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Al-Essah Z, Curlewis K, Chan G, Tokeisham K, Ghosh K, Stott P, Rogers BA. Comparison of acute outcomes from elective total hip replacements and after fragility femoral neck fractures in nonagenarians. BMC Musculoskelet Disord 2024; 25:324. [PMID: 38658870 DOI: 10.1186/s12891-024-07340-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 03/06/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Hip hemiarthroplasty has traditionally been used to treat displaced femoral neck fractures in older, frailer patients whilst total hip replacements (THR) have been reserved for younger and fitter patients. However, not all elderly patients are frail, and some may be able to tolerate and benefit from an acute THR. Nonagenarians are a particularly heterogenous subpopulation of the elderly, with varying degrees of independence. Since THRs are performed electively as a routine treatment for osteoarthritis in the elderly, its safety is well established in the older patient. The aim of this study was to compare the safety of emergency THR to elective THR in nonagenarians. METHODS A retrospective 10-year cohort study was conducted using data submitted to the National Hip Fracture Database (NHFD) across three hospitals in one large NHS Trust. Data was collected from 126 nonagenarians who underwent THRs between 1st January 2010 - 31st December 2020 and was categorised into emergency THR and elective THR groups. Mortality rates were compared between the two groups. Secondary outcomes were also compared including postoperative complications (dislocations, revision surgeries, and periprosthetic fracture), length of stay in hospital, and discharge destination. RESULTS There was no significant difference in mortality between the two groups, with 1-year mortality rates of 11.4% and 12.1% reported for emergency and elective patients respectively (p = 0.848). There were no significant differences in postoperative complication rate and discharge destination. Patients who had emergency THR spent 5.56 days longer in hospital compared to elective patients (p = 0.015). CONCLUSION There is no increased risk of 1-year mortality in emergency THR compared to elective THR, in a nonagenarian population. Therefore, nonagenarians presenting with a hip fracture who would have been considered for a THR if presenting on an elective basis should not be precluded from an emergency THR on safety grounds. TRIAL REGISTRATION Not necessary as this was deemed not to be clinical research, and was considered to be a service evaluation.
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Affiliation(s)
| | | | - Gareth Chan
- Brighton and Sussex Medical School, Brighton, UK.
- University Hospitals NHS Foundation Trust, Sussex, UK.
| | | | - Koushik Ghosh
- University Hospitals NHS Foundation Trust, Sussex, UK
| | - Philip Stott
- University Hospitals NHS Foundation Trust, Sussex, UK
| | - Benedict A Rogers
- Brighton and Sussex Medical School, Brighton, UK
- University Hospitals NHS Foundation Trust, Sussex, UK
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Basida SD, Dahiya DS, Yousaf MN, Basida B, Pinnam BSM, Gangwani MK, Ali H, Singh S, Shah YR, Ahluwalia D, Shah MP, Chandan S, Sharma NR, Thakkar S. Impact of frailty on endoscopic retrograde cholangiopancreatography outcomes in nonagenarians: A United States national experience. World J Gastrointest Endosc 2024; 16:148-156. [PMID: 38577647 PMCID: PMC10989256 DOI: 10.4253/wjge.v16.i3.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/19/2024] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP) is an essential therapeutic tool for biliary and pancreatic diseases. Frail and elderly patients, especially those aged ≥ 90 years are generally considered a higher-risk population for ERCP-related complications.
AIM To investigate outcomes of ERCP in the Non-agenarian population (≥ 90 years) concerning Frailty.
METHODS This is a cohort study using the 2018-2020 National Readmission Database. Patients aged ≥ 90 were identified who underwent ERCP, using the international classification of diseases-10 code with clinical modification. Johns Hopkins’s adjusted clinical groups frailty indicator was used to classify patients as frail and non-frail. The primary outcome was mortality, and the secondary outcomes were morbidity and the 30 d readmission rate related to ERCP. We used univariate and multivariate regression models for analysis.
RESULTS A total of 9448 patients were admitted for any indications of ERCP. Frail and non-frail patients were 3445 (36.46%) and 6003 (63.53%) respectively. Indications for ERCP were Choledocholithiasis (74.84%), Biliary pancreatitis (9.19%), Pancreatico-biliary cancer (7.6%), Biliary stricture (4.84%), and Cholangitis (1.51%). Mortality rates were higher in frail group [adjusted odds ratio (aOR) = 1.68, P = 0.02]. The Intra-procedural complications were insignificant between the two groups which included bleeding (aOR = 0.72, P = 0.67), accidental punctures/lacerations (aOR = 0.77, P = 0.5), and mechanical ventilation rates (aOR = 1.19, P = 0.6). Post-ERCP complication rate was similar for bleeding (aOR = 0.72, P = 0.41) and post-ERCP pancreatitis (aOR = 1.4, P = 0.44). Frail patients had a longer length of stay (6.7 d vs 5.5 d) and higher mean total charges of hospitalization ($78807 vs $71392) compared to controls (P < 0.001). The 30 d all-cause readmission rates between frail and non-frail patients were similar (P = 0.96).
CONCLUSION There was a significantly higher mortality risk and healthcare burden amongst nonagenarian frail patients undergoing ERCP compared to non-frail. Larger studies are warranted to investigate and mitigate modifiable risk factors.
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Affiliation(s)
- Sanket Dhirubhai Basida
- Department of Internal Medicine, University of Missouri-Columbia, Columbia, MO 65212, United States
| | - Dushyant Singh Dahiya
- Division of Gastroenterology, Hepatology & Motility, The University of Kansas School of Medicine, Kansas City, KS 66160, United States
| | - Muhammad Nadeem Yousaf
- Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, United States
| | - Brinda Basida
- Department of Rheumatology, Medical College of Georgia, Augusta University, North Augusta, GA 30912, United States
| | - Bhanu Siva Mohan Pinnam
- Department of Internal Medicine, John H. Stroger Hospital of Cook County, Chicago, IL 60612, United States
| | - Manesh Kumar Gangwani
- Department of Internal Medicine, The University of Toledo, Toledo, OH 43606, United States
| | - Hassam Ali
- Division of Gastroenterology and Hepatology, East Carolina University/Brody School of Medicine, Greenville, NC 27858, United States
| | - Sahib Singh
- Department of Internal Medicine, Sinai Hospital, Baltimore, MD 21215, United States
| | - Yash R Shah
- Department of Internal Medicine, Trinity Health Oakland/Wayne State University, Pontiac, MI 48341, United States
| | - Daksh Ahluwalia
- Department of Internal Medicine, John H. Stroger Hospital of Cook County, Chicago, IL 60612, United States
| | - Mihir Prakash Shah
- Department of Internal Medicine, John H. Stroger Hospital of Cook County, Chicago, IL 60612, United States
| | - Saurabh Chandan
- Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, NE 68131, United States
| | - Neil R Sharma
- Division of Interventional Oncology & Surgical Endoscopy, GI Oncology Tumor Site Team, Parkview Cancer Institute, Parkview Health, Fort Wayne, IN 46845, United States
| | - Shyam Thakkar
- Section of Gastroenterology & Hepatology, West Virginia University School of Medicine, Morgantown, WV 26505, United States
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Hermansen M, Nygaard M, Tan Q, Jeune B, Semkovska M, Christensen K, Thinggaard M, Mengel-From J. Cognitively high-performing oldest old individuals are physically active and have strong motor skills-A study of the Danish 1905 and 1915 birth cohorts. Arch Gerontol Geriatr 2024; 122:105398. [PMID: 38460266 DOI: 10.1016/j.archger.2024.105398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/01/2024] [Accepted: 03/03/2024] [Indexed: 03/11/2024]
Abstract
Preserving cognitive function with age or super-aging greatly contributes to successful aging. Super-aging nonagenarians born in Denmark in either year 1905 or 1915 were classified as Cognitively High-Performing Oldest Old individuals with a five item cognitive composite score, equivalent to or better than mean middle-aged subjects. Cognitively high-performers were more physically active and had a better physical performance on e.g., Activity of Daily Living (p-value < 0.01), gait speed (p-value < 0.01) and grip strength (p-value < 0.05) compared with age-matched peers. Cognitive high-performing was also linked to lower depression symptomatology. When comparing super-agers with semi super-agers classified by Mini Mental State Examination > 27, super-agers were still more physically active and had a better physical performance (p-value < 0.05). Results suggests that physical activity is a lifestyle factor strongly associated with both semi and full cognitive super-aging.
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Affiliation(s)
- Maja Hermansen
- The Danish Twin Registry and Danish Aging Research Center, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Marianne Nygaard
- The Danish Twin Registry and Danish Aging Research Center, Department of Public Health, University of Southern Denmark, Odense, Denmark; Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Qihua Tan
- The Danish Twin Registry and Danish Aging Research Center, Department of Public Health, University of Southern Denmark, Odense, Denmark; Department of Biochemistry, Odense University Hospital, Denmark
| | - Bernard Jeune
- The Danish Twin Registry and Danish Aging Research Center, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Maria Semkovska
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Kaare Christensen
- The Danish Twin Registry and Danish Aging Research Center, Department of Public Health, University of Southern Denmark, Odense, Denmark; Department of Clinical Genetics, Odense University Hospital, Odense, Denmark; Department of Biochemistry, Odense University Hospital, Denmark
| | - Mikael Thinggaard
- The Danish Twin Registry and Danish Aging Research Center, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jonas Mengel-From
- The Danish Twin Registry and Danish Aging Research Center, Department of Public Health, University of Southern Denmark, Odense, Denmark; Department of Clinical Genetics, Odense University Hospital, Odense, Denmark.
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Ismayl M, Ahmed H, Goldsweig AM, Freeman JV, Alkhouli M. In-hospital safety outcomes of left atrial appendage occlusion in octogenarians and nonagenarians. Europace 2024; 26:euae055. [PMID: 38391186 PMCID: PMC10927254 DOI: 10.1093/europace/euae055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/07/2024] [Accepted: 02/20/2024] [Indexed: 02/24/2024] Open
Abstract
AIMS Data on safety outcomes of left atrial appendage occlusion (LAAO) in elderly patients are limited. This study aimed to compare the outcomes of LAAO between octogenarians (age 80-89) and nonagenarians (age ≥90) vs. younger patients (age ≤79). METHODS AND RESULTS We conducted a retrospective cohort study using the National Inpatient Sample database to identify patients hospitalized for LAAO from 2016 to 2020 and to compare in-hospital safety outcomes in octogenarians and nonagenarians vs. younger patients. The primary outcome was a composite of in-hospital all-cause mortality or stroke. Secondary outcomes included procedural complications, length of stay (LOS), and total costs. Outcomes were determined using logistic regression models. Among 84 140 patients hospitalized for LAAO, 32.9% were octogenarians, 2.8% were nonagenarians, and 64.3% were ≤79 years of age. Over the study period, the volume of LAAO increased in all age groups (all Ptrend < 0.01). After adjustment for clinical and demographic factors, octogenarians and nonagenarians had similar odds of in-hospital all-cause mortality or stroke [adjusted odds ratio (aOR) 1.41, 95% confidence interval (CI) 0.93-2.13 for octogenarians; aOR 1.69, 95% CI 0.67-3.92 for nonagenarians], cardiac tamponade, acute kidney injury, major bleeding, and blood transfusion, in addition to similar LOS and total costs compared with younger patients (all P > 0.05). However, octogenarians and nonagenarians had higher odds of vascular complications compared with younger patients (aOR 1.47, 95% CI 1.08-1.99 for octogenarians; aOR 1.60, 95% CI 1.18-2.97 for nonagenarians). CONCLUSION Octogenarians and nonagenarians undergoing LAAO have a similar safety profile compared with clinically similar younger patients except for higher odds of vascular complications.
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Affiliation(s)
- Mahmoud Ismayl
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Hasaan Ahmed
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE, USA
| | - Andrew M Goldsweig
- Department of Cardiovascular Medicine, Baystate Medical Center, Springfield, MA, USA
| | - James V Freeman
- Department of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Lombardi G, Pancani S, Bagnoli S, Vannetti F, Nacmias B, Sorbi S, Cecchi F, Macchi C. Understanding the interplay between APO E polymorphism and cognition in the Italian oldest old: results from the "Mugello study". Neurol Sci 2024; 45:539-546. [PMID: 37710144 DOI: 10.1007/s10072-023-07073-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/09/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION Recent data suggest that the deleterious effect on general health and cognition of ε4 allele of Apolipoprotein E (ApoE) observed in the elderly population, may attenuate in extreme aging. This study aimed to describe the ApoE genotype distribution and its relationship with cognition in a group of nonagenarians living in the Mugello area, Italy. MATERIAL AND METHODS Cognition was evaluated using the Mini-Mental-State-Examination (MMSE). DNA was extracted from blood samples to determine ApoE genotyping. Participants were classified into three ApoE groups (ε2, ε3, ε4). Logistic and linear regression models were created, to assess the relationship between ApoE genotype group and dementia diagnosis and cognitive performance, respectively. RESULTS 169 subjects were included. ApoE ε3 was the most prevalent genotype (76.3%). Dementia prevalence was 26.6% and it was not associated with the presence of ApoE ε4. Participants of ε4 group were significantly more likely to have lower cognitive performances than ε2 and ε3, independently of a dementia diagnosis. DISCUSSION Results support that ApoE genotype no longer plays a role in the health condition of the oldest old, however, an interaction is detectable between ApoE polymorphism and cognitive performances at this extreme age.
