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Ludski J, Carp B, Makar T, Yii M, Lee DK, Weinberg L. Outcomes and complications of nonagenarians undergoing cardiac surgery: a scoping review protocol. BMJ Open 2023; 13:e072293. [PMID: 37463807 PMCID: PMC10357299 DOI: 10.1136/bmjopen-2023-072293] [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: 07/20/2023] Open
Abstract
INTRODUCTION Continually rising life expectancy and a shift towards an ageing population are resulting in an increasing population of nonagenarians. By 2030, the global population of nonagenarians is expected to exceed 30 million. The incidence of symptomatic cardiac disease is reported to occur in 25% of those aged over 75 years. Therefore, the number of nonagenarians undergoing cardiac surgery is also expected to increase. A linear relationship between advanced age and surgical risk has previously been demonstrated; however, it is not yet known whether this knowledge extends to the perioperative course and mortality of nonagenarians undergoing cardiac surgery. This scoping review aims to review the literature, assess whether a deficiency exists in the published literature and potentially identify knowledge gaps to guide future efforts to improve the understanding of nonagenarians undergoing cardiac surgery. METHODS AND ANALYSIS Following the relevant aspects of the Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Review guidelines, electronic databases of MEDLINE, EMBASE and the Cochrane Library will be systematically searched, with additional reference tracking of eligible studies. Studies reporting the outcomes of nonagenarians undergoing open cardiac surgery or minimally invasive cardiac surgery requiring cardiopulmonary bypass will be included. Screening and data extraction will be performed by two reviewers independently. The data will be analysed and summarised descriptively with a narrative approach. Qualitative data that capture quality-of-life outcomes will be subjected to thematic analysis where feasible. Additionally, reporting results will highlight similarities and differences in nonagenarian selection for surgery. ETHICS AND DISSEMINATION Ethics approval was not required. The findings will be disseminated through professional networks, conference presentations and publications in scientific journals.
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Affiliation(s)
- Jarryd Ludski
- Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Bradly Carp
- Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Tim Makar
- Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Michael Yii
- Department of Cardiac Surgery, Epworth Eastern Hospital, Box Hill, Victoria, Australia
| | - Dong-Kyu Lee
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Korea (the Republic of)
| | - Laurence Weinberg
- Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
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Hiltner E, Zinonos S, Kostis JB, Cabrera J, Cosgrove NM, Moreyra AE, Moussa I, Kostis WJ. A Twenty-Year Analysis of Demographics, Surgical Management, and Outcomes of Aortic Stenosis in New Jersey. Am J Cardiol 2021; 150:82-88. [PMID: 34006369 DOI: 10.1016/j.amjcard.2021.03.046] [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: 12/30/2020] [Revised: 03/12/2021] [Accepted: 03/12/2021] [Indexed: 10/21/2022]
Abstract
We investigated the incidence and characteristics of 14,996 patients with aortic stenosis (AS) who were hospitalized in New Jersey between the years 1995 to 2015. The average age was 72, the majority were Caucasian males and common co-morbidities were hypertension, coronary artery disease and hypercholesterolemia. Hospital admission for AS declined between 1995 to 2007, to 10/100,000 patients, and increased to 15/100,000 patients in 2015 (p for trend <0.001). During the study period, the percentage of patients who received aortic valve replacement (AVR) increased (p <0.001). All-cause and cardiovascular mortality were higher among patients who did not undergo AVR at 1-year (HR 1.98 CI 1.75 to 2.23, p <0.001 and HR 1.82 CI 1.57 to 2.11, p <0.001, respectively) and 3-years (HR 2.16 CI 1.96 to 2.38, p <0.001 and HR 2.16 CI 1.90 to 2.45, p <0.001, respectively). The probability for readmission for AS was higher in patients who did not receive AVR compared to patients who had AVR at 1 year (HR 92.95 CI 57.85 to 149.35, p <0.001) and 3 years (HR 70.36 CI 47.18 to 104.95, p <0.001). These data imply that earlier diagnosis of AS and AVR when indicated will improve outcomes.
