 1000 person-years) and the adjusted sub-hazard ratio was 1.32 (95% CI, 1.18-1.48), corresponding to 1 excess MACE per 112 persons who discontinued statins per year. In the secondary prevention cohort, the weighted rate difference was 13 per 1000 person-years (95% CI, 8-17 per 1000 person-years) and the adjusted sub-hazard ratio was 1.28 (95% CI, 1.18-1.39), corresponding to 1 excess MACE per 77 persons who discontinued statins per year. CONCLUSIONS AND RELEVANCE In this cohort study, among older adults receiving long-term statin treatment, discontinuation of statins was associated with a higher rate of MACE compared with statin continuation in both the primary and the secondary prevention cohorts. These findings suggest a need for robust evidence from randomized clinical trials.
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Affiliation(s)
- Wade Thompson
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Hospital Pharmacy Fyn, Odense University Hospital, Odense, Denmark
| | - Lucas Morin
- Inserm CIC 1431, Clinical Investigation Unit, University Hospital of Besançon, Besançon, France
- Inserm 1018, High-Dimensional Biostatistics for Drug Safety and Genomics, Centre de Recherche en Épidémiologie et Santé des Populations, Villejuif, France
| | - Dorte Ejg Jarbøl
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jacob Harbo Andersen
- Research Unit of Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Martin Thomsen Ernst
- Research Unit of Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jesper Bo Nielsen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Peter Haastrup
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark
| | - Anton Pottegård
- Hospital Pharmacy Fyn, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Yokoyama H, Tomita H, Honda S, Nishihira K, Kojima S, Takegami M, Asaumi Y, Yamashita J, Saji M, Kosuge M, Takahashi J, Sakata Y, Takayama M, Sumiyoshi T, Ogawa H, Kimura K, Yasuda S. Effect of Low Body Mass Index on the Clinical Outcomes of Japanese Patients With Acute Myocardial Infarction - Results From the Prospective Japan Acute Myocardial Infarction Registry (JAMIR). Circ J 2021; 86:632-639. [PMID: 34803127 DOI: 10.1253/circj.cj-21-0705] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Acute myocardial infarction (AMI) patients with low body mass index (BMI) exhibit worse clinical outcomes than obese patients; however, to our knowledge, no prospective, nationwide study has assessed the effect of BMI on the clinical outcomes of AMI patients.Methods and Results:In this multi-center, prospective, nationwide Japanese trial, 2,373 AMI patients who underwent emergent percutaneous coronary intervention within 12 h of onset from the Japanese AMI Registry (JAMIR) were identified. Patients were divided into the following 4 groups based on their BMI at admission: Q1 group (BMI <18.5 kg/m2, n=133), Q2 group (18.5≤BMI<25.0 kg/m2, n=1,424), Q3 group (25.0≤BMI<30.0 kg/m2, n=672), and Q4 group (30.0 kg/m2≤BMI, n=144). The primary endpoint was all-cause death, and the secondary endpoint was a composite of cardiovascular death, non-fatal myocardial infarction (MI), and non-fatal stroke. The median follow-up period was 358 days. Q1 patients were older and had lower prevalence of coronary risk factors. Q1 patients also had higher all-cause mortality and higher incidence of secondary endpoints than normal-weight or obese AMI patients. Multivariate analysis showed that low BMI (Q1 group) was an independent predictor for primary endpoint. CONCLUSIONS AMI patients with low BMI had fewer coronary risk factors but worse clinical outcomes than normal-weight or obese patients.