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Affiliation(s)
- Gemma Lombardi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Via Di Scandicci 269, 50143, Florence, Italy
| | - Silvia Pancani
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Via Di Scandicci 269, 50143, Florence, Italy.
| | - Silvia Bagnoli
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Via Di Scandicci 269, 50143, Florence, Italy
| | - Federica Vannetti
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Via Di Scandicci 269, 50143, Florence, Italy
| | - Benedetta Nacmias
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Via Di Scandicci 269, 50143, Florence, Italy
| | - Sandro Sorbi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Via Di Scandicci 269, 50143, Florence, Italy
| | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Via Di Scandicci 269, 50143, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Via Di Scandicci 269, 50143, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
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Nisson PL, Francis JJ, Michel M, Goel K, Patil CG. Extreme-aged patients (≥ 85 years) experience similar outcomes as younger geriatric patients following chronic subdural hematoma evacuation: a matched cohort study. GeroScience 2024:10.1007/s11357-024-01081-8. [PMID: 38286851 DOI: 10.1007/s11357-024-01081-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/12/2024] [Indexed: 01/31/2024] Open
Abstract
Subdural hematoma (SDH) evacuation represents one of the most frequently performed neurosurgical procedures. Several reports cite a rise in both the age and number of patient's requiring treatment, due in part to an aging population and expanded anticoagulation use. However, limited data and conflicting conclusions exist on extreme-aged geriatric patients (≥ 85 years of age) after undergoing surgery. Patients undergoing SDH evacuation at a tertiary academic medical center between November 2013-December 2021 were retrospectively identified. The study group consisted of patients ≥ 85 years (Group 1) diagnosed with a chronic SDH surgically evacuated. A control group was created matching patients by 70-84 years of age, gender, and anticoagulation use (Group 2). Multiple metrics were evaluated between the two including length-of hospital-stay, tracheostomy/PEG placement, reoperation rate, complications, discharge location, neurological outcome at the time of discharge, and survival. A total of 130 patients were included; 65 in Group 1 and 65 in Group 2. Patient demographics, medical comorbidities, SDH characteristics, international normalized ratio, partial thromboplastin time, and use of blood thinning agents were similar between the two groups. Kaplan Meier survival analysis at one-year was 80% for Group 1 and 76% for Group 2. No significant difference was identified using the log-rank test for equality of survivor functions (p = 0.26). All measured outcomes including GCS at time of discharge, length of stay, rate of reoperations, and neurological outcome were statistically similar between the two groups. Backwards stepwise conditional logistic regression revealed no significant association between poor outcomes at the time of discharge and age. Alternatively, anticoagulation use was found to be associated with poor outcomes (OR 3.55, 95% CI 1.08-11.60; p = 0.036). Several outcome metrics and statistical analyses were used to compare patients ≥ 85 years of age to younger geriatric patients (70-84 years) in a matched cohort study. Adjusting for age group, gender, and anticoagulation use, no significant difference was found between the two groups including neurological outcome at discharge, reoperation rate, and survival.
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Affiliation(s)
- Peyton L Nisson
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - John J Francis
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Michelot Michel
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Keshav Goel
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Chirag G Patil
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Mather MA, Ho EH, Bedjeti K, Karpouzian-Rogers T, Rogalski EJ, Gershon R, Weintraub S. Measuring Multidimensional Aspects of Health in the Oldest Old Using the NIH Toolbox: Results From the ARMADA Study. Arch Clin Neuropsychol 2024:acad105. [PMID: 38216151 DOI: 10.1093/arclin/acad105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/27/2023] [Accepted: 11/20/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVE The percentage of older adults living into their 80s and beyond is expanding rapidly. Characterization of typical cognitive performance in this population is complicated by a dearth of normative data for the oldest old. Additionally, little attention has been paid to other aspects of health, such as motor, sensory, and emotional functioning, that may interact with cognitive changes to predict quality of life and well-being. The current study used the NIH Toolbox (NIHTB) to determine age group differences between persons aged 65-84 and 85+ with normal cognition. METHOD Participants were recruited in two age bands (i.e., 65-84 and 85+). All participants completed the NIHTB Cognition, Motor, Sensation, and Emotion modules. Independent-samples t-tests determined age group differences with post-hoc adjustments using Bonferroni corrections. All subtest and composite scores were then regressed on age and other demographic covariates. RESULTS The 65-84 group obtained significantly higher scores than the 85+ group across all cognitive measures except oral reading, all motor measures except gait speed, and all sensation measures except pain interference. Age remained a significant predictor after controlling for covariates. Age was not significantly associated with differences in emotion scores. CONCLUSIONS Results support the use of the NIHTB in persons over 85 with normal cognition. As expected, fluid reasoning abilities and certain motor and sensory functions decreased with age in the oldest old. Inclusion of motor and sensation batteries is warranted when studying trajectories of aging in the oldest old to allow for multidimensional characterization of health.
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Affiliation(s)
- Molly A Mather
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily H Ho
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Katy Bedjeti
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Tatiana Karpouzian-Rogers
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily J Rogalski
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Richard Gershon
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sandra Weintraub
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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González PE, Lavados PM, Aguirre AI, Brunser AM, Olavarría VV. Intravenous Thrombolysis in Patients 90 Years or Older with Moderate to Severe Acute Ischemic Stroke Increases Ambulation at Discharge and Is Safe: A Prospective Cohort Study from a Single Center in Santiago, Chile. Cerebrovasc Dis Extra 2024; 14:16-20. [PMID: 38185102 PMCID: PMC10864013 DOI: 10.1159/000536129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/16/2023] [Accepted: 01/01/2024] [Indexed: 01/09/2024] Open
Abstract
INTRODUCTION The World Health Organization predicts that the global population aged 60 years and older will double by 2050, leading to a significant rise in the public health impact of acute ischemic stroke (AIS). Existing stroke guidelines do not specify an upper age limit for the administration of intravenous thrombolysis (IVT), although some suggest a relative exclusion criterion in patients aged ≥80 in the 3-4.5-h window. Many physicians avoid treating these patients with IVT, argumenting high risk and little benefit. Our aim was to investigate the efficacy and safety of IVT treatment in patients with non-minor AIS aged ≥90, admitted to our institution. The primary efficacy endpoint was the ability to walk at discharge (mRS 0-3), and the primary safety endpoints were death and symptomatic intracranial hemorrhagic transformation (sIHT) at discharge. METHODS Patients with AIS aged ≥90 admitted to our center from January 2003 to December 2022 were included. They were selected if had an NIHSS ≥5, were previously ambulatory (prestroke mRS score 3 or less), and arrived within 6 h from symptom onset. Those treated or not with IVT were compared with univariate analysis. RESULTS The mean age was 93.2 (2.4) years, and 51 (73.9%) were female. The admission mRS and NIHSS were 1 (IQR 0-2) and 14 (IQR 7-22), respectively. Thrombolyzed patients had a shorter time from symptom onset to door and lower glycemia on admission. IVT was associated with a higher proportion of patients achieving mRS 0-3 at discharge (p = 0.03) and at 90 days (p = 0.04). There were no differences between groups in the risk of death (p = 0.55) or sIHT (p = 0.38). CONCLUSION In this small sample, ambulatory patients aged ≥90 with moderate or severe AIS treated with IVT had increased odds of being able to walk independently at discharge than those not treated, without safety concerns.
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Affiliation(s)
- Pablo E. González
- Unidad de Neurología Vascular, Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Pablo M. Lavados
- Unidad de Neurología Vascular, Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - André I. Aguirre
- Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile
| | - Alejandro M. Brunser
- Unidad de Neurología Vascular, Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Verónica V. Olavarría
- Unidad de Neurología Vascular, Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
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Kucukkarapinar I, Gozacan B, Ekhtiari S, Dasci MF, Gehrke T, Citak M. In-hospital outcomes following primary and revision total hip arthroplasty in nonagenarian patients. Arch Orthop Trauma Surg 2024; 144:475-481. [PMID: 37634168 DOI: 10.1007/s00402-023-05032-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE The primary goal of this study was to assess the risk of postoperative surgical and medical complications and problems among nonagenarian patients operated with hip arthroplasty. METHODS Data from a specific high-volume arthroplasty clinic, were collected to evaluate postoperative morbidity and complication rates after hip arthroplasty in nonagenarians, compared with a control group of younger, but similar patients. Outcomes evaluated included length of stay, transfusion rate, and postoperative medical and surgical complication rates. RESULTS A total of 97 nonagenarian patients (mean age 91.4 years) were included, and compared with 89 control group patients (mean age 70.18 years). Nonagenarian patients had significantly longer length of stay (11.44 vs. 7.98 days, p < 0.01), significantly higher risk of needing a transfusion (11.30% vs. 3.40%, p = 0.04), and significantly higher risk of a postoperative medical complication (28.90% vs. 11.20%, p = 0.03). There was no difference in postoperative surgical complication rate (7.20% vs. 2.20%, p = 0.12). CONCLUSION Nonagenarian patients, when compared to a younger control group, experience significantly longer hospital stays, and risk of non-surgical complications. Arthroplasty in nonagenarian patients carries with it a high risk of complications, and thus careful pre-operative evaluation and the care of these patients at high volume, specialized clinics is important to optimize outcomes. LEVEL OF EVIDENCE Level III retrospective cohort analysis.
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Affiliation(s)
- Ibrahim Kucukkarapinar
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Beren Gozacan
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Seper Ekhtiari
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Mustafa Fatih Dasci
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
- Department of Orthopaedics and Traumatology, Istanbul Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Thorsten Gehrke
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Mustafa Citak
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany.
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Michelard M, Detante O, Heck O, Marcel S, Vadot W, Gavazzi G, Papassin J. Thrombolysis and thrombectomy for stroke in octogenarians and nonagenarians: A regional observational study. Rev Neurol (Paris) 2023; 179:1068-1073. [PMID: 37596186 DOI: 10.1016/j.neurol.2023.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/12/2022] [Revised: 02/24/2023] [Accepted: 03/01/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION Elderly patients are a growing population in stroke units, characterized by higher frailty, but underrepresented in clinical trials about acute care. We investigated efficacy of intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) in elderlies in current practice. METHODS We assessed consecutive patients with acute ischemic stroke (AIS) hospitalized in the four stroke units of the French Northern Alps Emergency Network between 2015 and 2020. We compared baseline characteristics, early neurological evolution and outcome of patients aged 80-89 and≥90years old (yo). RESULTS Among 8367 patients, 2744 (32.8%) were 80-89 yo and 541 (6.5%) were≥90 yo. IVT and/or MT were performed in 787 patients≥80 yo (632 patients aged 80-89, 155 patients aged>90). Early neurological improvement was more frequent in patients≥80 yo treated by IVT and/or MT compared to untreated patients (45.6% versus 38.4%, P=0.002). After adjustment, reperfusion treatments improved likelihood of good outcome at discharge (OR=2.0 [1.6-2.7]) and reduced in-hospital mortality (OR=0.5 [0.4-0.7]). Age and initial NIHSS score were independent factors of poor functional outcome at discharge and in-hospital mortality. The rate of successful recanalization was comparable between octogenarians and nonagenarians (87% versus 85.2%, P=0.8). Octogenarians had better functional outcome at discharge compared to nonagenarians [modified Rankin scale (mRS) 0-2: 36% versus 25.7%, P=0.02], whatever IVT or MT strategy. In-hospital mortality was lower for octogenarians compared to nonagenarians (19.5% versus 27.1%, P=0.04). DISCUSSION IVT and MT improve early neurological recovery and functional outcome at discharge of both octogenarians and nonagenarians in current practice. Despite a poorer outcome for nonagenarians than octogenarians, these reperfusion treatments should not be withheld on the basis of age only.
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Affiliation(s)
- M Michelard
- Medical intensive care unit, Grenoble Alpes University Hospital, Grenoble, France
| | - O Detante
- Stroke unit, Grenoble Alpes University Hospital, Grenoble, France; Université Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, 38000 Grenoble, France
| | - O Heck
- Neuroradiology, Grenoble Alpes University Hospital, Grenoble, France
| | - S Marcel
- Stroke unit, Métropole Savoie Hospital, 73000 Chambéry, France
| | - W Vadot
- Stroke unit, Annecy-Genevois Hospital, Annecy, France
| | - G Gavazzi
- Geriatric department, Grenoble Alpes University Hospital, Grenoble, France
| | - J Papassin
- Stroke unit, Métropole Savoie Hospital, 73000 Chambéry, France.
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Instenes I, Breivik K, Borregaard B, Larsen AI, Allore H, Bendz B, Deaton C, Rotevatn S, Norekvål TM. Phenotyping Self-Reported Health Profiles in Octogenarians and Nonagenarians After Percutaneous Coronary Intervention: A Latent Profile Analysis. Heart Lung Circ 2023; 32:1321-1333. [PMID: 37925313 DOI: 10.1016/j.hlc.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/17/2023] [Revised: 07/11/2023] [Accepted: 09/01/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Little is known about self-reported health in octogenarians (≥80 years) and nonagenarians (≥90 years) following percutaneous coronary intervention (PCI), including characteristics of different health outcomes. This study aimed to phenotype latent health profiles of self-reported health in older adults 2 months post-PCI. METHODS A prospective, multicentre, real-world study (CONCARDPCI) of 270 octogenarians and nonagenarians was performed with five validated and standardised measures of self-reported health at 2 months post-PCI. Latent profile analysis was used to identify health profiles, and multinomial logistic regression analyses were used to investigate the associations between patient characteristics and health profiles. RESULTS Three latent health profiles were identified: The Poor health profile included 29%, the Moderate health profile included 39%, and the Good health profile included 32% of the participants. Older adults who were frail (OR 2.50, 95% CI 1.17-5.33), had a low exercise level (OR 0.49, 95% CI 0.39-0.95), and low alcohol intake (OR 0.61, 95% CI 0.39-0.95) were more likely to belong to the Poor health profile relative to the Good health profile. Furthermore, older age (OR 1.19, 95% CI 1.03-1.37) and lower exercise level (OR 0.64, 95% CI 0.43-0.97) were associated with belonging to the Moderate health profile relative to the Good health profile. CONCLUSION Two months after PCI, most participants displayed having Moderate to Good health profiles. Those with a Poor health profile were more likely to be frail and less active. These findings highlight that follow-up care has to be patient-centred and tailored to improve the health status of older adults.
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Affiliation(s)
- Irene Instenes
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Kyrre Breivik
- Regional Centre for Child and Youth Mental Health and Child Welfare-West, Bergen, Norway
| | - Britt Borregaard
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Alf Inge Larsen
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Heather Allore
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; Department of Biostatistics, Yale School of Public Health, Yale University, Yale School of Public Health, New Haven, CT, USA
| | - Bjørn Bendz
- Department of Cardiology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Christi Deaton
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Svein Rotevatn
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Tone Merete Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway.