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Temporal Trends and Outcomes of Transcatheter Mitral Valve Repair Among Nonagenarians. JACC Cardiovasc Interv 2020; 13:1385-1387. [DOI: 10.1016/j.jcin.2019.11.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/13/2019] [Accepted: 11/19/2019] [Indexed: 11/20/2022]
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Galatas C, Afilalo J. Transcatheter aortic valve replacement over age 90: Risks vs benefits. Clin Cardiol 2019; 43:156-162. [PMID: 31840834 PMCID: PMC7021650 DOI: 10.1002/clc.23310] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 11/20/2019] [Indexed: 12/16/2022] Open
Abstract
As the population ages, clinicians will encounter a growing number of nonagenarians suffering from severe aortic stenosis who may be candidates for transcatheter aortic valve replacement (TAVR). By virtue of a healthy survivor effect or a referral bias, these patients may paradoxically have greater resilience and fewer comorbidities than their octogenarian counterparts. They tend to, on average, tolerate the TAVR procedure quite well with low in‐hospital and 1‐year mortality rates of 5.5% and 23%, respectively. Appropriate patient selection should consider individualized estimates of procedural risk, potential for functional recovery and for improved quantity and quality of life. Frailty is much more revealing than chronological age, and it can be measured by brief tools such as the Essential Frailty Toolset. Ultimately, the process of shared decision‐making is paramount to ensure that the course of action is patient‐centered and balances the procedure's expected risks and benefits with the nonagenarian's preferences and values.
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Affiliation(s)
- Christos Galatas
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Jonathan Afilalo
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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Prevention and Treatment of Acute Stroke in the Nonagenarians and Beyond: Medical and Ethical Issues. Curr Treat Options Neurol 2019; 21:27. [PMID: 31065827 DOI: 10.1007/s11940-019-0567-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE OF REVIEW As one of the fastest growing portions of the population, nonagenarians will constitute a significant percentage of the stroke patient population in the near future. Nonagenarians are nevertheless not specifically targeted by most clinical guidelines. In this review, we aimed to summarise the available evidence guiding stroke prevention and treatment in this age group. RECENT FINDINGS Several recent observational studies have shown that the benefits of anticoagulation for the oldest old patients with atrial fibrillation may outweigh the bleeding risk. A sub-analysis of the IST-3 trial has shown for the first time that thrombolysis treatment in acute ischaemic stroke may be beneficial and safe even in octogenarian patients and older. Several recent observational studies have assessed thrombolysis in nonagenarians. The latest of these has shown better disability outcomes without increased rates of symptomatic intracerebral haemorrhage with thrombolysis. Nonagenarian stroke patients may benefit from similar preventative and therapeutic strategies as their younger counterparts. A few important exceptions include primary prevention using aspirin or statins. Patient selection is nevertheless essential given the increased adverse event rates. Patient preference should play a key role in the decision-making process. Clinical trials including more nonagenarian patients are required to yield more robust evidence.
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Kingston A, Jagger C. Review of methodologies of cohort studies of older people. Age Ageing 2018; 47:215-219. [PMID: 29206896 DOI: 10.1093/ageing/afx183] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 11/17/2017] [Indexed: 01/28/2023] Open
Abstract
This paper describes a cohort study in terms of its design, the research questions answered by cohort studies, common analytic techniques and the strengths and limitations of this type of study. We also describe the main cohort studies of older populations, many of which are available for secondary data analysis.