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Affiliation(s)
- Hiroaki Yokoyama
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | - Hirofumi Tomita
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | - Satoshi Honda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Sunao Kojima
- Department of General Internal Medicine 3, Kawasaki Medical School
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Jun Yamashita
- Department of Cardiology, Tokyo Medical University Hospital
| | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University
| | - Yasuhiko Sakata
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | | | | | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University
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46
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Damluji AA, Chung SE, Xue QL, Hasan RK, Moscucci M, Forman DE, Bandeen-Roche K, Batchelor W, Walston JD, Resar JR, Gerstenblith G. Frailty and cardiovascular outcomes in the National Health and Aging Trends Study. Eur Heart J 2021; 42:3856-3865. [PMID: 34324648 PMCID: PMC8487013 DOI: 10.1093/eurheartj/ehab468] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/25/2021] [Accepted: 07/04/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Physical frailty is a commonly encountered geriatric syndrome among older adults without coronary heart disease (CHD). The impact of frailty on the incidence of long-term cardiovascular outcomes is not known.We aimed to evaluate the long-term association of frailty, measured by the Fried frailty phenotype, with all-cause-mortality and MACE among older adults without a history of CHD at baseline in the National Health and Aging Trends Study. METHODS AND RESULTS We used the National Health and Aging Trends Study, a prospective cohort study linked to a Medicare sample. Participants with a prior history of CHD were excluded. Frailty was measured during the baseline visit using the Fried physical frailty phenotype. Cardiovascular outcomes were assessed during a 6-year follow-up.Of the 4656 study participants, 3259 (70%) had no history of CHD 1 year prior to their baseline visit. Compared to those without frailty, subjects with frailty were older (mean age 82.1 vs. 75.1 years, P < 0.001), more likely to be female (68.3% vs. 54.9%, P < 0.001), and belong to an ethnic minority. The prevalence of hypertension, falls, disability, anxiety/depression, and multimorbidity was much higher in the frail and pre-frail than the non-frail participants. In a Cox time-to-event multivariable model and during 6-year follow-up, the incidences of death and of each individual cardiovascular outcomes were all significantly higher in the frail than in the non-frail patients including major adverse cardiovascular event (MACE) [hazard ratio (HR) 1.77, 95% confidence interval (CI) 1.53, 2.06], death (HR 2.70, 95% CI 2.16, 3.38), acute myocardial infarction (HR 1.95, 95% CI 1.31, 2.90), stroke (HR 1.71, 95% CI 1.34, 2.17), peripheral vascular disease (HR 1.80, 95% CI 1.44, 2.27), and coronary artery disease (HR 1.35, 95% CI 1.11, 1.65). CONCLUSION In patients without CHD, frailty is a risk factor for the development of MACEs. Efforts to identify frailty in patients without CHD and interventions to limit or reverse frailty status are needed and, if successful, may limit subsequent adverse cardiovascular events.
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Affiliation(s)
- Abdulla A Damluji
- The Inova Center of Outcomes Research, Inova Heart and Vascular Institute, 3300 Gallows Road, I-465, Falls Church, VA 22042, USA
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Shang-En Chung
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA
| | - Qian-Li Xue
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Rani K Hasan
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Mauro Moscucci
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Daniel E Forman
- Geriatric Cardiology Section, University of Pittsburgh, Pittsburgh, PA, USA
- Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Wayne Batchelor
- The Inova Center of Outcomes Research, Inova Heart and Vascular Institute, 3300 Gallows Road, I-465, Falls Church, VA 22042, USA
| | - Jeremy D Walston
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA
| | - Jon R Resar
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Gary Gerstenblith
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
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Wang P, Zhang S, Zhang K, Tian J. Frailty Predicts Poor Prognosis of Patients After Percutaneous Coronary Intervention: A Meta-Analysis of Cohort Studies. Front Med (Lausanne) 2021; 8:696153. [PMID: 34490292 PMCID: PMC8416907 DOI: 10.3389/fmed.2021.696153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Frailty has been related to a higher risk of cardiovascular events, while the association between frailty and outcomes for patients with coronary artery disease (CAD) after percutaneous coronary intervention (PCI) remains unclear. We performed a meta-analysis of cohort studies to evaluate the above association. Methods: Cohort studies aiming to determine the potential independent association between frailty and clinical outcomes after PCI were identified by search of PubMed, Embase, and Web of Science databases from inception to February 22, 2021. A random-effects model that incorporates the possible heterogeneity among the included studies was used to combine the results. Results: Ten cohort studies with 7,449,001 patients were included. Pooled results showed that frailty was independently associated with higher incidence of all-cause mortality [adjusted risk ratio (RR) = 2.94, 95% confidence intervals (CI): 1.90-4.56, I 2 = 56%, P < 0.001] and major adverse cardiovascular events [(MACEs), adjusted RR = 2.11, 95% CI: 1.32-3.66, I 2 = 0%, P = 0.002]. Sensitivity analyses limited to studies including elderly patients showed consistent results (mortality: RR = 2.27, 95% CI: 1.51-3.41, I 2 = 23%, P < 0.001; MACEs: RR = 2.44, 95% CI: 1.44-4.31, I 2 = 0%, P = 0.001). Subgroup analyses showed that characteristics of study design, follow-up duration, or type of PCI did not seem to significantly affect the associations (P-values for subgroup analyses all >0.05). Conclusions: Frailty may be an independent risk factor of poor prognosis for patients with CAD after PCI.