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Lucero CM, García-Mansilla A, Albani-Forneris A, Holc F, Slullitel PA, Zanotti G, Comba F, Piccaluga F, Buttaro MA. Do nonagenarians have more complications and unplanned readmissions than octogenarians following primary THA? A retrospective cohort study. Eur J Orthop Surg Traumatol 2023; 33:2981-2986. [PMID: 36930268 DOI: 10.1007/s00590-023-03502-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/26/2023] [Indexed: 03/18/2023]
Abstract
INTRODUCTION The performance of total hip arthroplasty in elderly patients, especially nonagenarians, is challenging due to higher patient frailty and medical comorbidities. We compared 90-day postoperative complications and unplanned readmissions between nonagenarians and octogenarians undergoing elective THA. METHODS One hundred and eleven patients undergoing elective, unilateral THA were retrospectively analyzed. Forty-four patients were nonagenarians (Group A), and 67 patients were octogenarians (Group B). Demographic data included age, gender, body mass index (BMI), ASA score and Charlson Comorbidity Index (CCI). Frailty was defined according to the Rockwood Frailty Index. All patients underwent a thorough preoperative assessment through a specific institutional clinical pathway created for this matter. Postoperative adverse events were grouped into major or minor. A regression model was used to evaluate independent risk factors for the development of complications. RESULTS There were no differences in the ASA score (65.9% vs. 53.7% ASA III-IV), prevalence of frailty (1% vs. 9%) and comorbidities between both groups (p > .05). The CCI was higher in nonagenarians (p = 0.007). Nonagenarians had more in-hospital complications, although most were minor (p = 0.002), none of which resulted in mortality. Ninety-day unplanned readmissions were similar between groups, with 4 (9.1%) and 6 (9%) in groups A and B, respectively (p = 1). Although age was a factor associated with the development of postoperative complications in the univariate regression model (OR 3.81, 95% CI 1.31 to 11.11, p = 0.014), it lost significance after performing the multivariate analysis (OR 2.48, 95% CI 0.78 to 7.90, p = 0.125). CONCLUSION The age of 90 years old was not a barrier to perform elective THA safely. Nonagenarians had higher in-hospital minor complications when compared to the younger cohort. However, age over 90 years was not an independent risk factor for unplanned readmissions or mortality. Multimodal protocols of perioperative care are paramount for improving outcomes after THA in very old patients.
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Affiliation(s)
- Carlos M Lucero
- 'Sir John Charnley' Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, 4190 Peron St., C1199ABH, Buenos Aires, Argentina.
| | - Agustín García-Mansilla
- 'Sir John Charnley' Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, 4190 Peron St., C1199ABH, Buenos Aires, Argentina
| | - Agustín Albani-Forneris
- 'Sir John Charnley' Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, 4190 Peron St., C1199ABH, Buenos Aires, Argentina
| | - Fernando Holc
- 'Sir John Charnley' Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, 4190 Peron St., C1199ABH, Buenos Aires, Argentina
| | - Pablo A Slullitel
- 'Sir John Charnley' Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, 4190 Peron St., C1199ABH, Buenos Aires, Argentina
| | - Gerardo Zanotti
- 'Sir John Charnley' Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, 4190 Peron St., C1199ABH, Buenos Aires, Argentina
| | - Fernando Comba
- 'Sir John Charnley' Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, 4190 Peron St., C1199ABH, Buenos Aires, Argentina
| | - Francisco Piccaluga
- 'Sir John Charnley' Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, 4190 Peron St., C1199ABH, Buenos Aires, Argentina
| | - Martin A Buttaro
- 'Sir John Charnley' Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, 4190 Peron St., C1199ABH, Buenos Aires, Argentina
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Toutoungy M, Venishetty N, Mounasamy V, Khazzam M, Sambandam S. Reverse Shoulder Arthroplasty in Nonagenarians - NIS-based study of perioperative and postoperative complications. J Orthop 2023; 42:40-44. [PMID: 37483644 PMCID: PMC10362003 DOI: 10.1016/j.jor.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 07/25/2023] Open
Abstract
Purpose Our aim is to investigate the length of stay (LOS), cost of care (COC) and postoperative complications associated with reverse shoulder arthroplasty (RSA) in nonagenarians (people aged 90-99 years old). Methods We used the National Inpatient Sample (NIS) database to identify 59,925 patients who underwent RSA between 2016 and 2019, including 555 nonagenarians. We investigated the incidences of various medical and orthopedic postoperative complications in nonagenarians compared to their younger counterparts, as well as compared nonagenarians undergoing elective and non-elective surgery. Results Nonagenarians were less likely admitted for elective surgery (69.9% in nonagenarians vs 92.8% in controls, p < 0.001) and were subject to longer LOS (3.5 days in nonagenarians vs 1.89 days in controls, p < 0.001) and greater COC ($91,794.69 US in nonagenarians vs $79,574.12 US in controls, p < 0.001). Nonagenarians had increased incidences of hospital mortality (0.72% in nonagenarians vs 0.06% in controls, p < 0.001), pneumonia (1.44% in nonagenarians vs 0.37% in controls, p < 0.001), blood loss anemia (22.34% in nonagenarians vs 10.12% in controls, p < 0.001), and ARF (6.85% in nonagenarians vs 2.18% in controls, p < 0.001). Nonagenarians undergoing elective RSA had fewer complications than those requiring non-elective RSA. Conclusion Nonagenarians undergoing RSA are subject to increased LOS, COC, and postoperative complications. Despite this, we feel that the associated complications can be deemed acceptable and that with adequate preparation, the benefits of a successful RSA may outweigh the associated complications in elderly patients. This is important to aid clinicians and patients in making informed decisions for patient care and resource allocation, as well as highlights room for improvement in costs and hospital stay, as well as sheds light on persistent health disparities in orthopedic surgery. Level of evidence IV.
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Affiliation(s)
- Michel Toutoungy
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Nikit Venishetty
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Varatharaj Mounasamy
- Department of Orthopedics, University of Texas Southwestern, Dallas VAMC, Dallas, TX, USA
| | - Michael Khazzam
- University of Texas Southwestern Medical Center, Orthopaedic Surgery, Dallas, TX, USA
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Ashraf M, Jan MF, Jahangir A, Galazka P, Sanders H, Schweitzer M, Tajik AJ. Never Too Old: A Nonagenarian With Apical Hypertrophic Cardiomyopathy. CASE (Phila) 2023; 7:215-219. [PMID: 37396480 PMCID: PMC10307591 DOI: 10.1016/j.case.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
We present the oldest living (age, 93 years) asymptomatic patient with marked ApHCM. ApHCM has a variable prognosis, and the elderly can have a benign course. Metastatic tumor to the apex should be considered in the differential diagnosis.
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Affiliation(s)
| | | | | | | | | | | | - A. Jamil Tajik
- Correspondence: A. Jamil Tajik, MD, Aurora Cardiovascular and Thoracic Services, Aurora St. Luke’s Medical Center, 2801 West Kinnickinnic River Parkway, Suite 130, Milwaukee, WI 53215.
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Fukutomi M, Onishi T, Ando T, Higuchi R, Hagiya K, Saji M, Takamisawa I, Iguchi N, Takayama M, Shimizu A, Shimizu J, Doi S, Okazaki S, Sato K, Tamura H, Yokoyama H, Takanashi S, Tobaru T. Impact of periprocedural bleeding on mid-term outcome in nonagenarians who underwent transcatheter aortic valve implantation: insights from LAPLACE registry. J Thromb Thrombolysis 2023:10.1007/s11239-023-02800-2. [PMID: 37061662 DOI: 10.1007/s11239-023-02800-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 04/17/2023]
Abstract
Data from several recent studies have demonstrated the safety and efficacy of transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) even in nonagenarians. However, the impact of periprocedural bleeding following TAVI on their outcome remains unclear. In the aLliAnce for exPloring cLinical prospects of AortiC valvE disease (LAPLACE) registry, we compared outcomes between the bleeding and no-bleeding groups among 1953 patients < 90 years old (mean age, 83.0 ± 4.6 years old) and 316 nonagenarians (mean age, 91.7 ± 1.9 years old) who underwent TAVI with a median follow-up period of 628 days. The group with any periprocedural bleeding showed a higher 30-day mortality than the no-bleeding group in patients < 90 years old (3.3% vs. 0.5%, p = 0.001) and nonagenarians (7.9% vs. 0.7%, p = 0.001). In patients < 90 years old, severe periprocedural bleeding (n = 85) was associated with a higher mid-term all-cause mortality rate than no severe bleeding (n = 1,868), even after adjusting for covariates (hazard ratio [HR], 1.994; 95% confidence interval [CI] 1.287-2.937; p = 0.002). On the other hand, in nonagenarians, any periprocedural bleeding (n = 38) was associated with a higher mid-term cardiovascular (CV) mortality rate (21.1% vs. 4.3%, log-rank p = 0.014) than no bleeding (n = 278), even after adjusting for covariates (HR, 3.104; 95% CI 1.140-8.449; p = 0.027). In conclusion, any periprocedural bleeding after TAVI was associated with mid-term CV mortality in nonagenarians, whereas severe bleeding was associated with mid-term all-cause mortality in patients < 90 years old.
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Affiliation(s)
- Motoki Fukutomi
- Department of Cardiology, Kawasaki Saiwai Hospital, 31-27, Kawasaki, Kanagawa, 212-0014, Japan.
| | - Takayuki Onishi
- Department of Cardiology, Kawasaki Saiwai Hospital, 31-27, Kawasaki, Kanagawa, 212-0014, Japan
| | - Tomo Ando
- Department of Cardiology, Kawasaki Saiwai Hospital, 31-27, Kawasaki, Kanagawa, 212-0014, Japan
| | - Ryosuke Higuchi
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Kenichi Hagiya
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Itaru Takamisawa
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Nobuo Iguchi
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | | | - Atsushi Shimizu
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan
| | - Jun Shimizu
- Department of Anesthesiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Shinichiro Doi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shinya Okazaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kei Sato
- Department of Cardiology, Mie University Hospital, Thu, Japan
| | - Harutoshi Tamura
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University Hospital, Yamagata, Japan
| | - Hiroaki Yokoyama
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | | | - Tetsuya Tobaru
- Department of Cardiology, Kawasaki Saiwai Hospital, 31-27, Kawasaki, Kanagawa, 212-0014, Japan
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Duran Crane A, Saijo Y, Kocyigit D, Tharwani A, Datta S, Godoy Rivas C, Gillinov AM, Kapadia SR, Krishnaswamy A, Grimm RA, Griffin BP, Xu B. Severe mitral regurgitation in nonagenarians: Impact of symptomatic status, frailty and etiology on management and outcomes. Int J Cardiol 2023; 377:92-8. [PMID: 36702362 DOI: 10.1016/j.ijcard.2023.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/26/2022] [Accepted: 01/16/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND Data regarding mitral regurgitation (MR) in extremely elderly patients are limited. The aim of the present study was to assess symptomatic status, frailty, etiology and outcomes for nonagenarians with severe MR. METHODS Single-center cohort study of patients ≥90 years of age with at least 3+ MR on echocardiography between September 2010 and August 2018. Out of a total of 11,998 patients with at least 3+ MR, 267 patients were included in the present study. RESULTS The average age was 93.5 ± 2.6 years, and 57% were female. At baseline, 88% were symptomatic, with mean Charlson co-morbidity index of 6 ± 2 points, and mean frailty score of 2.9 ± 1.4 points. Primary MR was present in 50%, secondary in 47%, and prosthetic valve dysfunction in 3%. Among patients with primary MR, the most common etiology was mitral annular calcification (58%). In comparison, the most common etiology of secondary MR was atrial functional MR (52%). Of all, 95% were treated conservatively, and 5% underwent interventional management. Among 253 patients who had follow-up data with a median follow-up of 14 months (25th-75th interquartile range: 3-31 months), 191 patients (75%) died. Mortality trended higher in the conservative group versus the interventional group (60% vs. 22%, log-rank P = 0.063). CONCLUSIONS Most nonagenarians with significant MR were symptomatic at presentation, had elevated Charlson co-morbidity index and frailty scores. Etiologies of MR were almost equally distributed between primary and secondary causes. The vast majority of nonagenarians with significant MR were conservatively managed.
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Roedl K, Daniels R, Theile P, Kluge S, Müller J, Behrendt CA. The Independent Impact of Peripheral Arterial Disease on Mortality in Nonagenarians and Centenarians Who Were Treated in an Intensive Care Unit: A Consecutive Cohort of 1 108 Patients. Eur J Vasc Endovasc Surg 2023; 65:582-589. [PMID: 36682405 DOI: 10.1016/j.ejvs.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/01/2022] [Revised: 11/18/2022] [Accepted: 01/13/2023] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To investigate the clinical characteristics, risk factors, and outcomes of inpatients with peripheral arterial disease (PAD) including lower extremity PAD, abdominal aortic aneurysm (AAA), and carotid artery disease in a large cohort of critically ill patients aged ≥ 90 years. METHODS A retrospective analysis was conducted of all adult patients aged ≥ 90 years consecutively admitted to the intensive care unit at a tertiary care centre in Hamburg, Germany, between 1 January 2008 and 30 April 2019. Multivariable regression and Kaplan-Meier methods were used to determine the independent impact of PAD on short and long term mortality endpoints. The analyses were adjusted for confounding by several sociodemographic and clinical parameters including Charlson Comorbidity Index (CCI) and established clinical risk scores. RESULTS A total of 1 108 eligible patients were identified (92.3 years, 33% men). Of these, 24% had PAD (9% lower extremity PAD, 2% AAA, 15% coronary artery disease) and 76% did not have any history of PAD and were used as a comparison group. When compared with the comparison group, patients with PAD had a higher CCI (2 vs. 1, p < .001), more often had chronic kidney disease (28% vs. 21%, p = .019), and renal replacement therapy (5% vs. 2%, p = .016). Furthermore, they needed vasopressors (48% vs. 40%, p = .027) and parenteral nutrition (10% vs. 6%, p = .041) more often. After adjusting for confounding, PAD was independently associated with increased in hospital (hazard ratio [HR] 1.97, 95% confidence interval [CI] 1.39 - 2.81, p < .001) and long term mortality rates (HR 1.32, 95% CI 1.05 - 1.66, p = .019). CONCLUSION One of four critically ill nonagenarians and centenarians in an ICU in Germany had PAD. PAD was associated with both higher short and long term mortality rates while its impact outweighed higher age. Future studies should address this increasingly important population beyond 89 years of age.
