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Yang X, Lupón J, Vidán MT, Ferguson C, Gastelurrutia P, Newton PJ, Macdonald PS, Bueno H, Bayés-Genís A, Woo J, Fung E. Impact of Frailty on Mortality and Hospitalization in Chronic Heart Failure: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2019; 7:e008251. [PMID: 30571603 PMCID: PMC6405567 DOI: 10.1161/jaha.117.008251] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Although frailty has been associated with increased risks for hospitalization and mortality in chronic heart failure, the precise average effect remains uncertain. We performed a systematic review and meta‐analysis to summarize the hazards for mortality and incident hospitalization in patients with heart failure and frailty compared with those without frailty and explored the heterogeneity underlying the effect size estimates. Methods and Results MEDLINE, EMBASE, and Cochrane databases were queried for articles published between January 1966 and March 2018. Predefined selection criteria were used. Hazard ratios (HRs) were pooled for meta‐analyses, and where odds ratios were used previously, original data were recalculated for HR. Overlapping data were consolidated, and only unique data points were used. Study quality and bias were assessed. Eight studies were included for mortality (2645 patients), and 6 studies were included for incident hospitalization (2541 patients) during a median follow‐up of 1.82 and 1.12 years, respectively. Frailty was significantly associated with an increased hazard for mortality (HR, 1.54; 95% confidence interval, 1.34–1.75; P<0.001) and incident hospitalization (HR, 1.56; 95% confidence interval, 1.36–1.78; P<0.001) in chronic heart failure. The Fried phenotype estimated a 16.9% larger effect size than the combined Fried/non‐Fried frailty assessment for the end point of mortality (HR, 1.80; 95% confidence interval, 1.41–2.28; P<0.001), but not for hospitalization (HR, 1.57; 95% confidence interval, 1.30–1.89; P<0.001). Study heterogeneity was found to be low (I2=0%), and high quality of studies was verified by the Newcastle‐Ottawa scale. Conclusions Overall, the presence of frailty in chronic heart failure is associated with an increased hazard for death and hospitalization by ≈1.5‐fold.
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Affiliation(s)
- Xiaobo Yang
- 1 Department of Medicine and Therapeutics Faculty of Medicine The Chinese University of Hong Kong Hong Kong, SAR.,2 Laboratory for Heart Failure and Circulation Research Li Ka Shing Institute of Health Sciences Prince of Wales Hospital Hong Kong, SAR
| | - Josep Lupón
- 3 Cardiology Department Hospital Universitari Germans Trias i Pujol Badalona Spain.,4 Department of Medicine Universitat Autonòma de Barcelona Spain.,5 CIBERCV Instituto de Salud Carlos III Madrid Spain
| | - Maria T Vidán
- 6 Department of Geriatrics Instituto de Investigación IiSGM and CIBERFES Hospital General Universitario Gregorio Marañón Madrid Spain.,7 Universidad Complutense de Madrid Spain
| | - Caleb Ferguson
- 8 Western Sydney Nursing and Midwifery Research Centre Western Sydney University and Western Sydney Local Health District Sydney Australia
| | - Paloma Gastelurrutia
- 5 CIBERCV Instituto de Salud Carlos III Madrid Spain.,9 Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol Badalona Spain
| | - Phillip J Newton
- 8 Western Sydney Nursing and Midwifery Research Centre Western Sydney University and Western Sydney Local Health District Sydney Australia
| | - Peter S Macdonald
- 10 Heart and Lung Transplant Unit St Vincent's Hospital University of New South Wales Sydney Australia.,11 Transplantation Research Laboratory Victor Chang Cardiac Research Institute Sydney Australia
| | - Héctor Bueno
- 7 Universidad Complutense de Madrid Spain.,12 Centro Nacional de Investigaciones Cardiovasculares Madrid Spain.,13 Instituto de Investigación i+12 and Cardiology Department Hospital Universitario 12 de Octubre Madrid Spain
| | - Antoni Bayés-Genís
- 3 Cardiology Department Hospital Universitari Germans Trias i Pujol Badalona Spain.,4 Department of Medicine Universitat Autonòma de Barcelona Spain.,5 CIBERCV Instituto de Salud Carlos III Madrid Spain
| | - Jean Woo
- 1 Department of Medicine and Therapeutics Faculty of Medicine The Chinese University of Hong Kong Hong Kong, SAR.,14 CUHK Jockey Club Institute of Ageing The Chinese University of Hong Kong Hong Kong, SAR
| | - Erik Fung