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Affiliation(s)
- Peng Wang
- Department of Gerontology, Fuling Central Hospital of Chongqing City, Chongqing, China
| | - Shutang Zhang
- Department of Gerontology, Fuling Central Hospital of Chongqing City, Chongqing, China
| | - Ke Zhang
- Department of Gerontology, Fuling Central Hospital of Chongqing City, Chongqing, China
| | - Jie Tian
- Department of Gerontology, Fuling Central Hospital of Chongqing City, Chongqing, China
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48
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Patlolla SH, Gurumurthy G, Sundaragiri PR, Cheungpasitporn W, Vallabhajosyula S. Body Mass Index and In-Hospital Management and Outcomes of Acute Myocardial Infarction. ACTA ACUST UNITED AC 2021; 57:medicina57090926. [PMID: 34577849 PMCID: PMC8464976 DOI: 10.3390/medicina57090926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 08/23/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Contemporary data on the prevalence, management and outcomes of acute myocardial infarction (AMI) in relation to body mass index (BMI) are limited. Materials and Methods: Using the National Inpatient Sample from 2008 through 2017, we identified adult AMI hospitalizations and categorized them into underweight (BMI < 19.9 kg/m2), normal BMI and overweight/obese (BMI > 24.9 kg/m2) groups. We evaluated in-hospital mortality, utilization of cardiac procedures and resource utilization among these groups. Results: Among 6,089,979 admissions for AMI, 38,070 (0.6%) were underweight, 5,094,721 (83.7%) had normal BMI, and 957,188 (15.7%) were overweight or obese. Over the study period, an increase in the prevalence of AMI was observed in underweight and overweight/obese admissions. Underweight AMI admissions were, on average, older, with higher comorbidity, whereas overweight/obese admissions were younger and had lower comorbidity. In comparison to the normal BMI and overweight/obese categories, significantly lower use of coronary angiography (62.3% vs. 74.6% vs. 37.9%) and PCI (40.8% vs. 47.7% vs. 19.6%) was observed in underweight admissions (all p < 0.001). The underweight category was associated with significantly higher in-hospital mortality (10.0% vs. 5.5%; OR 1.23 (95% CI 1.18–1.27), p < 0.001), whereas being overweight/obese was associated with significantly lower in-hospital mortality compared to normal BMI admissions (3.1% vs. 5.5%; OR 0.73 (95% CI 0.72–0.74), p < 0.001). Underweight AMI admissions had longer lengths of in-hospital stay with frequent discharges to skilled nursing facilities, while overweight/obese admissions had higher hospitalization costs. Conclusions: In-hospital management and outcomes of AMI vary by BMI. Underweight status was associated with worse outcomes, whereas the obesity paradox was apparent, with better outcomes for overweight/obese admissions.
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Affiliation(s)
- Sri Harsha Patlolla
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN 55905, USA;
| | - Gayathri Gurumurthy
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA;
| | - Pranathi R. Sundaragiri
- Primary Care Internal Medicine, Wake Forest Baptist Health Westwood, High Point, NC 27262, USA;
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA;
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, High Point, NC 27262, USA
- Correspondence: ; Tel.: +1-(336)-878-6000
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Secemsky EA, Butala N, Raja A, Khera R, Wang Y, Curtis JP, Maddox TM, Virani SS, Armstrong EJ, Shunk KA, Brindis RG, Bhatt D, Yeh RW. Comparative Outcomes of Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial Infarction Among Medicare Beneficiaries With Multivessel Coronary Artery Disease: An National Cardiovascular Data Registry Research to Practice Project. Circ Cardiovasc Interv 2021; 14:e010323. [PMID: 34372676 DOI: 10.1161/circinterventions.120.010323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Eric A Secemsky
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine (E.A.S., N.B., A.R., R.W.Y.), Beth Israel Deaconess Medical Center, Boston, MA.,Division of Cardiology, Department of Medicine (E.A.S., R.W.Y.), Beth Israel Deaconess Medical Center, Boston, MA.,Harvard Medical School, Boston, MA (E.A.S., N.B., D.B., R.W.Y.)
| | - Neel Butala
- Harvard Medical School, Boston, MA (E.A.S., N.B., D.B., R.W.Y.).,Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston (N.B.)
| | | | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (R.K., Y.W., J.P.C.).,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (R.K., Y.W., J.P.C.)
| | - Yongfei Wang
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (R.K., Y.W., J.P.C.).,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (R.K., Y.W., J.P.C.)