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Affiliation(s)
- Kevin Roedl
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Rikus Daniels
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Pauline Theile
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob Müller
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Department of Anaesthesiology, Tabea Hospital, Hamburg, Germany
| | - Christian-Alexander Behrendt
- Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
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Bruoha S, Maller T, Loutati R, Perel N, Tabi M, Taha L, Yosefy C, Jafari J, Braver O, Amsalem I, Hitter R, Manassra M, Levy N, Abu-Alkean I, Hamyil K, Steinmetz Y, Karameh H, Karmi M, Marmor D, Wolak A, Glikson M, Asher E. Nonagenarians admission and prognosis in a tertiary center intensive coronary care unit - a prospective study. BMC Geriatr 2023; 23:152. [PMID: 36941571 PMCID: PMC10029169 DOI: 10.1186/s12877-023-03851-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/27/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND With increasing life expectancy, the prevalence of nonagenarians with cardiovascular disease is steadily growing. However, this population is underrepresented in randomized trials and thus poorly defined, with little quality evidence to support and guide optimal management. The aim of the present study was to evaluate the clinical management, therapeutic approach, and outcomes of nonagenarians admitted to a tertiary care center intensive coronary care unit (ICCU). METHODS We prospectively collected all patients admitted to a tertiary care center ICCU between July 2019 - July 2022 and compared nonagenarians to all other patients. The primary outcome was in-hospital mortality. RESULTS A total of 3807 patients were included in the study. Of them 178 (4.7%) were nonagenarians and 93 (52%) females. Each year the prevalence of nonagenarians has increased from 4.0% to 2019, to 4.2% in 2020, 4.6% in 2021 and 5.3% in 2022. Admission causes differed between groups, including a lower rate of acute coronary syndromes (27% vs. 48.6%, p < 0.001) and a higher rate of septic shock (4.5% vs. 1.2%, p < 0.001) in nonagenarians. Nonagenarians had more comorbidities, such as hypertension, renal failure, and atrial fibrillation (82% vs. 59.6%, 23% vs. 12.9%, 30.3% vs. 14.4% p < 0.001, respectively). Coronary intervention was the main treatment approach, although an invasive strategy was less frequent in nonagenarians in comparison to younger subjects. In-hospital mortality rate was 2-fold higher in the nonagenarians (5.6% vs. 2.5%, p = 0.025). CONCLUSION With increasing life expectancy, the prevalence of nonagenarians in ICCU's is expected to increase. Although nonagenarian patients had more comorbidities and higher in-hospital mortality, they generally have good outcomes after admission to the ICCU. Hence, further studies to create evidence-based practices and to support and guide optimal management in these patients are warranted.
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Affiliation(s)
- Sharon Bruoha
- Department of Cardiology, Barzilai Medical Center, The Ben-Gurion University of the Negev, Hahistadrout 2, Ashkelon, 7830604, Israel.
| | - Tomer Maller
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ranel Loutati
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nimrod Perel
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Meir Tabi
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Louay Taha
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Chaim Yosefy
- Department of Cardiology, Barzilai Medical Center, The Ben-Gurion University of the Negev, Hahistadrout 2, Ashkelon, 7830604, Israel
| | - Jamal Jafari
- Department of Cardiology, Barzilai Medical Center, The Ben-Gurion University of the Negev, Hahistadrout 2, Ashkelon, 7830604, Israel
| | - Omri Braver
- Department of Cardiology, Barzilai Medical Center, The Ben-Gurion University of the Negev, Hahistadrout 2, Ashkelon, 7830604, Israel
| | - Itshak Amsalem
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rafael Hitter
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mohamed Manassra
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nir Levy
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ismael Abu-Alkean
- Department of Cardiology, Barzilai Medical Center, The Ben-Gurion University of the Negev, Hahistadrout 2, Ashkelon, 7830604, Israel
| | - Kamal Hamyil
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yoed Steinmetz
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hani Karameh
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mohamed Karmi
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - David Marmor
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Arik Wolak
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michael Glikson
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Elad Asher
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
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Eredics K, Drerup M, Özsoy M, Wehrberger C, Lenz M, Ramesmayer C, Stolzlechner P, Zanier J, Falkensammer CE, Handjiev I, Wasserscheid A, Seklehner S. Active stone removal is a safe option for ocotogenarians and nonagenarians with nephrolithiasis. World J Urol 2023; 41:849-856. [PMID: 36754879 DOI: 10.1007/s00345-023-04304-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/17/2023] [Indexed: 02/10/2023] Open
Abstract
PURPOSE To assess the contemporary in-hospital management of octogenarians and nonagenarians with renal calculi. MATERIAL AND METHODS A multicentric retrospective evaluation of patients aged ≥ 80 years hospitalized with kidney stones between 01/2000 and 12/2019. Stone and patient related data were collected, including stone size and location, geriatric status and comorbidities. Surgical treatment patterns and outcome were assessed. RESULTS A total of 299 patients (57% female) with kidney stones were analyzed. Mean age was 84.7 years. Patients were largely multimorbid (ASA ≥ 3 in 70%) and about 25% were classified as frail. Active stone treatment was performed in 65% and 35% were treated with urinary diversion (stent or nephrostomy). Prognostic factors for receiving an active stone treatment were age < 90 years, male sex, stone size and quantity, and performance status. Mean overall survival was 23.7 months and when stratified to treatment mean survival were 21 months after urinary diversion, 28 months after URS, 29 months after PCNL and 45 months after SWL. CONCLUSION Age, frailty and performance-status as well as stone size and quantity are predictors for active stone treatment. Octogenarians and nonagenarians, who are considered fit for surgery, tend to live long enough to profit from active stone treatment.
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Affiliation(s)
- Klaus Eredics
- Department of Urology, Paracelsus Medizinische Privatuniversität Salzburg, Strubergasse 21, 5020, Salzburg, Austria. .,Department of Urology, Klinik Donaustadt, Langobardenstraße 122, 1220, Vienna, Austria.
| | - Martin Drerup
- Department of Urology, Paracelsus Medizinische Privatuniversität Salzburg, Strubergasse 21, 5020, Salzburg, Austria.,Department of Urology, Krankenhaus der Barmherzigen Brüder Salzburg, Kajetanerplatz 1, 5010, Salzburg, Austria
| | - Mehmet Özsoy
- UROMED KompetenzZentrum Urologie, Neubaugürtel 47/OG5, 1150, Vienna, Austria
| | - Clemens Wehrberger
- Department of Urology, Klinik Donaustadt, Langobardenstraße 122, 1220, Vienna, Austria
| | - Matthias Lenz
- Department of Urology, Universitätsklinikum Krems an der Donau, Mitterweg 10, 3500, Krems an der Donau, Austria
| | - Christian Ramesmayer
- Department of Urology, Paracelsus Medizinische Privatuniversität Salzburg, Strubergasse 21, 5020, Salzburg, Austria
| | - Philipp Stolzlechner
- Department of Urology, Tauernklinikum Zell am See, Paracelsusstraße 8, 5700, Zell am See, Austria
| | - Johannes Zanier
- Department of Urology, Medizinische Universität Innsbruck, Christoph-Probst-Platz 1, Innrain 52 A, Fritz-Pregl-Straße 3, 6020, Innsbruck, Austria
| | | | - Ivan Handjiev
- Department of Urology, Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Austria
| | - Andreas Wasserscheid
- Department of Urology, Landesklinikum Baden-Mödling, Waltersdorferstraße 75, 2500, Baden bei Vienna, Austria
| | - Stephan Seklehner
- Department of Urology, Paracelsus Medizinische Privatuniversität Salzburg, Strubergasse 21, 5020, Salzburg, Austria.,Department of Urology, Landesklinikum Baden-Mödling, Waltersdorferstraße 75, 2500, Baden bei Vienna, Austria
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20
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Merenstein JL, Corrada MM, Kawas CH, Bennett IJ. White matter microstructural correlates of associative learning in the oldest-old. Cogn Affect Behav Neurosci 2023; 23:114-24. [PMID: 36163584 DOI: 10.3758/s13415-022-01035-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/09/2022] [Indexed: 11/08/2022]
Abstract
The ability to learn associations between events is critical for everyday functioning (e.g., decision making, social interactions) and has been attributed to structural differences in white matter tracts connecting cortical regions to the hippocampus (e.g., fornix) and striatum (e.g., internal capsule) in younger-old adults (ages 65-85 years). However, evidence of associative learning has not been assessed within oldest-old adults (ages 90+ years), despite its relevance to other extensively characterized cognitive abilities in the oldest-old and the relatively large effect of advanced age on the microstructural composition of these white matter tracts. We acquired multicompartment diffusion-weighted magnetic resonance imaging data from 22 oldest-old adults without dementia (mean age = 92.91 ± 1.44 years) who also completed an associative learning task. Behavioral results revealed significantly better associative learning performance during later task stages, as expected if participants incidentally learned the cue-cue-target associations for frequently occurring event triplets. Moreover, better learning performance was significantly predicted by better microstructure of cortico-striatal white matter (posterior limb of the internal capsule). Finding that associative learning abilities in the 10th decade of life are supported by better microstructure of white matter tracts connecting the cortex to the striatum underscores their importance to learning performance across the entire lifespan.
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Jalal M, Khan A, Ijaz S, Gariballa M, El-Sherif Y, Al-Joudeh A. Endoscopic removal of common bile duct stones in nonagenarians: a tertiary centre experience. Clin Endosc 2023; 56:92-99. [PMID: 36600656 PMCID: PMC9902683 DOI: 10.5946/ce.2022.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/04/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND/AIMS There are few studies assessed the efficacy and mortality of endoscopic retrograde cholangiopancreatography (ERCP) for the removal of common bile duct (CBD) stones in the elderly aged ≥90 years. We aimed to assess the safety and efficacy of endoscopic removal of CBD stones in nonagenarians. METHODS We retrospectively reviewed ERCP reports for CBD stone removal. The endoscopic and therapeutic outcomes were collected. The length of stay (LOS), the total number of adverse events, and mortality rate were compared between groups. RESULTS A total of 125 nonagenarians were compared with 1,370 controls (65-89 years old individuals). The mean LOS for nonagenarians was significantly higher than in controls (13.6 days vs. 6.5 days). Completed intended treatment was similar in the nonagenarians and controls (89.8% and 89.5%, respectively). The overall complication rate did not differ between the groups. However, nonagenarians had a higher incidence of post-ERCP pneumonia (3.9%). None of the nonagenarians were readmitted to the hospital within 7 days. Four nonagenarians (3.2%) and 25 (1.8%) controls died within 30 days. CONCLUSION Advanced age alone did not affect the decision to perform the procedure. However, prompt diagnosis and treatment of post-ERCP pneumonia in nonagenarians could improve the outcomes and reduce mortality.
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Affiliation(s)
- Mustafa Jalal
- Department of Gastroenterology, Northern General Hospital, Sheffield, UK,Correspondence: Mustafa Jalal Department of Gastroenterology, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK E-mail:
| | - Amaan Khan
- Department of Gastroenterology, Northern General Hospital, Sheffield, UK
| | - Sijjad Ijaz
- Department of Gastroenterology, Northern General Hospital, Sheffield, UK
| | - Mohammed Gariballa
- Department of Gastroenterology, Northern General Hospital, Sheffield, UK
| | - Yasser El-Sherif
- Department of Gastroenterology, Northern General Hospital, Sheffield, UK
| | - Amer Al-Joudeh
- Department of Gastroenterology, Northern General Hospital, Sheffield, UK
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22
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Sarpong N, Boettner F, Cushner F, Krell E, Premkumar A, Valle AGD, Hanreich C. Is there a difference in mobility and inpatient physical therapy need after primary total hip and knee arthroplasty? A decade-by-decade analysis from 60 to 99 years. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04624-w. [PMID: 36258048 DOI: 10.1007/s00402-022-04624-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 09/10/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Extended inpatient rehabilitation (PT) after total hip (THA) and knee arthroplasty (TKA) has a significant impact on total care costs. As patients age, extended PT might be required following THA and TKA. This study examined the relationship between patient age, functional mobility, inpatient PT need, and discharge disposition in THA and TKA patients. MATERIALS AND METHODS This retrospective study included patients aged 60 + undergoing primary THA or TKA between 2018 and 2020 at an orthopedic hospital. Comparing by age-decade, 7374 (3600 THA, 3774 TKA) sexagenarians, 5350 (2367 THA, 2983 TKA) septuagenarians, 1356 (652 THA, 704 TKA) octogenarians, and 78 (52 THA, 26 TKA) nonagenarians were analyzed. We compared the number of PT sessions needed for discharge clearance and the postoperative functional mobility using the Activity Measure for Post-Acute Care (AM-PAC) tool. Statistical analyses included ANOVA with post-hoc Tukey's HSD for continuous data and Chi-squared test for categorical variables. RESULTS The number of PT sessions required for discharge clearance increased with age after THA (3.3 ± 1.9 sessions vs 3.8 ± 2.1 vs 5.0 ± 2.7 vs 6.2 ± 3.0; p < 0.01) and TKA (4.0 ± 2.1 vs 4.7 ± 3.1 vs 5.2 ± 2.8 vs 5.0 ± 1.6; p < 0.01). The functional mobility improvement as measured by AM-PAC was significantly lower for nonagenarians after THA (4.9 ± 2.8 vs 5.1 ± 2.8 vs 4.6 ± 3.3 vs 3.3 ± 3.9; p < 0.01) and TKA (5.0 ± 2.9 vs 4.7 ± 3.2 vs 3.9 ± 3.4 vs 3.2 ± 2.6; p < 0.01). CONCLUSION Patients in their eighth and ninth decade had less improvement in functional mobility during in-hospital rehabilitation and utilized more PT services. However, clinical results in the elderly are still satisfying and the data may be helpful for resource utilization planning and risk-adjustment in value-based payment models.
