Antithrombotic treatment tailoring and risk score evaluation in elderly patients diagnosed with an acute coronary syndrome

Effects of Personalized Nursing plus Dietary Nursing Management on LP-PLA2, Hcy Levels, and Quality of Life in Elderly Patients with Acute Coronary Syndrome

Objective

To explore the effect of individual nursing combined with dietary management on blood glucose levels and quality of life in elderly patients with acute coronary syndrome with diabetes.

Method

This study included 68 elderly patients who underwent acute coronary syndrome at Department of Emergency in our hospital from January 2018 to January 2020. And they were assigned to a control group (n = 34) treated with individual nursing and a research group (n = 34) treated with individual nursing and dietary management according to the random number table. A comparison of the changes in blood glucose levels, anxiety and depression, quality of life, and nursing satisfaction was made between groups before and after nursing.

Result

Before nursing, the differences in blood glucose levels, SAS scores, and SDS scores between groups were not considered statistically significant (P > 0.05). After nursing, the blood glucose levels, SAS, and SDS levels of patients in both groups significantly decreased, and the research group presented a higher decrease when compared with the control group (P < 0.05). The short form health survey (SF-36) showed that the research group had higher scores in physical function (PF), general health (GH), vitality (VT), mental health (MH), social function (SF), role-physical (RP), bodily pain (BP), and role-emotional (RE) compared with the control group (P < 0.05). The satisfaction survey presented that the research group had a significantly higher total score than the control group [(91.40 ± 5.23) vs. (86.61 ± 7.14), P < 0.05].

Conclusion

The combination of individual nursing and dietary management not only effectively reduces glycosylated hemoglobin levels and anxiety and depression but also wins better nursing satisfaction in the treatment of acute coronary syndrome in elderly patients. Moreover, their quality of life has been significantly improved after discharge.

Prognostic value of frailty in elderly patients with acute coronary syndrome: a systematic review and meta-analysis

BACKGROUND

Frailty is common and associated with poorer outcomes in the elderly, but its prognostic value in acute coronary syndromes (ACS) requires clarification. We thus undertook a systematic review and meta-analysis to evaluate the relationship between frailty and poor prognosis in patients with ACS.

METHODS

We systematically searched PubMed, Embase to find literatures which studied the prognostic value of frailty in elderly patients with ACS. Our main endpoints were the all-cause mortality, cardiovascular disease (CVD), major bleeding and readmissions. We pooled studies using random-effect generic inverse variance method, and conducted three pre-specified subgroup analyses.

RESULTS

Of 1216 identified studies, 15 studies were included in our analysis. Compared with the normal group, frailty (HR = 2.65; 95%CI: 1.81-3.89, I2 = 60.2%) and pre-frailty (HR = 1.41; 95%CI: 1.19-1.66, I2 = 0%) were characterized by a higher risk of mortality after adjustment. Frailty also was associated with increased risk of any-type CVD, major bleeding and hospital readmissions in elderly patients with ACS. The pooled effect sizes in frail patients were 1.54 (95%CI: 1.32-1.79), 1.51 (95%CI: 1.14-1.99) and 1.51 (95%CI: 1.09-2.10).

CONCLUSIONS

Frailty provides quantifiable and significant prognostic value for mortality and adverse events in elderly ACS patients, helping doctors to appraise the comprehensive prognosis risk and to applicate appropriate management strategies.

Bleeding risk assessment in elderly patients with acute coronary syndrome

Nowadays, elderly people represent a growing population segment with a well known increased risk of both ischemic and bleeding events. Current acute coronary syndrome guidelines, strongly recommend dual antiplatelet therapy (DAPT) with few specific references for aged patients due to lack of evidence. Patients aged ≥ 75 years are misrepresented in the classic derivation trials cohorts. Strategies to reduce the bleeding risk in this group of patients are urgently needed for the daily clinical practice. Identify the specific age related bleeding risk factors and the importance of an integral geriatric assessment remains challenging. Some of the available in-hospital and out-hospital bleeding risk scores have shown a lower to moderate predictive ability in older patients and no specific tools are developed in elderly population. The importance of an appropriate vascular access choice, type and duration of antiplatelet drugs is crucial to reduce the bleeding risk. Increase radial approaches and short DAPT duration leads to reduce hemorrhages. One interesting subgroup of patients is those who need chronic anticoagulation therapy after percutaneous coronary intervention, due to their very high risk of bleeding. New alternatives as dual therapy with oral anticoagulation and only one antiplatlet drug should be considered. In current review, we evaluate the available evidence about bleeding risk in elderly.