- 1 Department of Medicine and Therapeutics Faculty of Medicine The Chinese University of Hong Kong Hong Kong, SAR.,2 Laboratory for Heart Failure and Circulation Research Li Ka Shing Institute of Health Sciences Prince of Wales Hospital Hong Kong, SAR.,15 School of Public Health Imperial College London London United Kingdom.,16 CARE Programme Lui Che Woo Institute of Innovative Medicine Faculty of Medicine The Chinese University of Hong Kong Hong Kong, SAR.,17 Gerald Choa Cardiac Research Centre Faculty of Medicine The Chinese University of Hong Kong Hong Kong, SAR
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Bernal E, Bayés-Genís A, Ariza-Solé A, Formiga F, Vidán MT, Escobar-Robledo LA, Aboal J, Alcoberro L, Guerrero C, Ariza-Segovia I, de Benito AH, Vilardell P, Sánchez-Salado JC, Lorente V, de Luna AB, Martinez-Sellés M. Corrigendum to “Interatrial block, frailty and prognosis in elderly patients with myocardial infarction” [J Electrocardiol 51(2018) 1–7]. J Electrocardiol 2018; 51:747. [DOI: 10.1016/j.jelectrocard.2018.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Bernal E, Bayés-Genís A, Ariza-Solé A, Formiga F, Vidán MT, Escobar-Robledo LA, Aboal J, Alcoberro L, Guerrero C, Ariza-Segovia I, Hernández de Benito A, Vilardell P, Sánchez-Salado JC, Lorente V, Bayés de Luna A, Martinez-Sellés M. Interatrial block, frailty and prognosis in elderly patients with myocardial infarction. J Electrocardiol 2017; 51:1-7. [PMID: 28969847 DOI: 10.1016/j.jelectrocard.2017.08.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Eva Bernal
- Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Spain
| | - Antoni Bayés-Genís
- Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Spain
| | - Albert Ariza-Solé
- Cardiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Francesc Formiga
- Internal Medicine Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Maria T Vidán
- Geriatric Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Jaime Aboal
- Cardiology Department, Hospital Universitari Josep Trueta, Girona, Spain
| | - Lídia Alcoberro
- Cardiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Carme Guerrero
- Cardiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Iván Ariza-Segovia
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ana Hernández de Benito
- Geriatric Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pau Vilardell
- Cardiology Department, Hospital Universitari Josep Trueta, Girona, Spain
| | | | - Victoria Lorente
- Cardiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Antoni Bayés de Luna
- Instituto Catalán de Ciencias Cardiovasculares, Hospital de Sant Pau, Barcelona, Spain
| | - Manuel Martinez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain
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Martínez-Sellés M, García de la Villa B, Cruz-Jentoft AJ, Vidán MT, Ramos Cortés M, González Guerrero JL, Gil P, Barros Cerviño SM, Díaz Castro Ó, López Díaz J. Sex-Related Differences in Centenarians and Their Hearts. J Am Geriatr Soc 2016; 64:444-6. [DOI: 10.1111/jgs.13976] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Manuel Martínez-Sellés
- Servicio de Cardiología; Hospital General Universitario Gregorio Marañón y Universidad Europea y Universidad Complutense; Madrid Spain
| | | | | | - Maria T. Vidán
- Hospital General Universitario Gregorio Marañón; Madrid Spain
| | | | | | - Pedro Gil
- Hospital Clínico de San Carlos; Madrid Spain
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Datino T, Rexach L, Vidán MT, Alonso A, Gándara Á, Ruiz-García J, Fontecha B, Martínez-Sellés M. [Guidelines on the management of implantable cardioverter defibrillators at the end of life]. Rev Esp Geriatr Gerontol 2013; 49:29-34. [PMID: 24331838 DOI: 10.1016/j.regg.2013.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 09/16/2013] [Indexed: 11/17/2022]
Abstract
This article is a joint document of the Spanish Society of Geriatrics and Gerontology, the Spanish Society of Palliative Care and the Section of Geriatric Cardiology of the Spanish Society of Cardiology. Its aim is to address the huge gap that exists in Spain with regard to the management of implantable cardioverter defibrillators (ICDs) in the final stages of life. It is increasingly common to find patients carrying these devices that are in the terminal stage of an advanced disease. This occurs in patients with advanced heart disease and subsequent heart failure refractory to treatment but also in a patient with an ICD who develops cancer disease, organ failure or other neurodegenerative diseases with poor short-term prognosis. The vast majority of these patients are over 65, so the paper focuses particularly on the elderly who are in this situation, but the decision-making process is similar in younger patients with ICDs who are in the final phase of their life.