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Affiliation(s)
- Nana Sarpong
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - Friedrich Boettner
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA.
| | - Fred Cushner
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - Ethan Krell
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - Ajay Premkumar
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - Alejandro Gonzalez Della Valle
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - Carola Hanreich
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
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Inoue M, Ota T, Hara T, Shigeta K, Kamiya Y, Arakawa H, Aoki R, Tsuruta W, Ichijo M, Kaneko J, Shiokawa Y, Hirano T. An Initial High National Institutes of Health Stroke Scale Score and Any Intracranial Hemorrhage Are Independent Factors for a Poor Outcome in Nonagenarians Treated with Thrombectomy for Acute Large Vessel Occlusion: The Tokyo/Tama-REgistry of Acute Endovascular Thrombectomy (TREAT) Study. World Neurosurg 2022; 165:e325-e330. [PMID: 35717017 DOI: 10.1016/j.wneu.2022.06.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Mechanical thrombectomy (MT) is effective in acute ischemic stroke patients ≥80 years old with large vessel occlusion (LVO). However, data for patients ≥90 years old remain very limited, and factors influencing functional outcomes are unclear. This study aimed to investigate factors influencing functional outcomes in patients ≥90 years old treated with MT for acute LVO. METHODS This retrospective observational study used prospectively collected data from the Tokyo/tama-REgistry of Acute endovascular Thrombectomy (TREAT) study. Inclusion criteria were as follows: 1) patients ≥90 years old treated with MT for LVO and 2) prestroke modified Rankin Scale (mRS) score, 0-3. The functional outcome was defined based on the mRS score at 90 days after the procedure: good functional outcome, mRS score 0-3 and poor functional outcome, mRS score 4-6. RESULTS Data were analyzed for 104 patients ≥90 years old. The good functional outcome was observed in 25 patients (24.0%), and the poor functional outcome was observed in the remaining 79 patients. Significant differences were identified in initial National Institutes of Health Stroke Scale (NIHSS) score, modified Thrombolysis in Cerebral Infarction grade 2b-3, modified Thrombolysis in Cerebral Infarction grade 3, and any intracranial hemorrhage and hemorrhagic infarction in univariate analyses. Multivariable analysis confirmed the initial NIHSS score (odds ratio, 1.08; 95% confidence interval, 1.01-1.17; P = 0.045) and any intracranial hemorrhage (odds ratio, 11.6; 95% confidence interval, 1.43-95.0; P = 0.022) as independent factors for the functional outcome. CONCLUSIONS An initial high NIHSS score and any intracranial hemorrhage are independent factors for the poor functional outcome in acute ischemic stroke patients ≥90 years old treated with MT.
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Affiliation(s)
- Masato Inoue
- Department of Neurosurgery, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan.
| | - Takahiro Ota
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Tetsuo Hara
- Department of Neurosurgery, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Keigo Shigeta
- Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Yuki Kamiya
- Department of Neurology, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Hideki Arakawa
- Department of Neurosurgery, Omori Red Cross Hospital, Tokyo, Japan
| | - Rie Aoki
- Department of Neurosurgery, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Wataro Tsuruta
- Department of Endovascular Neurosurgery, Toranomon Hospital, Tokyo, Japan
| | - Masahiko Ichijo
- Department of Neurology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Junya Kaneko
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | | | - Teruyuki Hirano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University, Tokyo, Japan
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Rotschild O, Honig A, Hallevi H, Horev A, Seyman E, Ben-Assayag E, Jonas-Kimchi T, Sadeh U, Cohen J, Leker RR, Molad J. Endovascular thrombectomy is beneficial for functional nonagenarians - a multicenter cohort analysis. J Stroke Cerebrovasc Dis 2022; 31:106699. [PMID: 36054973 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/19/2022] [Accepted: 08/01/2022] [Indexed: 10/14/2022] Open
Abstract
INTRODUCTION The use of endovascular thrombectomy (EVT) has dramatically increased in recent years. However, most existing studies used an upper age limit of 80 and data regarding the safety and efficacy of EVT among nonagenarians is still lacking. METHODS 767 consecutive patients undergoing EVT for large vessel occlusion (LVO) in three participating centers were recruited into a prospective ongoing database. Demographic, clinical and imaging characteristics were documented. Statistical analysis was done to evaluate EVT outcome among nonagenarians compared to younger patients. RESULTS The current analysis included 41 (5.4%) patients older than 90 years. Compared to younger patients, nonagenarians were more often female (78% versus 50.3%, p ≤ 0.001), had worse baseline mRS scores (2 [0-3] versus 0 [0-2], p < 0.001), higher rates of hypertension and hyperlipidemia and a higher admission NIHSS (20 [14-23] versus 16 [11-20], p < 0.001). No differences were found between groups regarding the involved vessel, stroke etiology, time from symptoms to door or symptoms to EVT, successful recanalization rates and hemorrhagic transformation rates. Nonagenarians had worse mRS at 90 days (5 [3-6] versus 3 [2-5], p = 0.001), similar discharge NIHSS (5 [1-11] versus 4 [1-11], p = 0.78) and higher mortality rates (36.6% versus 15.8%, p < 0.001). All nonagenarians with baseline mRS 4 have died within 90 days. 36.4% of nonagenarian patients with baseline MRS of 3 or less had favorable outcome. DISCUSSION This study demonstrates that nonagenarian stroke patients with baseline mRS of 3 or less benefit from EVT with no significant difference in the rate of favorable outcome compared to octogenarians.
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Affiliation(s)
- Ofer Rotschild
- Department of Stroke & Neurology, Tel-Aviv Sourasky Medical Center, 6 Weizmann Street, Tel-Aviv 64239, Israel
| | - Asaf Honig
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Hen Hallevi
- Department of Stroke & Neurology, Tel-Aviv Sourasky Medical Center, 6 Weizmann Street, Tel-Aviv 64239, Israel; Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Anat Horev
- Department of Neurology, Soroka- University Medical Center, Beer-Sheva, Israel
| | - Estelle Seyman
- Department of Stroke & Neurology, Tel-Aviv Sourasky Medical Center, 6 Weizmann Street, Tel-Aviv 64239, Israel
| | - Einor Ben-Assayag
- Department of Stroke & Neurology, Tel-Aviv Sourasky Medical Center, 6 Weizmann Street, Tel-Aviv 64239, Israel; Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tali Jonas-Kimchi
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Udi Sadeh
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Jose Cohen
- Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ronen R Leker
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Jeremy Molad
- Department of Stroke & Neurology, Tel-Aviv Sourasky Medical Center, 6 Weizmann Street, Tel-Aviv 64239, Israel.
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Bouget J, Jouhanny A, Soulat L, Oger E. Ground-level falls among nonagenarians: the impact of pre-injury antithrombotic therapy. Intern Emerg Med 2022; 17:1309-1319. [PMID: 35112277 DOI: 10.1007/s11739-021-02914-6] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 12/16/2021] [Indexed: 12/21/2022]
Abstract
Among nonagenarians admitted to our emergency department (ED) for ground-level falls, we assessed the impact of pre-injury antithrombotic (AT) treatment on the post-traumatic consequences, and identified risk factors for 1-month mortality. All eligible patients were consecutively included over an 18-month period. Head trauma was attested by reliable medical history, witnesses or recent external signs. Patient characteristics, post-traumatic consequences and outcomes were compared across patients with and without AT. Risk factors for 1-month mortality were assessed using multivariate logistic regression analyses. 1014 consecutive nonagenarians were analysed, 675 (66.6%) with AT and 339 (33.4%) without. Head trauma (n = 429, 42.3%) was significantly more frequent among patients with AT (49.2 vs 28.6%, p < 0.001). Intracranial hemorrhage (ICH, n = 43, 4.2%), mostly subdural hematomas (58%), were more frequently found among patients with AT (p < 0.015). At least one fracture was diagnosed for 23.9% of the population, mostly hip fractures, without any significant association with AT. At 1 month, 103 patients (10.2%) had died. The independent risk factors for 1-month mortality were: ICH associated with head trauma (OR = 5.9, 95% CI 2.5-14), Glasgow coma score ≤ 12 at admission (OR = 10; 95% CI 2.2-46), atrial fibrillation (OR = 2.2, 95% CI 1.4-3.4) and age ≥ 95 years (OR = 1.6, 95% CI 1.0-2.5). Our results support accurate and regular assessment of the benefit/risk ratio for antithrombotic treatment among elderly people at high risk for falls.
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Affiliation(s)
- Jacques Bouget
- Emergency Department, University Hospital, 35033, Rennes, France.
- University of Rennes, CHU Rennes, EA 7449 (Pharmacoepidemiology and Health Services Research) REPERES, University Hospital, F-35043, Rennes, France.
| | - Alexia Jouhanny
- Emergency Department, University Hospital, 35033, Rennes, France
| | - Louis Soulat
- Emergency Department, University Hospital, 35033, Rennes, France
| | - Emmanuel Oger
- University of Rennes, CHU Rennes, EA 7449 (Pharmacoepidemiology and Health Services Research) REPERES, University Hospital, F-35043, Rennes, France
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Carr JA, NeCamp T. Results of emergency colectomy in nonagenarians and octogenarians previously labeled as prohibitive surgical risk. Eur J Trauma Emerg Surg 2022; 48:4927-4933. [PMID: 35759007 DOI: 10.1007/s00068-022-02030-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/06/2022] [Accepted: 05/30/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE There are no standardized criteria for what constitutes prohibitive risk for emergency abdominal surgery. METHODS A retrospective review was performed comparing two groups of patients having emergent colectomy. One group had previously been labeled as being prohibitive surgical risk and the other was a contemporary, non-prohibitive risk group also requiring emergency colectomy. All operations were performed by a single surgeon. RESULTS There were 27 prohibitive risk patients and 81 non-prohibitive risk (control group) patients. The average age of the prohibitive risk group was 85 years (range 78-99) compared to the control group mean age of 52 years (18-79, p < 0.00001). Prohibitive risk was due to extremes of age combined with congestive heart failure in 44%, followed by chronic obstructive pulmonary disease combined with heart failure in 19%. The groups were closely matched by the type of colectomy performed. The total complication rate was much higher in the prohibitive risk group compared to the non-prohibitive risk patients (81% versus 48%, p 0.005). But the 30-day mortality rate was similar between groups (7% versus 4%, p 0.6). CONCLUSION Patients who are labeled as prohibitive surgical risk may be inaccurately assessed in the majority of cases. Additional research will need to be performed to evaluate the presence of quantifiable high-risk physiological conditions, and not just comorbidities, that place a patient at high risk of death after abdominal surgery. Until then, elderly patients should not be denied colectomy based upon comorbidities alone.
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Affiliation(s)
- John Alfred Carr
- ProMedica Health System, 100 Madison Avenue, Toledo, OH, 43606, USA.
| | - Timothy NeCamp
- Data Bloom Statistical Consultants, 104 Fieldstone Drive, Terrace Park, OH, 45174, USA
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Matta A, Lhermusier T, Bouisset F, Parada FC, ELBaz M, Nader V, Blanco S, Roncalli J, Carrié D. Outcomes of Transcatheter Aortic Valve Implantation in Nonagenarians Compared to Younger than 90 Year Old Patients. Am J Med 2022; 135:745-751. [PMID: 35296400 DOI: 10.1016/j.amjmed.2022.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Given that life expectancy has improved, nonagenarians have become a significant proportion of world population. As aortic stenosis is primarily a disease of the elderly, the need for invasive cardiac approaches is expected to increase in people of extreme age. Herein, we compare the in-hospital adverse clinical outcomes and mortality after transcatheter aortic valve implantation (TAVI) procedures in nonagenarians to younger than 90 year old patients. METHODS A retrospective study was conducted on 1336 patients who underwent TAVI between January 2016 and March 2020 at Toulouse University Hospital, Rangueil, France. Post-TAVI adverse clinical outcomes were defined according to Valve Academic Research Consortium-2 Criteria. The studied population was divided into 2 groups according to age. RESULTS Out of 1336 patients, 250 (18.7%) were nonagenarians with a mean age of 91.8 ± 1.9 years. Pacemaker implantation (12.4% vs 12.1%), stroke (2% vs 1.8%), and major vascular complications (9.2% vs 6.7%) were more common in nonagenarians, whereas acute kidney injury (1.2% vs 2.7%) and major bleeding events (3.2% vs 3.4%) were more common in the <90-year-old group. Nonagenarians are more likely to develop major vascular complications (odds ratio [OR] = 1.76 95% confidence interval [CI] 1.04-3, P = .03). The prevalence of in-hospital mortality in nonagenarians and <90-year-old patients were 5.2% and 2%, respectively. Survival analysis showed a significant difference in mortality during hospitalization period only ( P = .04). CONCLUSION The prevalence of TAVI procedural success is remarkably high in nonagenarians and comparable to that of younger patients. However, the in-hospital mortality rate was 2-fold more than that of <90-year-old patients.