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Affiliation(s)
- Andrew Kingston
- Instiute of Health and Society, Newcastle University, UK
- Newcastle University Institute for Ageing, UK
| | - Carol Jagger
- Instiute of Health and Society, Newcastle University, UK
- Newcastle University Institute for Ageing, UK
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De Sciscio P, Brubert J, De Sciscio M, Serrani M, Stasiak J, Moggridge GD. Quantifying the Shift Toward Transcatheter Aortic Valve Replacement in Low-Risk Patients: A Meta-Analysis. Circ Cardiovasc Qual Outcomes 2018; 10:CIRCOUTCOMES.116.003287. [PMID: 28600455 DOI: 10.1161/circoutcomes.116.003287] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 04/12/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND In recent years, use of transcatheter aortic valve replacement has expanded to include patients at intermediate- and low-risk cohorts. We sought to determine disease prevalence and treatment distribution including transcatheter aortic valve replacement eligibility in low-risk patients across 37 advanced economies. METHODS AND RESULTS Four systematic searches were conducted across MEDLINE, EMBASE, and the Cochrane database for studies evaluating disease prevalence, severity, decision making, and survival in patients with aortic stenosis. Estimates of disease prevalence and treatment eligibility were calculated using stochastic simulation and population data for the 37 countries comprising the International Monetary Fund's advanced economies index. Fifty-six studies comprising 42 965 patients were included across 5 domains: prevalence, severity, symptom status, treatment modality, and outcome. The pooled prevalence in the general population aged 60 to 74 years and >75 years was 2.8% (95% confidence interval [CI], 1.4%-4.1%) and 13.1% (95% CI, 8.2%-17.9%), respectively-corresponding to an estimated 16.1 million (95% CI, 12.2-20.3) people in 37 advanced economies. Of these, an estimated 3.2 million (95% CI, 2.2-4.4) patients have severe aortic stenosis with 1.9 million (95% CI, 1.3-2.6) eligible for surgical aortic valve replacement. There are ≈485 230 (95% CI, 284 550-66 7350) high-risk/inoperable patients, 152 690 (95% CI, 73 410-263 000) intermediate-risk patients, and 378 890 (95% CI, 205 130-610 210) low-risk patients eligible for transcatheter aortic valve replacement. CONCLUSIONS With a prevalence of 4.5%, an estimated 16.1 million people aged ≥60 years across 37 advanced economies have aortic stenosis. Of these, there are ≈1.9 million patients eligible for surgical aortic valve replacement and 1.0 million patients eligible for transcatheter aortic valve replacement.
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Affiliation(s)
- Paolo De Sciscio
- From the Departments of Engineering (P.D.S.) and Chemical Engineering and Biotechnology (P.D.S., J.B., M.S., J.S., G.M.), University of Cambridge, United Kingdom; and Department of General Medicine, Royal Adelaide Hospital, Internal Medicine Service, Royal Adelaide Hospital, Adelaide, Australia (M.D.S.).
| | - Jacob Brubert
- From the Departments of Engineering (P.D.S.) and Chemical Engineering and Biotechnology (P.D.S., J.B., M.S., J.S., G.M.), University of Cambridge, United Kingdom; and Department of General Medicine, Royal Adelaide Hospital, Internal Medicine Service, Royal Adelaide Hospital, Adelaide, Australia (M.D.S.)
| | - Michele De Sciscio
- From the Departments of Engineering (P.D.S.) and Chemical Engineering and Biotechnology (P.D.S., J.B., M.S., J.S., G.M.), University of Cambridge, United Kingdom; and Department of General Medicine, Royal Adelaide Hospital, Internal Medicine Service, Royal Adelaide Hospital, Adelaide, Australia (M.D.S.)
| | - Marta Serrani
- From the Departments of Engineering (P.D.S.) and Chemical Engineering and Biotechnology (P.D.S., J.B., M.S., J.S., G.M.), University of Cambridge, United Kingdom; and Department of General Medicine, Royal Adelaide Hospital, Internal Medicine Service, Royal Adelaide Hospital, Adelaide, Australia (M.D.S.)
| | - Joanna Stasiak
- From the Departments of Engineering (P.D.S.) and Chemical Engineering and Biotechnology (P.D.S., J.B., M.S., J.S., G.M.), University of Cambridge, United Kingdom; and Department of General Medicine, Royal Adelaide Hospital, Internal Medicine Service, Royal Adelaide Hospital, Adelaide, Australia (M.D.S.)
| | - Geoff D Moggridge
- From the Departments of Engineering (P.D.S.) and Chemical Engineering and Biotechnology (P.D.S., J.B., M.S., J.S., G.M.), University of Cambridge, United Kingdom; and Department of General Medicine, Royal Adelaide Hospital, Internal Medicine Service, Royal Adelaide Hospital, Adelaide, Australia (M.D.S.)