| | - Jeptha P Curtis
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (R.K., Y.W., J.P.C.).,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (R.K., Y.W., J.P.C.)
| | - Thomas M Maddox
- Division of Cardiology, Washington University School of Medicine, St. Louis, MO (T.M.M.).,Healthcare Innovation Lab, BJC HealthCare/Washington University School of Medicine, St. Louis, MO (T.M.M.)
| | - Salim S Virani
- Michael E. DeBakey Veterans Affairs Medical Center and Section of Cardiovascular Research, Baylor College of Medicine, Houston, TX (S.S.V.)
| | - Ehrin J Armstrong
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver (E.J.A.)
| | - Kendrick A Shunk
- University of California and Veterans Affairs Medical Center, San Francisco (K.A.S.)
| | - Ralph G Brindis
- Department of Medicine & the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco (R.G.B.)
| | - Deepak Bhatt
- Harvard Medical School, Boston, MA (E.A.S., N.B., D.B., R.W.Y.).,Brigham and Women's Hospital, Heart & Vascular Center, Harvard Medical School, Boston, MA (D.B.)
| | - Robert W Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine (E.A.S., N.B., A.R., R.W.Y.), Beth Israel Deaconess Medical Center, Boston, MA.,Division of Cardiology, Department of Medicine (E.A.S., R.W.Y.), Beth Israel Deaconess Medical Center, Boston, MA.,Harvard Medical School, Boston, MA (E.A.S., N.B., D.B., R.W.Y.)
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50
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Nadlacki B, Horton D, Hossain S, Hariharaputhiran S, Ngo L, Ali A, Aliprandi-Costa B, Ellis CJ, Adams RJ, Visvanathan R, Ranasinghe I. Long term survival after acute myocardial infarction in Australia and New Zealand, 2009-2015: a population cohort study. Med J Aust 2021; 214:519-525. [PMID: 33997979 DOI: 10.5694/mja2.51085] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 01/14/2021] [Accepted: 02/05/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess long term survival and patient characteristics associated with survival following acute myocardial infarction (AMI) in Australia and New Zealand. DESIGN Cohort study. SETTING, PARTICIPANTS All patients admitted with AMI (ICD-10-AM codes I21.0-I21.4) to all public and most private hospitals in Australia and New Zealand during 2009-2015. MAIN OUTCOME MEASURE All-cause mortality up to seven years after an AMI. RESULTS 239 402 initial admissions with AMI were identified; the mean age of the patients was 69.3 years (SD, 14.3 years), 154 287 were men (64.5%), and 64 335 had ST-elevation myocardial infarction (STEMI; 26.9%). 7-year survival after AMI was 62.3% (STEMI, 70.8%; non-ST-elevation myocardial infarction [NSTEMI], 59.2%); survival exceeded 85% for people under 65 years of age, but was 17.4% for those aged 85 years or more. 120 155 patients (50.2%) underwent revascularisation (STEMI, 72.2%; NSTEMI, 42.1%); 7-year survival exceeded 80% for patients in each group who underwent revascularisation, and was lower than 45% for those who did not. Being older (85 years or older v 18-54 years: adjusted hazard ratio [aHR], 10.6; 95% CI, 10.1-11.1) or a woman (aHR, 1.15; 95% CI, 1.13-1.17) were each associated with greater long term mortality during the study period, as was prior heart failure (aHR, 1.79; 95% CI, 1.76-1.83). Several non-cardiac conditions and geriatric syndromes common in these patients were independently associated with lower long term survival, including major and metastatic cancer, cirrhosis and end-stage liver disease, and dementia. CONCLUSION AMI care in Australia and New Zealand is associated with high rates of long term survival; 7-year rates exceed 80% for patients under 65 years of age and for those who undergo revascularisation. Efforts to further improve survival should target patients with NSTEMI, who are often older and have several comorbid conditions, for whom revascularisation rates are low and survival after AMI poor.
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Affiliation(s)
| | | | | | | | - Linh Ngo
- The Prince Charles Hospital, Brisbane, QLD.,The University of Queensland, Brisbane, QLD
| | - Anna Ali
- University of Adelaide, Adelaide, SA
| | | | | | | | - Renuka Visvanathan
- University of Adelaide, Adelaide, SA.,The Queen Elizabeth Hospital, Adelaide, SA
| | - Isuru Ranasinghe
- The Prince Charles Hospital, Brisbane, QLD.,The University of Queensland, Brisbane, QLD
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