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Affiliation(s)
- Anthony Matta
- Department of Cardiology, University Hospital Toulouse, Rangueil, France; Faculty of Medicine, Holy Spirit University of Kaslik, Jounieh, Lebanon.
| | | | - Fréderic Bouisset
- Department of Cardiology, University Hospital Toulouse, Rangueil, France
| | | | - Meyer ELBaz
- Department of Cardiology, University Hospital Toulouse, Rangueil, France
| | - Vanessa Nader
- Department of Cardiology, University Hospital Toulouse, Rangueil, France
| | - Stephanie Blanco
- Department of Cardiology, University Hospital Toulouse, Rangueil, France
| | - Jerome Roncalli
- Department of Cardiology, University Hospital Toulouse, Rangueil, France
| | - Didier Carrié
- Department of Cardiology, University Hospital Toulouse, Rangueil, France
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Tuaillon E, Pisoni A, Gamon L, Henry S, Mondain AM, Pastor P, Van De Perre P, Bousquet J, Picot MC, Blain H. Amplitudes and kinetic of antibodies after second and third doses of BNT162b2 vaccine in nonagenarians and centenarians with and without prior SARS-CoV-2 infection. Clin Microbiol Infect 2022; 28:1393-1395. [PMID: 35659927 PMCID: PMC9151454 DOI: 10.1016/j.cmi.2022.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/10/2022] [Accepted: 05/14/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Edouard Tuaillon
- Pathogenesis & Control of Chronic and Emerging Infections, Institut National de la Santé et de la Recherche Médicale (INSERM), U1058, Établissement Français du Sang (EFS), Montpellier University and Laboratory of Virology, Centre Hospitalier Universitaire de Montpellier, France.
| | - Amandine Pisoni
- Pathogenesis & Control of Chronic and Emerging Infections, Institut National de la Santé et de la Recherche Médicale (INSERM), U1058, Établissement Français du Sang (EFS), Montpellier University and Laboratory of Virology, Centre Hospitalier Universitaire de Montpellier, France
| | - Lucie Gamon
- Clinical research and epidemiology unit, University hospital, Montpellier, France
| | - Steven Henry
- Montpellier University Hospital, Montpellier, France
| | | | | | - Philippe Van De Perre
- Pathogenesis & Control of Chronic and Emerging Infections, Institut National de la Santé et de la Recherche Médicale (INSERM), U1058, Établissement Français du Sang (EFS), Montpellier University and Laboratory of Virology, Centre Hospitalier Universitaire de Montpellier, France
| | - Jean Bousquet
- Charité, Univeersitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Comprehensive Allergy Center, Department of Dermatology and Allergy, Berlin, Germany; University Hospital, Montpellier, France
| | | | - Hubert Blain
- Department of Geriatrics, Montpellier University Hospital, Montpellier University, France
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29
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Merenstein JL, Bennett IJ. Bridging patterns of neurocognitive aging across the older adult lifespan. Neurosci Biobehav Rev 2022; 135:104594. [PMID: 35227712 PMCID: PMC9888009 DOI: 10.1016/j.neubiorev.2022.104594] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/27/2022] [Accepted: 02/23/2022] [Indexed: 02/02/2023]
Abstract
Magnetic resonance imaging (MRI) studies of brain and neurocognitive aging rarely include oldest-old adults (ages 80 +). But predictions of neurocognitive aging theories derived from MRI findings in younger-old adults (ages ~55-80) may not generalize into advanced age, particularly given the increased prevalence of cognitive impairment/dementia in the oldest-old. Here, we reviewed the MRI literature in oldest-old adults and interpreted findings within the context of regional variation, compensation, brain maintenance, and reserve theories. Structural MRI studies revealed regional variation in brain aging as larger age effects on medial temporal and posterior regions for oldest-old than younger-old adults. They also revealed that brain maintenance explained preserved cognitive functioning into the tenth decade of life. Very few functional MRI studies examined compensatory activity in oldest-old adults who perform as well as younger groups, although there was evidence that higher brain reserve in oldest-old adults may mediate effects of brain aging on cognition. Despite some continuity, different cognitive and neural profiles across the older adult lifespan should be addressed in modern neurocognitive aging theories.
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Iqbal U, Anwar H, Khan MA, Weissman S, Kothari ST, Kothari TH, Confer BD, Khara HS. Safety and Efficacy of Endoscopic Retrograde Cholangiopancreatography in Nonagenarians: A Systematic Review and Meta-Analysis. Dig Dis Sci 2022; 67:1352-61. [PMID: 33770331 DOI: 10.1007/s10620-021-06950-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/08/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Recent advances in modern medicine have translated into increase in life expectancy in the USA and with that, a rise in the demand for invasive procedures in elderly patients. Endoscopic retrograde cholangiopancreatography (ERCP) is the procedure of choice for managing various benign and malignant pancreatobiliary conditions and can be associated with various adverse events. AIM We performed a systematic review and meta-analysis to evaluate outcomes of ERCP in nonagenarians. METHODS A comprehensive literature search was performed in Embase, MEDLINE, Web of Science, and Cochrane Review library until July 2020. Our primary outcomes were the rate of technical success and adverse events in nonagenarians. Secondary outcomes were comparison of technical success and adverse events compared with younger patients. RESULTS The initial search revealed 4933 studies, of which 24 studies with 5521 patients met our inclusion criteria. Pooled technical success rate of ERCP in nonagenarians was 92%, and pooled adverse event rate was 7.8%. There was no significant difference in technical success rate and overall rate of adverse events comparing ERCP outcomes in nonagenarians with a relatively younger population. The risk of post-ERCP bleeding was significantly higher in nonagenarians compared to younger patients with OR = 1.986 [1.113-3.544], I2 = 0. ERCP-related mortality was also significantly higher in nonagenarians compared to younger patients with OR = 4.720 [1.368-16.289], I2 = 0. CONCLUSION There was no significant difference in technical success rate and risk of adverse events related to ERCP in nonagenarians compared to younger patients. However, the risk of bleeding and procedure-related mortality was significantly higher.
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Salinero-Fort MA, Mostaza J, Lahoz C, Cárdenas-Valladolid J, Vicente-Díez JI, Gómez-Campelo P, de Miguel-Yanes JM. All-cause mortality and cardiovascular events in a Spanish nonagenarian cohort according to type 2 diabetes mellitus status and established cardiovascular disease. BMC Geriatr 2022; 22:224. [PMID: 35303825 PMCID: PMC8931574 DOI: 10.1186/s12877-022-02893-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 02/28/2022] [Indexed: 11/30/2022] Open
Abstract
Background Despite the progressive aging of the population in industrialized countries, few studies have focused on the natural history of cardiovascular disease in the very old, and recommendations on prevention of cardiovascular disease in this population are lacking. We aimed to analyze all-cause mortality and cardiovascular events according to prevalent type 2 diabetes mellitus and established cardiovascular disease in nonagenarians from a Mediterranean population. Methods We analyzed the primary health records of all nonagenarians living in the Community of Madrid (N = 59,423) and collected data for 4 groups: Group 1, individuals without T2DM or established CVD (T2DM-, CVD-); Group 2, individuals without T2DM but with established CVD (T2DM-, CVD +); Group 3, individuals with T2DM but without established CVD (T2DM + , CVD-); and Group 4, individuals with both T2DM and established CVD (T2DM + , CVD +), taking into account the influence of sex on the outcomes. Follow-up was 2.5 years. The primary outcomes were cumulative incidence and incidence density rates for all-cause mortality, non-fatal myocardial infarction, non-fatal stroke (the first composite primary outcome [CPO1]), combined with heart failure (CPO2). We evaluated the adjusted effect of each group on all-cause mortality (Cox regression). Results Mean age was 93.3 ± 2.8 years (74.2% women). Hypertension, dyslipidemia, heart failure, albuminuria, and estimated glomerular filtration rate < 60 mL/min/1.73 m2 were significantly more prevalent in G4 than in the other groups (all p values < 0.001). We observed significantly higher cumulative incidence rates for all-cause mortality, CPO1, and CPO2 in participants belonging to G4 (all p values ≤ 0.001). People in G2 presented higher rates of all-cause mortality, heart failure, CPO1, and CPO2 than people in G3 (all p values ≤ 0.001). In the fully adjusted model, G4 independently predicted all-cause mortality (HR = 1.48 [95% CI, 1.40 to 1.57] vs reference G1 [p < 0.01]). In addition, significant HRs were recorded for cardiovascular disease alone (G2) and type 2 diabetes mellitus alone (G3) (1.13 and 1.14, respectively; both p values < 0.01). Conclusions In Spanish nonagenarians, established cardiovascular disease and type 2 diabetes mellitus conferred a modest risk of all-cause mortality. However, the simultaneous presence of both conditions conferred the highest risk of all-cause mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02893-z.
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Affiliation(s)
- M A Salinero-Fort
- Fundación de Investigación e Innovación Biosanitaria de Atención Primaria, Madrid, Spain. .,Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdIPAZ, Madrid, Spain. .,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain. .,Subdirección General de Investigación y Documentación, Consejería de Sanidad, Madrid, Spain.
| | - J Mostaza
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdIPAZ, Madrid, Spain.,Servicio de Medicina Interna, Hospital Universitario La Paz-Cantoblanco-Carlos III, Madrid, Spain
| | - C Lahoz
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdIPAZ, Madrid, Spain.,Servicio de Medicina Interna, Hospital Universitario La Paz-Cantoblanco-Carlos III, Madrid, Spain
| | - J Cárdenas-Valladolid
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdIPAZ, Madrid, Spain.,Fundación de Investigación e Innovación Biosanitaria de Atención Primaria, Sistemas de Información, Madrid, Spain.,Universidad Alfonso X El Sabio, Madrid, Spain
| | - J I Vicente-Díez
- Centro de Salud Monóvar, Comunidad de Madrid Servicio Madrileño de Salud, Madrid, Spain
| | - P Gómez-Campelo
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdIPAZ, Madrid, Spain
| | - J M de Miguel-Yanes
- Departamento de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
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Kurazumi H, Suzuki R, Shirasawa B, Miyazaki Y, Tateishi H, Oda T, Okamura T, Mikamo A, Yano M, Hamano K. Early and Long-Term Outcomes of Transcatheter Aortic Valve Replacement for Selected Nonagenarians in Japan. Circ J 2022; 86:1748-1755. [PMID: 35135943 DOI: 10.1253/circj.cj-21-0949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is increasingly being performed in very elderly patients, although its efficacy and validity remain unclear. This study evaluated real-world TAVI outcomes in Japanese nonagenarians with severe aortic stenosis.Methods and Results:This single-center study retrospectively assessed the early and long-term clinical outcomes of TAVI in nonagenarians (n=35) and in patients aged <90 years (group Y; n=171). There were no in-hospital deaths in either group. The device success rate and early safety were comparable between the 2 groups. The 5-year rates of freedom from cardiac events and deaths were equivalent in both groups. The cumulative survival rate at 5 years was non-significantly lower in nonagenarians (32.6% in nonagenarians vs. 57.5% in patients aged <90 years, P=0.49). There were no differences in the 5-year survival between nonagenarians after TAVI and the sex- and age-matched populations (P=0.18). The Cox regression model revealed that lower hemoglobin levels were associated with all-cause mortality (P=0.02), and age ≥90 years was not associated with all-cause mortality. CONCLUSIONS The early and long-term clinical outcomes of TAVI for selected Japanese nonagenarians were comparable to those in patients aged <90 years. Nonagenarians who underwent TAVI achieved an acceptable prognosis compared to the sex- and age-matched population; thus, TAVI appears to be effective for treating aortic stenosis in Japanese nonagenarians.
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Affiliation(s)
- Hiroshi Kurazumi
- Division of Cardiac Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Ryo Suzuki
- Division of Cardiac Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Bungo Shirasawa
- Division of Cardiac Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Yosuke Miyazaki
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Hiroki Tateishi
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Tetsuro Oda
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Takayuki Okamura
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Akihito Mikamo
- Division of Cardiac Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Masafumi Yano
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Kimikazu Hamano
- Division of Cardiac Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine
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Lahoz C, Cárdenas-Valladolid J, Salinero-Fort MÁ, Mostaza JM. Use of statins and associated factors in nonagenarians in the Community of Madrid, Spain. Aging Clin Exp Res 2022; 34:439-444. [PMID: 34363590 PMCID: PMC8349136 DOI: 10.1007/s40520-021-01945-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/27/2021] [Indexed: 11/08/2022]
Abstract
Background The role of statins in the management of dyslipidemia in elderly patients with different cardiovascular risks remains unclear. Objective To study use of statins and associated factors in subjects aged 90 or over in the Community of Madrid, Spain. Methods Observational, cross-sectional study that included all people aged 90 or more residing in the Community of Madrid as of December 31, 2015. The clinical information was obtained from the database that contains the electronic medical records collected by family doctors in primary care. Comorbidity data are collected according to the International Classification of Primary Care, Second Edition (ICPC-2). Results The study population comprised 59,423 subjects, with a mean age of 93.3 (2.5) years (25.8% males). Slightly more than one quarter of the population (28.2%) was in treatment with statins, 21.9% were in primary prevention, and 48.1% in secondary prevention. The multivariate analysis revealed the factors independently associated with statin treatment to be younger age, not being institutionalized, a higher Barthel score, a lower Charlson score, a higher body mass index, and a history of diabetes, dyslipidemia, chronic kidney disease, and cardiovascular disease. Conclusions A significant percentage of nonagenarians—mainly less frail patients with more comorbidities—in the Community of Madrid receive statin treatment. No clear efficacy has been demonstrated in reducing cardiovascular events in an age group with such a short life expectancy.
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Nishimura YK, Kubokawa SI, Imai RI, Nakaoka Y, Nishida K, Seki SI, Kubo T, Yamasaki N, Kitaoka H, Kawai K, Hamashige N, Doi Y. Takotsubo Syndrome in Octogenarians and Nonagenarians. Circ Rep 2021; 3:724-732. [PMID: 34950798 PMCID: PMC8651470 DOI: 10.1253/circrep.cr-21-0090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/26/2021] [Accepted: 10/05/2021] [Indexed: 12/25/2022] Open
Abstract
Background:
Takotsubo syndrome (TTS) in the very elderly is poorly understood. We sought to clarify the characteristics of octogenarians and nonagenarians with TTS. Methods and Results:
From 148 patients with TTS who underwent coronary angiography, 68 very elderly patients aged ≥80 years (octogenarians/nonagenarians) were compared with 80 younger patients aged ≤79 years. Emotional triggers of TTS were less frequent (7% vs. 19%; P=0.043), whereas physical triggers were more frequent (69% vs. 46%; P=0.005), in octogenarians/nonagenarians than in patients aged ≤79 years. As initial clues to the diagnosis, electrocardiogram changes were more frequent (71% vs. 46%; P=0.003) and chest pain and/or dyspnea were less common (25% vs. 51%; P=0.001) in octogenarians/nonagenarians than in patients aged ≤79 years. Twenty-nine patients had acute heart failure (AHF) as a complication. AHF was more frequently found in octogenarians/nonagenarians than in patients aged ≤79 years (29% vs. 11%, respectively; P=0.006). Cardiac death occurred in 2 octogenarians/nonagenarians; non-cardiac death occurred in 3 octogenarians/nonagenarians and in 2 patients aged ≤79 years. Conclusions:
Emotional triggers of TTS were infrequent in octogenarians/nonagenarians with TTS. AHF was common and there was significant in-hospital all-cause mortality among octogenarians/nonagenarians.