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Leibowitz D, Jacobs JM, Lande-Stessman I, Gilon D, Stessman J. Cardiac structure and function predicts functional decline in the oldest old. Eur J Prev Cardiol 2017; 25:263-269. [PMID: 29164920 DOI: 10.1177/2047487317744365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background This study examined the association between cardiac structure and function and the deterioration in activities of daily living (ADLs) in an age-homogenous, community-dwelling population of patients born in 1920-1921 over a five-year follow-up period. Design Longitudinal cohort study. Methods Patients were recruited from the Jerusalem Longitudinal Cohort Study, which has followed an age-homogenous cohort of Jerusalem residents born in 1920-1921. Patients underwent home echocardiography and were followed up for five years. Dependence was defined as needing assistance with one or more basic ADL. Standard echocardiographic assessment of cardiac structure and function, including systolic and diastolic function, was performed. Reassessment of ADLs was performed at the five-year follow-up. Results A total of 459 patients were included in the study. Of these, 362 (79%) showed a deterioration in at least one ADL at follow-up. Patients with functional deterioration had a significantly higher left ventricular mass index and left atrial volume with a lower ejection fraction. There was no significant difference between the diastolic parameters the groups in examined. When the data were examined categorically, a significantly larger percentage of patients with functional decline had an abnormal left ventricular ejection fraction and left ventricular hypertrophy. The association between left ventricular mass index and functional decline remained significant in all multivariate models. Conclusions In this cohort of the oldest old, an elevated left ventricular mass index, higher left atrial volumes and systolic, but not diastolic dysfunction, were predictive of functional disability.
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Affiliation(s)
- David Leibowitz
- 1 Heart Institute, Hebrew University Hadassah Medical School, Israel
| | - Jeremy M Jacobs
- 2 Department of Geriatrics and Rehabilitation, Hebrew University Hadassah Medical School, Israel
| | - Irit Lande-Stessman
- 2 Department of Geriatrics and Rehabilitation, Hebrew University Hadassah Medical School, Israel
| | - Dan Gilon
- 1 Heart Institute, Hebrew University Hadassah Medical School, Israel
| | - Jochanan Stessman
- 2 Department of Geriatrics and Rehabilitation, Hebrew University Hadassah Medical School, Israel
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Rezzoug N, Vaes B, de Meester C, Degryse J, Van Pottelbergh G, Mathei C, Adriaensen W, Pasquet A, Vanoverschelde JL. The clinical impact of valvular heart disease in a population-based cohort of subjects aged 80 and older. BMC Cardiovasc Disord 2016; 16:7. [PMID: 26754575 PMCID: PMC4709950 DOI: 10.1186/s12872-016-0184-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 01/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In our ageing society, valvular heart diseases (VHD) have become an increasing public health problem. However, the lack of studies describing the impact of these diseases on the outcome of very old subjects makes it difficult to appreciate their real clinical burden. METHODS Prospective, observational, population-based cohort study in Belgium. Five hundred fifty six subjects aged 80 years and older were followed up for 5.1 ± 0.25 years for mortality and 3.0 ± 0.25 years for hospitalization. Echocardiograms were performed at baseline. The Cumulative Illness Rating Scale (CIRS) was calculated for each subject. RESULTS The prevalence of moderate-to-severe VHD was 17% (n = 97). Mitral stenosis was more prevalent in women and an age-dependent increase of the prevalence of severe aortic stenosis was seen. The overall disease burden was higher in participants with VHD (median CIRS 3 [IQR 3-5] vs 4 [IQR 3-6] (P = 0.008)). Moderate-to-severe VHD, and more specifically mitral stenosis and aortic stenosis, was found to be an independent predictor of both all-cause (HR 1.42 (95% CI 1.04-1.95)) and cardiovascular mortality (HR 2.13 (95% CI 1.38-3.29)). Moderate-to-severe VHD was also found to be an independent predictor of the need for a first unplanned hospitalization (HR 1.43 (95% CI 1.06-1.94)). CONCLUSIONS A high prevalence of moderate-to-severe VHD was found in the very old. Moderate-to-severe VHD was identified as an independent risk factor for all-cause and cardiovascular mortality and as well for unplanned hospitalizations, independent of other structural cardiac abnormalities, ventricular function and major co-morbidities.