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Affiliation(s)
- T Datino
- Unidad de Arritmias y Electrofisiología, Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - L Rexach
- Unidad de Cuidados Paliativos, Hospital Universitario Ramón y Cajal, Madrid, España
| | - M T Vidán
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - A Alonso
- Unidad de Cuidados Paliativos, Hospital Universitario La Paz, Madrid, España
| | - Á Gándara
- Unidad del Dolor y Cuidados Paliativos, Clínica Ruber, Madrid, España
| | - J Ruiz-García
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, España
| | - B Fontecha
- Servicio de Geriatría y Cuidados Paliativos, Consorci Sanitari Integral L'Hospitalet de Llobregat, Barcelona, España
| | - M Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, España; Universidad Europea de Madrid, Madrid, España.
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Ariza-Solé A, Formiga F, Vidán MT, Bueno H, Curós A, Aboal J, Llibre C, Rueda F, Bernal E, Cequier A. Impact of frailty and functional status on outcomes in elderly patients with ST-segment elevation myocardial infarction undergoing primary angioplasty: rationale and design of the IFFANIAM study. Clin Cardiol 2013; 36:565-9. [PMID: 24114768 DOI: 10.1002/clc.22182] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 07/01/2013] [Indexed: 11/12/2022] Open
Abstract
The IFFANIAM study (Impact of frailty and functional status in elderly patients with ST segment elevation myocardial infarction undergoing primary angioplasty) is an observational multicenter registry to assess the impact of frailty and functional status on outcomes of elderly patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary angioplasty. STEMI patients age 75 years or older undergoing primary angioplasty will be extensively studied during admission in 4 tertiary care Hospitals in Spain, assessing their baseline functional status (Barthel index, Lawton-Brody index), frailty (Fried criteria, FRAIL scale [fatigue, resistance, ambulation, illnesses, and loss of weight]), comorbidities (Charlson index), nutritional status (Mini Nutritional Assessment-Short Form), and quality of life (Seattle Angina Questionnaire). Participants will be managed according current recommendations. The primary outcome will be the description of 1-year mortality, its causes, and associated factors. Secondary outcomes will be functional capacity and quality of life. Results will help to better understand the impact of frailty and functional ability on outcomes in elderly STEMI patients undergoing primary angioplasty, thus potentially contributing to improving their clinical management. Higher life expectancy has resulted in a large segment of elderly population and an increase in myocardial infarction in these patients. This calls attention to healthcare systems to focus on promoting methods to improve the clinical management of this population.
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Affiliation(s)
- Albert Ariza-Solé
- Cardiology Department, Internal Medicine Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Vidán MT, Sánchez E, Alonso M, Montero B, Ortiz J, Serra JA. RESPONSE LETTER TO DR. INOUYE ET AL. J Am Geriatr Soc 2010. [DOI: 10.1111/j.1532-5415.2010.02836.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ross JS, Chen J, Lin Z, Bueno H, Curtis JP, Keenan PS, Normand SLT, Schreiner G, Spertus JA, Vidán MT, Wang Y, Wang Y, Krumholz HM. Recent national trends in readmission rates after heart failure hospitalization. Circ Heart Fail 2009; 3:97-103. [PMID: 19903931 DOI: 10.1161/circheartfailure.109.885210] [Citation(s) in RCA: 323] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND In July 2009, Medicare began publicly reporting hospitals' risk-standardized 30-day all-cause readmission rates (RSRRs) among fee-for-service beneficiaries discharged after hospitalization for heart failure from all the US acute care nonfederal hospitals. No recent national trends in RSRRs have been reported, and it is not known whether hospital-specific performance is improving or variation in performance is decreasing. METHODS AND RESULTS We used 2004-2006 Medicare administrative data to identify all fee-for-service beneficiaries admitted to a US acute care hospital for heart failure and discharged alive. We estimated mean annual RSRRs, a National Quality Forum-endorsed metric for quality, using 2-level hierarchical models that accounted for age, sex, and multiple comorbidities; variation in quality was estimated by the SD of the RSRRs. There were 570 996 distinct hospitalizations for heart failure in which the patient was discharged alive in 4728 hospitals in 2004, 544 550 in 4694 hospitals in 2005, and 501 234 in 4674 hospitals in 2006. Unadjusted 30-day all-cause readmission rates were virtually identical over this period: 23.0% in 2004, 23.3% in 2005, and 22.9% in 2006. The mean and SD of RSRRs were also similar: mean (SD) of 23.7% (1.3) in 2004, 23.9% (1.4) in 2005, and 23.8% (1.4) in 2006, suggesting similar hospital variation throughout the study period. CONCLUSIONS National mean and RSRR distributions among Medicare beneficiaries discharged after hospitalization for heart failure have not changed in recent years, indicating that there was neither improvement in hospital readmission rates nor in hospital variations in rates over this time period.