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Affiliation(s)
- Yu-Ki Nishimura
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
| | - Sho-Ichi Kubokawa
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
| | - Ryu-Ichiro Imai
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
| | - Yoko Nakaoka
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
| | - Koji Nishida
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
| | - Shu-Ichi Seki
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
| | - Toru Kubo
- Department of Cardiology and Aging Science, Kochi Medical School Kochi Japan
| | - Naohito Yamasaki
- Department of Cardiology and Aging Science, Kochi Medical School Kochi Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Aging Science, Kochi Medical School Kochi Japan
| | - Kazuya Kawai
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
| | - Naohisa Hamashige
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
| | - Yoshinori Doi
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan.,Cardiomyopathy Institute, Chikamori Hospital Kochi Japan
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Catapano JS, Rumalla K, Srinivasan VM, Labib MA, Nguyen CL, Baranoski JF, Cole TS, Rutledge C, Rahmani R, Zabramski JM, Jadhav AP, Ducruet AF, Albuquerque FC, Lawton MT. Treatment of octogenarians and nonagenarians with aneurysmal subarachnoid hemorrhage: a 17-year institutional analysis. Acta Neurochir (Wien) 2021; 163:2941-2946. [PMID: 34580755 DOI: 10.1007/s00701-021-04985-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/22/2021] [Accepted: 08/23/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Outcomes for octogenarians and nonagenarians after an aneurysmal subarachnoid hemorrhage (aSAH) are particularly ominous, with mortality rates well above 50%. The present analysis examines the neurologic outcomes of patients ≥ 80 years of age treated for aSAH. METHOD A retrospective review was performed of all aSAH patients treated at Barrow Neurological Institute from January 1, 2003, to July 31, 2019. Patients were placed in 2 groups by age, < 80 vs ≥ 80 years. The ≥ 80-year-old group of octogenarians and nonagenarians was subsequently analyzed to compare treatment modalities. Poor neurologic outcome was defined as a modified Rankin Scale (mRS) score of > 2. RESULTS During the study period, 1418 patients were treated for aSAH. The mean (standard deviation) age was 55.1 (13.6) years, the mean follow-up was 24.6 (40.0) months, and the rate of functional independence (mRS 0-2) at follow-up was 54% (751/1395). Logistic regression analysis found increasing age strongly associated with declining functional independence (R2 = 0.929, p < 0.001). Forty-three patients ≥ 80 years old were significantly more likely to be managed endovascularly than with open microsurgery (67% [n = 29] vs 33% [n = 14], p < 0.001). Compared with younger patients, those ≥ 80 years old had an increased risk of mortality and poor neurologic outcomes at follow-up. In the ≥ 80-year-old group, only 4 patients had good outcomes; none of the 4 had preexisting comorbidities, and all 4 were treated endovascularly. CONCLUSIONS Age is a significant prognostic indicator of functional outcomes and mortality after aSAH. Most octogenarians and nonagenarians with aSAH will become severely disabled or die.
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Affiliation(s)
- Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Kavelin Rumalla
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Mohamed A Labib
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Candice L Nguyen
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Jacob F Baranoski
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Tyler S Cole
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Caleb Rutledge
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Redi Rahmani
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Joseph M Zabramski
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Ashutosh P Jadhav
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
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Bruno RR, Wernly B, Kelm M, Boumendil A, Morandi A, Andersen FH, Artigas A, Finazzi S, Cecconi M, Christensen S, Faraldi L, Lichtenauer M, Muessig JM, Marsh B, Moreno R, Oeyen S, Öhman CA, Pinto BB, Soliman IW, Szczeklik W, Valentin A, Watson X, Leaver S, Boulanger C, Walther S, Schefold JC, Joannidis M, Nalapko Y, Elhadi M, Fjølner J, Zafeiridis T, De Lange DW, Guidet B, Flaatten H, Jung C. Management and outcomes in critically ill nonagenarian versus octogenarian patients. BMC Geriatr 2021; 21:576. [PMID: 34666709 PMCID: PMC8524896 DOI: 10.1186/s12877-021-02476-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 09/17/2021] [Indexed: 11/10/2022] Open
Abstract
Background Intensive care unit (ICU) patients age 90 years or older represent a growing subgroup and place a huge financial burden on health care resources despite the benefit being unclear. This leads to ethical problems. The present investigation assessed the differences in outcome between nonagenarian and octogenarian ICU patients. Methods We included 7900 acutely admitted older critically ill patients from two large, multinational studies. The primary outcome was 30-day-mortality, and the secondary outcome was ICU-mortality. Baseline characteristics consisted of frailty assessed by the Clinical Frailty Scale (CFS), ICU-management, and outcomes were compared between octogenarian (80–89.9 years) and nonagenarian (> 90 years) patients. We used multilevel logistic regression to evaluate differences between octogenarians and nonagenarians. Results The nonagenarians were 10% of the entire cohort. They experienced a higher percentage of frailty (58% vs 42%; p < 0.001), but lower SOFA scores at admission (6 + 5 vs. 7 + 6; p < 0.001). ICU-management strategies were different. Octogenarians required higher rates of organ support and nonagenarians received higher rates of life-sustaining treatment limitations (40% vs. 33%; p < 0.001). ICU mortality was comparable (27% vs. 27%; p = 0.973) but a higher 30-day-mortality (45% vs. 40%; p = 0.029) was seen in the nonagenarians. After multivariable adjustment nonagenarians had no significantly increased risk for 30-day-mortality (aOR 1.25 (95% CI 0.90–1.74; p = 0.19)). Conclusion After adjustment for confounders, nonagenarians demonstrated no higher 30-day mortality than octogenarian patients. In this study, being age 90 years or more is no particular risk factor for an adverse outcome. This should be considered– together with illness severity and pre-existing functional capacity - to effectively guide triage decisions. Trial registration NCT03134807 and NCT03370692.
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Affiliation(s)
- Raphael Romano Bruno
- Department of Cardiology, Pulmonary Diseases, and Vascular Medicine, Medical Faculty, Heinrich Heine University of Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Bernhard Wernly
- Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria.,Division of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Malte Kelm
- Department of Cardiology, Pulmonary Diseases, and Vascular Medicine, Medical Faculty, Heinrich Heine University of Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.,Cardiovascular Research Institute Düsseldorf (CARID), Duesseldorf, Germany
| | - Ariane Boumendil
- Service de Réanimation Médicale, Publique-Hôpital de Paris, Hôpital Saint-Antoine, F-75012, Paris, France
| | - Alessandro Morandi
- Department of Rehabilitation Hospital Ancelle di Cremona, Cremona, Italy.,Geriatric Research Group, Brescia, Italy
| | - Finn H Andersen
- Department Of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway.,NTNU, Dep of Circulation and Medical Imaging, Trondheim, Norway
| | - Antonio Artigas
- Department of Intensive Care Medicine, CIBERes Corporacion Sanitaria Universitaria Parc Tauli, Barcelona, Spain
| | - Stefano Finazzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica, BG, Italy
| | - Maurizio Cecconi
- Department of Anaesthesia, IRCCS Instituto Clínico Humanitas, Humanitas University, Milan, Italy
| | - Steffen Christensen
- Department of Anaesthesia and Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Johanna M Muessig
- Department of Cardiology, Pulmonary Diseases, and Vascular Medicine, Medical Faculty, Heinrich Heine University of Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Brian Marsh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Rui Moreno
- Unidade de Cuidados Intensivos Neurocríticos e Trauma, Faculdade de Ciências Médicas de Lisboa, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Nova Médical School, Lisbon, Portugal
| | - Sandra Oeyen
- Department of Intensive Care, 1K12IC Ghent University Hospital, Ghent, Belgium
| | | | | | - Ivo W Soliman
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Wojciech Szczeklik
- Intensive Care and Perioperative Medicine Division, Jagiellonian University Medical College, Kraków, Poland
| | | | | | - Susannah Leaver
- Research Lead Critical Care Directorate St George's Hospital, London, UK
| | - Carole Boulanger
- NAHP Committee ESICM, Intensive Care Unit, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Sten Walther
- Linkoping University Hospital, Linkoping, Sweden
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Yuriy Nalapko
- European Wellness International, ICU, Luhansk, Ukraine
| | | | - Jesper Fjølner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | | | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Bertrand Guidet
- Service de Réanimation Médicale, Publique-Hôpital de Paris, Hôpital Saint-Antoine, F-75012, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France.,INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France
| | - Hans Flaatten
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Anaestesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Christian Jung
- Department of Cardiology, Pulmonary Diseases, and Vascular Medicine, Medical Faculty, Heinrich Heine University of Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
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Brandão D, Paúl C, Ribeiro O. Health care utilization in very advanced ages: A study on predisposing, enabling and need factors. Arch Gerontol Geriatr 2021; 98:104561. [PMID: 34706319 DOI: 10.1016/j.archger.2021.104561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/11/2021] [Accepted: 10/16/2021] [Indexed: 12/21/2022]
Abstract
This study aims to examine the effects of predisposing, enabling, and need factors on healthcare utilization in advanced age. Data from a sample of 270 Portuguese community-dwelling persons aged ≥80 years was used. Face-to-face interviews were conducted and included the application of a research protocol addressing a set of sociodemographic and health-related variables that expressed the Andersen Behavioral model (i.e., predisposing, enabling, and need factors). Predictors of visits to general practitioners (GP) and specialist physicians, as well as emergency department (ED) use and hospitalizations were investigated. Multivariate linear and logistic regression analyzes were used to model the effects of predictor factors specified in the Andersen Behavioral model. Our findings underscore that younger age and having multimorbidity were significantly associated with having GP visits. Specialist physician visits were associated with younger age and a higher number of daily medications. ED use was associated with being male, having formal social support and a higher number of daily medications. Hospitalizations were associated with being younger, being male and having multimorbidity. Our findings revealed that need and predisposing factors determined the most healthcare use.
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Kumar M, Long GW, Major M, Gates E, Studzinski DM, Callahan RE, Brown OW, Welsh RJ. Predictors of mortality in nonagenarians undergoing abdominal aortic aneurysm repair: analysis of the National Surgical Quality Improvement Program dataset. J Vasc Surg 2021; 75:1223-1233. [PMID: 34634420 DOI: 10.1016/j.jvs.2021.09.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The present study used the American College of Surgeons National Surgical Quality Improvement Program dataset to identify the predictors of 30-day mortality for nonagenarians undergoing endovascular aortic aneurysm repair (EVAR) or open surgical repair (OSR). METHODS Patients aged >90 years who had undergone abdominal aortic aneurysm repair from 2005 to 2017 were identified using procedure codes. Those with operative times <15 minutes were excluded. The demographics, preoperative comorbidities, and postoperative complications of those who had died by 30 days were compared with those of the patients alive at 30 days. RESULTS A total of 1356 nonagenarians met the criteria: 1229 (90.6%) had undergone EVAR and 127 (9.4%) had undergone OSR. The overall 30-day mortality was 10.4%. The patients who had died within 30 days were significantly more likely to have undergone OSR than EVAR (40.9% vs 7.2%; P < .001). They also had a greater incidence of dependent functional status (22.0% for those who had died vs 8.1% for those alive at 30 days; P < .001), American Society of Anesthesiology (ASA) classification of ≥4 (81.2% vs 18.8%; P < .001), perioperative blood transfusion (59.6% vs 20.3%; P < .001), postoperative pneumonia (12.1% vs 2.9%; P = .001), mechanical ventilation >48 hours (22.7% vs 2.6%; P < .001), and acute renal failure (12.1% vs 0.5%; P < .001). The EVAR group had a 30-day mortality rate of 2.6% in 1008 elective cases and 28.6% in 221 emergent cases. The OSR group had a 30-day mortality rate of 19.1% in 47 elective cases and 53.7% in 80 emergent cases. In the EVAR cohort, the 30-day mortality group had had a significantly greater incidence of dependent functional status (17% for those who had died vs 8% for those alive at 30 days; P = .004), ASA classification of ≥4 (76.4% vs 40.3%; P < .001), perioperative blood transfusion (57% vs 19%; P < .001), emergency surgery (71% vs 14%; P < .001), and longer operative times (150 vs 128 minutes; P = .001). CONCLUSIONS Nonagenarians had an incrementally increased, but acceptable, risk of 30-day mortality with EVAR in elective and emergent cases compared with that reported for octogenarians and cohorts of patients not selected for age. We found greater mortality for patients with dependent status, a higher ASA classification, emergent repair, and OSR. These preoperative risk factors could help identify the best surgical candidates. Given these results, consideration for EVAR or OSR might be reasonable for highly selected patients, especially for elective patients with a larger abdominal aortic aneurysm diameter for whom the risk of rupture is higher.