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Affiliation(s)
- Nawel Rezzoug
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.
| | - Bert Vaes
- Institute of Health and Society, Université Catholique de Louvain (UCL), Brussels, Belgium.
- Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium.
| | - Christophe de Meester
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.
| | - Jan Degryse
- Institute of Health and Society, Université Catholique de Louvain (UCL), Brussels, Belgium.
- Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium.
| | - Gijs Van Pottelbergh
- Institute of Health and Society, Université Catholique de Louvain (UCL), Brussels, Belgium.
- Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium.
| | - Catharina Mathei
- Institute of Health and Society, Université Catholique de Louvain (UCL), Brussels, Belgium.
- Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium.
| | - Wim Adriaensen
- Institute of Health and Society, Université Catholique de Louvain (UCL), Brussels, Belgium.
- Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium.
| | - Agnes Pasquet
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.
| | - Jean-Louis Vanoverschelde
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.
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van Riet EES, Hoes AW, Wagenaar KP, Limburg A, Landman MAJ, Rutten FH. Epidemiology of heart failure: the prevalence of heart failure and ventricular dysfunction in older adults over time. A systematic review. Eur J Heart Fail 2016; 18:242-52. [PMID: 26727047 DOI: 10.1002/ejhf.483] [Citation(s) in RCA: 466] [Impact Index Per Article: 58.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 11/08/2015] [Accepted: 11/29/2015] [Indexed: 12/31/2022] Open
Abstract
The 'epidemic' of heart failure seems to be changing, but precise prevalence estimates of heart failure and left ventricular dysfunction (LVD) in older adults, based on adequate echocardiographic assessment, are scarce. Systematic reviews including recent studies on the prevalence of heart failure and LVD are lacking. We aimed to assess the trends in the prevalence of LVD, and heart failure with reduced (HFrEF) and preserved ejection fraction (HFpEF) in the older population at large. A systematic electronic search of the databases Medline and Embase was performed. Studies that reported prevalence estimates in community-dwelling people ≥60 years old were included if echocardiography was used to establish the diagnosis. In total, 28 articles from 25 different study populations were included. The median prevalence of systolic and 'isolated' diastolic LVD was 5.5% (range 3.3-9.2%) and 36.0% (range 15.8-52.8%), respectively. A peak in systolic dysfunction prevalence seems to have occurred between 1995 and 2000. 'All type' heart failure had a median prevalence rate of 11.8% (range 4.7-13.3%), with fairly stable rates in the last decade and with HFpEF being more common than HFrEF [median prevalence 4.9% (range 3.8-7.4%) and 3.3% (range 2.4-5.8%), respectively]. Both LVD and heart failure remain common in the older population at large. The prevalence of diastolic dysfunction is on the rise and currently higher than that of systolic dysfunction. The prevalence of the latter seems to have decreased in the 21st century.