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Affiliation(s)
- Joseph S Ross
- Department of Geriatrics, Mount Sinai School of Medicine, New York, NY 10029, USA.
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9
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Lenderink T, Hernández AV, Boersma E, Martínez-Sellés M, Juárez M, Sánchez PL, Vidán MT, Simoons ML, Fernández-Avilés F, Bueno H. Prediction of 30-day mortality in older patients with a first acute myocardial infarction. Cardiology 2009; 115:1-9. [PMID: 19816019 DOI: 10.1159/000243770] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Accepted: 06/19/2009] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study sought predictors of mortality in patients aged >or=75 years with a first ST-segment elevation myocardial infarction (STEMI) and evaluated the validity of the GUSTO-I and TIMI risk models. METHODS Clinical variables, treatment and mortality data from 433 consecutive patients were collected. Univariable and multivariable logistic regression analyses were applied to identify baseline factors associated with 30-day mortality. Subsequently a model predicting 30-day mortality was created and compared with the performance of the GUSTO-I and TIMI models. RESULTS After adjustment, a higher Killip class was the most important predictor (OR 16.1; 95% CI 5.7-45.6). Elevated heart rate, longer time delay to admission, hyperglycemia and older age were also associated with increased risk. Patients with hypercholesterolemia had a significantly lower risk (OR 0.46; 95% CI 0.24-0.86). Discrimination (c-statistic 0.79, 95% CI 0.75-0.84) and calibration (Hosmer-Lemeshow 6, p = 0.5) of our model were good. The GUSTO-I and TIMI risk scores produced adequate discrimination within our dataset (c-statistic 0.76, 95% CI 0.71-0.81, and c-statistic 0.77, 95% CI 0.72-0.82, respectively), but calibration was not satisfactory (HL 21.8, p = 0.005 for GUSTO-I, and HL 20.6, p = 0.008 for TIMI). CONCLUSIONS Short-term mortality in elderly patients with a first STEMI depends most importantly on initial clinical and hemodynamic status. The GUSTO-I and TIMI models are insufficiently adequate for providing an exact estimate of 30-day mortality risk.
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Affiliation(s)
- Timo Lenderink
- Department of Cardiology, Atrium Medisch Centrum, Heerlen, The Netherlands
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Abstract
This case report describes an atypical case of duodenal leishmaniasis in an elderly patient not infected with human immunodeficiency virus. Investigation of this 84 year old woman with a constitutional syndrome and dysphagia revealed anaemia of chronic disorder, a high erythrocyte sedimentation rate, and polyclonal hypergammaglobulinaemia. Abdominal ultrasonography revealed thickening of the stomach wall, which was seen to be inflamed during gastroscopy. Duodenal histology revealed numerous leishmania amastigotes within macrophages. This was confirmed by bone marrow biopsy and leishmania serology. This case report stresses the importance of atypical symptoms and the unusual location of visceral leishmaniasis, not only in immunodepressed patients, but also in elderly immunocompetent patients.
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Affiliation(s)
- M L Alvarez-Nebreda
- Geriatrics Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain.