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Affiliation(s)
- Evelien E S van Riet
- Julius Centre for Health Sciences and Primary care, University Medical Centre Utrecht, PO Box 85500, 3508 AB Utrecht, the Netherlands
| | - Arno W Hoes
- Julius Centre for Health Sciences and Primary care, University Medical Centre Utrecht, PO Box 85500, 3508 AB Utrecht, the Netherlands
| | - Kim P Wagenaar
- Julius Centre for Health Sciences and Primary care, University Medical Centre Utrecht, PO Box 85500, 3508 AB Utrecht, the Netherlands
| | | | - Marcel A J Landman
- Former Institution (retired) Meander Medical Centre, Amersfoort, the Netherlands
| | - Frans H Rutten
- Julius Centre for Health Sciences and Primary care, University Medical Centre Utrecht, PO Box 85500, 3508 AB Utrecht, the Netherlands
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Rezzoug N, Vaes B, Pasquet A, Gerber B, de Meester C, Van Pottelbergh G, Adriaensen W, Matheï C, DeGryse J, Vanoverschelde JL. Prevalence and Prognostic Impact of Valve Area-Gradient Patterns in Patients ≥80 Years With Moderate-to-Severe Aortic Stenosis (from the Prospective BELFRAIL Study). Am J Cardiol 2015. [PMID: 26219495 DOI: 10.1016/j.amjcard.2015.05.062] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Although degenerative aortic valve stenosis (AS) is common with increasing age, limited data exist regarding the prevalence and prognostic impact of its various valve area-gradient patterns in patients ≥80 years. To test this, echocardiograms were obtained in 542 randomly selected subjects aged ≥80 years recruited in the Belgium Cohort Study of the Very Elderly study (BFC80+). Subjects were divided into 3 groups: no or mild AS, moderate AS, and severe AS. Patients with severe AS were further stratified into those with high mean gradients (HG-AS) and those with paradoxically low mean gradients (LG-AS). Prevalence of moderate-to-severe AS was 14.7% and that of severe AS was 5.9%. In patients with severe AS, most (72%) exhibited paradoxical LG-AS. All patients with severe HG-AS were asymptomatic at the time of inclusion, whereas 48% of those with severe paradoxical LG-AS had significant symptoms. During follow-up, there were 2 aortic valve replacements and 230 deaths, of which 100 (43%) were of cardiovascular origin. Five-year overall survival rate was significantly worse in severe HG-AS than in any of the other groups (22 ± 14% vs 62 ± 2% in no or mild AS, 48 ± 7% in moderate AS, and 43 ± 10% in severe paradoxical LG-AS, p <0.01). Survival rate was similar among severe paradoxical LG-AS with and without low flow. In conclusion, in this large population-based sample of subjects ≥80 years, the prevalence of severe AS was 5.9%. Most of these subjects presented with the severe paradoxical LG-AS and a third of them were symptomatic. In this elderly community, severe HG-AS is a major determinant of prognosis, even in the absence of symptoms, whereas severe paradoxical LG-AS seems to behave similarly to moderate AS.
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Affiliation(s)
- Nawel Rezzoug
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium; Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Bert Vaes
- Institut de Recherche Santé-Société, Université Catholique de Louvain, Brussels, Belgium
| | - Agnès Pasquet
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium; Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Bernhard Gerber
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium; Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Christophe de Meester
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium; Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Gijs Van Pottelbergh
- Institut de Recherche Santé-Société, Université Catholique de Louvain, Brussels, Belgium
| | - Wim Adriaensen
- Institut de Recherche Santé-Société, Université Catholique de Louvain, Brussels, Belgium
| | - Catharina Matheï
- Institut de Recherche Santé-Société, Université Catholique de Louvain, Brussels, Belgium
| | - Jan DeGryse
- Institut de Recherche Santé-Société, Université Catholique de Louvain, Brussels, Belgium
| | - Jean-Louis Vanoverschelde
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium; Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
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Collerton J, Kingston A, Yousaf F, Davies K, Kenny A, Neely D, Martin-Ruiz C, MacGowan G, Robinson L, Kirkwood TBL, Keavney B. Utility of NT-proBNP as a rule-out test for left ventricular dysfunction in very old people with limiting dyspnoea: the Newcastle 85+ Study. BMC Cardiovasc Disord 2014; 14:128. [PMID: 25257704 PMCID: PMC4189162 DOI: 10.1186/1471-2261-14-128] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 09/18/2014] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Guidelines advocate using B-type natriuretic peptides in the diagnostic work-up of suspected heart failure (HF). Their main role is to limit echocardiography rates by ruling out HF/LV dysfunction where peptide level is low. Recommended rule-out cut points vary between guidelines. The utility of B-type natriuretic peptides in the very old (85+) requires further investigation, with optimal cut points yet to be established. We examined NT-proBNP's utility, alone and in combination with history of myocardial infarction (MI), as a rule-out test for LV dysfunction in very old people with limiting dyspnoea. METHODS DESIGN Cross-sectional analysis. SETTING Population-based sample; North-East England. PARTICIPANTS 155 people (aged 87-89) with limiting dyspnoea. MEASURES Dyspnoea assessed by questionnaire. Domiciliary echocardiography performed; LV systolic/diastolic function graded. NT-proBNP measured (Roche Diagnostics). Receiver operating characteristic analyses examined NT-proBNP's diagnostic accuracy for LV dysfunction. RESULTS AUC for LVEF less than or equal to 50% was poor (0.58, 95% CI 0.49-0.65), but good for LVEF less than or equal to 40% (0.80, 95% CI 0.73-0.86). At ESC cut point (125 ng/l), few cases of systolic dysfunction were missed (NPV 94-100%, depending on severity), but echocardiography (88%) and false positive rates (56-81 per 100 screened) were high. At NICE cut point (400 ng/l), echocardiography (51%) and false positive rates (33-45) were lower; exclusionary performance was good for LVEF less than or equal to 40% (1 case missed per 100 screened, 15% of cases; NPV 97%), but poor for LVEF less than or equal to 50% (16 cases missed per 100 screened, 45% of cases; NPV 68%). Incorporating isolated moderate/severe diastolic dysfunction into target condition increased the proportion of cases missed (lower NPV), whilst improving case detection. Incorporating MI history as an additional referral prompt slightly reduced the number of cases missed at expense of higher echocardiography and false positive rates. CONCLUSIONS High echocardiography rates and poor exclusionary performance for mild degrees of systolic dysfunction and for diastolic dysfunction limit NT-proBNP's utility as a rule-out test for LV dysfunction in very old people with limiting dyspnoea. Incorporating MI history as an additional echocardiography prompt yields no overall benefit compared to using NT-proBNP level alone.
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Affiliation(s)
- Joanna Collerton
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK.
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Aortic stenosis in the elderly: disease prevalence and number of candidates for transcatheter aortic valve replacement: a meta-analysis and modeling study. J Am Coll Cardiol 2013; 62:1002-12. [PMID: 23727214 DOI: 10.1016/j.jacc.2013.05.015] [Citation(s) in RCA: 813] [Impact Index Per Article: 73.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 04/08/2013] [Accepted: 05/08/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the prevalence of aortic stenosis (AS) in the elderly and to estimate the current and future number of candidates for transcatheter aortic valve replacement (TAVR). BACKGROUND Severe AS is a major cause of morbidity and mortality in the elderly. A proportion of these patients is at high or prohibitive risk for surgical aortic valve replacement, and is now considered for TAVR. METHODS A systematic search was conducted in multiple databases, and prevalence rates of patients (>75 years) were pooled. A model was based on a second systematic literature search of studies on decision making in AS. Monte Carlo simulations were performed to estimate the number of TAVR candidates in 19 European countries and North America. RESULTS Data from 7 studies (n = 9,723 subjects) were used. The pooled prevalence of all AS in the elderly was 12.4% (95% confidence interval [CI]: 6.6% to 18.2%), and the prevalence of severe AS was 3.4% (95% CI: 1.1% to 5.7%). Among elderly patients with severe AS, 75.6% (95% CI: 65.8% to 85.4%) were symptomatic, and 40.5% (95% CI: 35.8% to 45.1%) of these patients were not treated surgically. Of those, 40.3% (95% CI: 33.8% to 46.7%) received TAVR. Of the high-risk patients, 5.2% were TAVR candidates. Projections showed that there are approximately 189,836 (95% CI: 80,281 to 347,372) TAVR candidates in the European countries and 102,558 (95% CI: 43,612 to 187,002) in North America. Annually, there are 17,712 (95% CI: 7,590 to 32,691) new TAVR candidates in the European countries and 9,189 (95% CI: 3,898 to 16,682) in North America. CONCLUSIONS With a pooled prevalence of 3.4%, the burden of disease among the elderly due to severe AS is substantial. Under the current indications, approximately 290,000 elderly patients with severe AS are TAVR candidates. Nearly 27,000 patients become eligible for TAVR annually.