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Fernández-Gutiérrez B, Jover JA, De Miguel S, Hernández-García C, Vidán MT, Ribera JM, Bañares A, Serra JA. Early lymphocyte activation in elderly humans: impaired T and T-dependent B cell responses. Exp Gerontol 1999; 34:217-29. [PMID: 10363788 DOI: 10.1016/s0531-5565(98)00068-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Immunosenescence is characterized by an increase in autoantibody production. Because both T and B cell stimulation are key events for producing antibodies, we investigated early T and B cell activation by means of CD23 and CD40L (two very early activation antigens). PBMC from elderly humans (EH) were studied following culture with either medium, anti-CD3mAb, rIL-4, or PMA + ionomycin. CD23 expression on elderly B cells after anti-CD3 challenge of PBMC, a reflect of T-dependent B cell activation, was clearly defective. Conversely, CD23 expression on EH B cells following activation with soluble factors as rIL-4 was preserved. CD40L expression was also impaired in EH T cells following anti-CD3 challenge. However, activation by means of PMA and/or ionomycin was preserved both in T cells (CD40L expression) and in B cells (CD23 expression). These results indicate that a defective T-dependent B cell activation related to defective T cell activation located between surface membrane and PKC/ionomycin function is an intrinsic characteristic of immunosenescence. We have not found intrinsic B-cell defects, and we conclude that the characteristically impaired early B cell activation in EH is mostly due to T cell defects.
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Vidán MT, Fernández-Gutiérrez B, Hernández-García C, Serra JA, Ribera JM, Pérez-Blas M, Regueiro JR, Bañares A, Jover JA. Functional integrity of the CD28 co-stimulatory pathway in T lymphocytes from elderly subjects. Age Ageing 1999; 28:221-7. [PMID: 10350423 DOI: 10.1093/ageing/28.2.221] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION the antigen CD28, expressed in most T cells, has co-stimulatory properties and plays a pivotal role in clonal T cell anergy mechanisms. METHODS we have compared proliferative T cell responses after anti-CD3 or in phorbol myristate acetate activation with concomitant CD28 signal in peripheral blood mononuclear cells from healthy donors aged over 65 [elderly donors; ED] and young healthy donors (YD); mean age 30+/-2.7 years). RESULTS no proliferative responses were observed in ED and YD with anti-CD28 monoclonal antibody alone. These responses both were defective in ED, particularly after anti-CD3 monoclonal antibody stimulus (7604 compared with 12,438 c.p.m. in YD, P=0.001) and were corrected when anti-CD28 monoclonal antibody was added to the culture (17,216 vs 18,536, not significant). Functional integrity of the CD28 co-stimulatory pathway was demonstrated by analysis of CD25 expression, interleukin-2 secretion and interleukin-2 gene expression on T cells from ED and YD. Age-associated phenotypic T cell changes were not crucial for an adequate CD28 response. CONCLUSION these experiments demonstrate the integrity of the CD28 pathway in elderly people, and suggest that ageing does not affect different T cell activation pathways equally.
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Affiliation(s)
- M T Vidán
- Services of Geriatrics, Hospital Clínico San Carlos, Madrid, Spain
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Abstract
BACKGROUND Sex seems to affect the course of acute myocardial infarction (AMI) in the general population. Although the epidemiological importance of female sex among patients with AMI is more important from the sixth decade of life, little is known about the impact of sex on the outcome of AMI in the elderly. METHODS AND RESULTS To determine the differences between sexes in the outcome of AMI in the elderly, we compared the clinical history and evolution of 204 consecutive patients (99 men, 105 women) > or = 75 years of age admitted with a first AMI. Women had a higher prevalence (P < .01) of hypertension (60% versus 32%) and diabetes (41% versus 18%), whereas men were more frequently smokers (41% versus 4%, P < .0001); these factors were associated with higher rates of congestive heart failure. Women showed lower ejection fractions and higher rates of congestive heart failure (odds ratio [OR], 2.32; 95% CI, 1.32 to 4.12) and shock (OR, 2.78; 95% CI, 1.29 to 6.40). Mortality rate was higher in women (40% versus 23%, P = .01; OR, 2.29; 95% CI, 1.26 to 4.26); however, sex was excluded as an independent predictor of in-hospital mortality in every regression model tested (OR, 0.75; 95% CI, 0.25 to 2.21). CONCLUSIONS After a first AMI, elderly women experience a more complicated hospital course than men. The increase in mortality risk seems to be related to the impact of cardiovascular risk factors on left ventricular function more than to sex itself.
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Affiliation(s)
- H Bueno
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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