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Yousaf F, Collerton J, Kingston A, Kenny A, Davies K, Jagger C, Robinson L, Kirkwood TBL, Keavney B. Prevalence of left ventricular dysfunction in a UK community sample of very old people: the Newcastle 85+ study. Heart 2012; 98:1418-23. [PMID: 22859497 PMCID: PMC3437786 DOI: 10.1136/heartjnl-2012-302457] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective Heart failure (HF) prevalence rises sharply among those aged 85 years and over. Previous population based echocardiographic studies of left ventricular (LV) dysfunction, the substrate for HF, have included only small numbers in this age group. We used domiciliary echocardiography to estimate the prevalence of LV systolic and diastolic dysfunction in 87–89 year olds and the proportion remaining undiagnosed. Design Cross sectional analysis of data from Newcastle 85+ Study. Setting Primary care, North-East England. Participants 376 men and women aged 87–89 years. Measures Domiciliary echocardiography was performed and LV systolic and diastolic function was graded. The presence of limiting dyspnoea was assessed by questionnaire. Previous diagnoses of HF were abstracted from general practice (GP) records. Results 32% of participants (119/376) had LV systolic dysfunction (ejection fraction (EF) ≤50%) and a further 20% (75/376) had moderate or severe LV diastolic dysfunction with preserved EF. Both echocardiographic assessment of LV function and dyspnoea status were available in 74% (278/376) of participants. Among these participants, limiting dyspnoea was present in approximately two thirds of those with significant (systolic or isolated moderate/severe diastolic) LV dysfunction. 84% (73/87) of participants with significant LV dysfunction and limiting dyspnoea did not have a pre-existing HF diagnosis in their GP records. Overall, 26% (73/278) of participants with both echocardiographic and dyspnoea data had undiagnosed, symptomatic, significant LV dysfunction. Conclusion Significant systolic and diastolic LV dysfunction is much commoner in community dwelling 87–89 year olds than previous studies have suggested. The majority are both symptomatic and undiagnosed.
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Affiliation(s)
- Fahad Yousaf
- Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK
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Stessman-Lande I, Jacobs JM, Gilon D, Leibowitz D. Physical Activity and Cardiac Function in the Oldest Old. Rejuvenation Res 2012; 15:32-40. [DOI: 10.1089/rej.2011.1198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- Irit Stessman-Lande
- Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- As a partial fulfillment of the requirements for her M.D. degree at the Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Jeremy M. Jacobs
- Department of Geriatrics and Rehabilitation, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel, and the Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Dan Gilon
- Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - David Leibowitz
- Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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The prevalence of cardiac dysfunction and the correlation with poor functioning among the very elderly. Int J Cardiol 2012; 155:134-43. [DOI: 10.1016/j.ijcard.2011.07.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 07/04/2011] [Indexed: 11/23/2022]
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Díaz-Castro Ó, Datino T, López-Palop R, Martínez-Sellés M. [Update on geriatric cardiology]. Rev Esp Cardiol 2011; 64 Suppl 1:3-12. [PMID: 21276485 DOI: 10.1016/s0300-8932(11)70002-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This article contains a review of the main developments in the field of geriatric cardiology reported during 2010. The focus is on research into the specific characteristics of elderly patients with heart failure, ischemic heart disease, valvular heart disease and arrhythmias.
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Affiliation(s)
- Óscar Díaz-Castro
- Servicio de Cardiología, Hospital do Meixoeiro, CHUVI, Vigo, Pontevedra, España
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