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Affiliation(s)
- Mohineesh Kumar
- Section of Vascular Surgery, Department of Surgery, Oakland University William Beaumont School of Medicine, Royal Oak, Mich
| | - Graham W Long
- Section of Vascular Surgery, Department of Surgery, Oakland University William Beaumont School of Medicine, Royal Oak, Mich.
| | - Matthew Major
- Section of Vascular Surgery, Department of Surgery, Oakland University William Beaumont School of Medicine, Royal Oak, Mich
| | - Elizabeth Gates
- Section of Vascular Surgery, Department of Surgery, Oakland University William Beaumont School of Medicine, Royal Oak, Mich
| | - Diane M Studzinski
- Section of Vascular Surgery, Department of Surgery, Oakland University William Beaumont School of Medicine, Royal Oak, Mich
| | - Rose E Callahan
- Section of Vascular Surgery, Department of Surgery, Oakland University William Beaumont School of Medicine, Royal Oak, Mich
| | - O William Brown
- Section of Vascular Surgery, Department of Surgery, Oakland University William Beaumont School of Medicine, Royal Oak, Mich
| | - Robert J Welsh
- Section of Vascular Surgery, Department of Surgery, Oakland University William Beaumont School of Medicine, Royal Oak, Mich
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Blanc E, Chaize G, Fievez S, Féger C, Herquelot E, Vainchtock A, Timsit JF, Gaillat J. The impact of comorbidities and their stacking on short- and long-term prognosis of patients over 50 with community-acquired pneumonia. BMC Infect Dis 2021; 21:949. [PMID: 34521380 PMCID: PMC8442401 DOI: 10.1186/s12879-021-06669-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 08/28/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The prognosis of patients hospitalized with community-acquired pneumonia (CAP) with regards to intensive care unit (ICU) admission, short- and long-term mortality is correlated with patient's comorbidities. For patients hospitalized for CAP, including P-CAP, we assessed the prognostic impact of comorbidities known as at-risk (AR) or high-risk (HR) of pneumococcal CAP (P-CAP), and of the number of combined comorbidities. METHODS Data on hospitalizations for CAP among the French 50+ population were extracted from the 2014 French Information Systems Medicalization Program (PMSI), an exhaustive national hospital discharge database maintained by the French Technical Agency of Information on Hospitalization (ATIH). Their admission diagnosis, comorbidities (nature, risk type and number), other characteristics, and their subsequent hospital stays within the year following their hospitalization for CAP were analyzed. Logistic regression models were used to assess the associations between ICU transfer, short- and 1-year in-hospital mortality and all covariates. RESULTS From 182,858 patients, 149,555 patients aged ≥ 50 years (nonagenarians 17.8%) were hospitalized for CAP in 2014, including 8270 with P-CAP. Overall, 33.8% and 90.5% had ≥ 1 HR and ≥ 1 AR comorbidity, respectively. Cardiac diseases were the most frequent AR comorbidity (all CAP: 77.4%). Transfer in ICU occurred for 5.4% of CAP patients and 19.4% for P-CAP. Short-term and 1-year in-hospital mortality rates were 10.9% and 23% of CAP patients, respectively, significantly lower for P-CAP patients: 9.2% and 19.8% (HR 0.88 [95% CI 0.84-0.93], p < .0001). Both terms of mortality increased mostly with age, and with the number of comorbidities and combination of AR and HR comorbidities, in addition of specific comorbidities. CONCLUSIONS Not only specific comorbidities, but also the number of combined comorbidities and the combination of AR and HR comorbidities may impact the outcome of hospitalized CAP and P-CAP patients.
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Affiliation(s)
| | | | | | - C Féger
- EMIBiotech, Paris, France
- ICUREsearch, Paris, France
| | | | | | - J F Timsit
- Medical and Infectious Diseases ICU, Bichat-Claude Bernard Hospital, APHP, Paris, France
- UMR 1137-IAME Team 5-DeSCID: Decision SCiences in Infectious Diseases Control and Care INSERM/University of Paris, Paris, France
| | - J Gaillat
- Infectious Diseases Department, Annecy-Genevois Hospital, Annecy, France.
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Yasukawa T, Ohya J, Yoshida Y, Kobayashi M, Onishi Y, Kudo Y, Shirahata T, Kawamura N. Surgical treatment for cervical spine injury in nonagenarians: A report of three cases. Trauma Case Rep 2021; 35:100531. [PMID: 34485669 DOI: 10.1016/j.tcr.2021.100531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 11/30/2022] Open
Abstract
Among the elderly, even minor injuries can cause cervical spine fractures. With the increasing number of nonagenarians, the opportunities for treatment of cervical spine injuries in nonagenarians are getting to be more common. Conservative therapy is often chosen in nonagenarians with cervical spine injuries because of high risk associated with surgical treatment; however, we present herein the cases of three patients in nonagenarians who underwent surgical treatment for cervical spine injury. After a fall, three cases of nonagenarians who lived alone and independent were diagnosed with a Jefferson fracture and minor dislocated type II odontoid fracture, a C4 fracture with diffuse idiopathic skeletal hyperostosis, and a fracture-dislocation of C2, respectively. Their past medical history included several diseases, but we decided that spine surgery under general anesthesia was acceptable based on their pre-injury condition. We performed posterior fixation for all cases. As a result, while two patients developed postoperative minor complications, all cases showed favorable postoperative courses. They acquired independent or partially assisted walking and were transferred to the hospital for rehabilitation. If fundamental activity of daily living and general condition permit, posterior fixation seems to be a good choice even in nonagenarians.
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Salhadar N, Dibas M, Sarraj A, Tekle W, Hassan AE. The outcomes of mechanical thrombectomy in nonagenarians and octogenarians in a majority hispanic population. Clin Neurol Neurosurg 2021; 208:106872. [PMID: 34391086 DOI: 10.1016/j.clineuro.2021.106872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/26/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND/OBJECTIVE Elderly patients (≥ 80 years) were underrepresented in randomized trials that proved the efficacy and safety of mechanical thrombectomy (MT) in acute ischemic strokes (AIS) due to large vessel occlusion (LVO). Additionally, the impact of race and socioeconomics on AIS outcomes is well-reported. We sought to compare the MT clinical outcomes between octogenarians and nonagenarians, the majority of whom are Hispanic, in underserved border communities. METHODS This is a retrospective cohort study that was conducted in a comprehensive stroke center between 2012 and 2020. The baseline characteristics and outcomes were compared between the two groups. The primary measured outcome included a favorable outcome on the modified Rankin Scale (mRS) after three months (mRS ≤ 2). Secondary outcomes included mortality, symptomatic intracerebral hemorrhage (sICH), and an improvement in NIH Stroke Scale (NIHSS) score (≤4). RESULTS Of 215 included patients, 184 (85.6%) were octogenarians and 31 (14.4%) were nonagenarians. There were no significant differences between octogenarians and nonagenarians in terms of rates of favorable outcomes after three months (30.4% vs. 19.4%, p = 0.247), clinical improvement in discharge NIHSS (16.3% vs. 19.4%, p = 0.753), mortality (24.5% vs. 29.0%; p = 0.710) and sICH (6.5% vs. 3.2%, p = 0.780). Furthermore, Hispanic and non-Hispanic patients had similar outcomes. CONCLUSION There were no significant differences in the outcomes of MT between octogenarians and nonagenarians and between Hispanic and non-Hispanic patients. The similar clinical outcomes between both age groups in our study and the lower rates of sICH support the use of this treatment among people who are aged 80 or older.
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Affiliation(s)
- Nura Salhadar
- University of Texas Rio Grande Valley, Brownsville, TX, USA
| | - Mahmoud Dibas
- Sulaiman Al Rajhi University, College of Medicine, Qassim, Saudi Arabia.
| | - Amrou Sarraj
- Department of Neurology, University of Texas at Houston Stroke Center, USA
| | - Wondwossen Tekle
- Department of Neurology, University of Texas Rio Grande Valley, Valley Baptist Medical Center - Harlingen, TX, USA
| | - Ameer E Hassan
- Department of Neurology, University of Texas Rio Grande Valley, Valley Baptist Medical Center - Harlingen, TX, USA
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Hendrix P, Killer-Oberpfalzer M, Broussalis E, Melamed I, Sharma V, Mutzenbach S, Pikija S, Collins M, Lieberman N, Hecker C, Goren O, Zand R, Schirmer CM, Trinka E, Griessenauer CJ. Outcome Following Mechanical Thrombectomy for Anterior Circulation Large Vessel Occlusion Stroke in the Elderly. Clin Neuroradiol 2021. [PMID: 34313798 DOI: 10.1007/s00062-021-01063-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Pooled data of randomized controlled trials investigating mechanical thrombectomy (MT) to treat anterior circulation large vessel occlusion have demonstrated safety and effectiveness across all age groups, including ≥ 80 years of age; however, only a few nonagenarians were in the ≥ 80 years subgroup. Therefore, the benefit of MT in nonagenarians is mostly unknown. METHODS Two comprehensive stroke centers retrospectively reviewed all acute ischemic stroke patients who underwent MT for anterior circulation large vessel occlusion (LVO) stroke between February 2016 and August 2020. Revascularization TICI2b/3, symptomatic intracranial hemorrhage (ICH), and functional outcome using modified Rankin scale (mRS) were assessed for cases aged < 80 years, 80-89 years, and 90-99 years. Favorable functional outcome was defined as mRS 0-2 or reaching the prestroke mRS and moderate as mRS 0-3. RESULTS The final data set comprised a total of 736 cases. Of these, 466 aged < 80 years, 219 aged 80-89 years, and 51 aged 90-99 years. In nonagenarians, TICI 2b/3 revascularization was observed in 84.3% while symptomatic ICH was observed in 4%. These rates were similar to 80-89 years and < 80 years age groups. Favorable and moderate functional outcome as well as death rates differed significantly between nonagenarians and < 80 years (19.6%, 29.4%, 51.0% vs 47.9%, 60.7%, 18.7%, respectively, p < 0.001), but were similar between nonagenarians and octogenarians (29.7%, 38.8%, 38.8%, p = 0.112-0.211). CONCLUSION A moderate outcome among nonagenarians was observed in about 30%, while mortality rates were about 50%. Withholding mechanical thrombectomy does not appear justifiable, although the absolute treatment effect among nonagenarians remains unknown.
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Poulain M, Herm A, Errigo A, Chrysohoou C, Legrand R, Passarino G, Stazi MA, Voutekatis KG, Gonos ES, Franceschi C, Pes GM. Specific features of the oldest old from the Longevity Blue Zones in Ikaria and Sardinia. Mech Ageing Dev 2021; 198:111543. [PMID: 34265327 DOI: 10.1016/j.mad.2021.111543] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/17/2021] [Accepted: 07/09/2021] [Indexed: 11/23/2022]
Abstract
Human longevity may be found in single individuals as well as in the population as a whole ("population longevity"). Longevity Blue Zones (LBZs), which are areas with an unusually high number of oldest old, have been identified in Sardinia and the Greek island of Ikaria. We compared the lifestyle, health status and some genetic markers of the LBZ populations with those of reference populations from Italy and Greece; the data were extracted from the GEHA database. In the LBZs, the proportion of individuals who never married or were married and still living with their spouse was significantly greater. Nonagenarians males and females with a high self‒perception of optimism and/or a high score for self-rated health were also found in larger proportions in LBZs. Among the variables with lower frequency were the proportion of the widowed, the percentage of subjects who had suffered a stroke and the frequency of Apoε4 and Apoε2 and the TT genotype of FOXO3A gene. Compared to behavioral and health indicators, the impact of genetic factors might be relatively less important in the LBZs. Nevertheless, further research is needed to identify potential epigenetic traits that might play a predominant role due to the interaction between genetics and the human and physical environments.
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Al-Rashdan A, Xu Y, Quan ML, Cao JQ, Cheung W, Bouchard-Fortier A, Kong S, Barbera L. Higher-risk breast cancer in women aged 80 and older: Exploring the effect of treatment on survival. Breast 2021; 59:203-210. [PMID: 34274566 PMCID: PMC8319352 DOI: 10.1016/j.breast.2021.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 11/28/2022] Open
Abstract
Background To understand the association between various treatments and survival for older women with higher-risk breast cancer when controlling for patient and tumor factors. Materials and methods We conducted a retrospective, population-based study. Women aged 80 years or older and diagnosed between 2004 and 2017 with non-metastatic, higher-risk breast cancer were identified form the provincial cancer registry in Alberta, Canada. Higher-risk was defined as any of following: T3/4, node positive, human epidermal factor receptor-2 (Her2) positive or triple negative disease. Treatments were surgery, radiotherapy and systemic therapy (hormonal therapy, and/or chemotherapy and/or trastuzumab) or a combination of the previous. Cox regression models were used to examine the association between treatments and breast cancer specific survival (BCSS) and overall survival (OS). Results 1369 patients were included. The median age was 84 years. 332 (24%) of women had T3-T4 tumors, 792 (58%) had nodal involvement, 130 (10%) had Her2 positive tumors, 124 (9%) had triple negative tumors. After a median follow-up of 35 months, 29.5% of patients died of breast cancer whereas 34.2% died from other causes. Patients had a lower adjusted hazard for BCSS if they had surgery (hazard ratio [HR] = 0.37 95% confidence interval [CI]: 0.27, 0.51), or systemic therapy (HR = 0.75, 95%CI: 0.58, 0.98). Patients had an increased probability of breast cancer death in the first 5 years after diagnosis compared to death from other causes. Conclusions Surgery and systemic therapy were associated with longer BCSS and OS. This suggests that maximizing treatments might benefit higher-risk patients. Breast cancer patients aged 80 or older are rarely represented in clinical trials. Association between survival and treatment is unknown for higher-risk patients. Breast cancer death affected around one-third of the higher-risk population. Surgery and systemic therapy were associated with lower breast cancer death.
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Affiliation(s)
- Abdulla Al-Rashdan
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Yuan Xu
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Tom Baker Cancer Centre, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - May Lynn Quan
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Tom Baker Cancer Centre, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jeffrey Q Cao
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Winson Cheung
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Tom Baker Cancer Centre, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Antoine Bouchard-Fortier
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Tom Baker Cancer Centre, Calgary, Alberta, Canada; Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shiying Kong
- The Department of Analytics, Alberta Health Services, Calgary, Alberta, Canada
| | - Lisa Barbera
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Tom Baker Cancer Centre, Calgary, Alberta, Canada.
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Merenstein JL, Corrada MM, Kawas CH, Bennett IJ. Age affects white matter microstructure and episodic memory across the older adult lifespan. Neurobiol Aging 2021; 106:282-291. [PMID: 34332220 DOI: 10.1016/j.neurobiolaging.2021.06.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 02/07/2023]
Abstract
Diffusion imaging studies have observed age-related degradation of white matter that contributes to cognitive deficits separately in younger-old (ages 65-89) and oldest-old (ages 90+) adults. But it remains unclear whether these age effects are magnified in advanced age groups, which may reflect disease-related pathology. Here, we tested whether age-related differences in white matter microstructure followed linear or nonlinear patterns across the entire older adult lifespan (65-98 years), these patterns were influenced by oldest-old adults at increased risk of dementia (cognitive impairment no dementia, CIND), and they explained age effects on episodic memory. Results revealed nonlinear microstructure declines across fiber classes (medial temporal, callosal, association, projection and/or thalamic) that were largest for medial temporal fibers. These patterns remained after excluding oldest-old participants with CIND, indicating that aging of white matter microstructure cannot solely be explained by pathology associated with early cognitive impairment. Moreover, finding that the effect of age on episodic memory was mediated by medial temporal fiber microstructure suggests it is essential for facilitating memory-related neural signals across the older adult lifespan.
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Affiliation(s)
| | - María M Corrada
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA; Department of Neurology, University of California, Irvine, CA, USA; Department of Epidemiology, University of California, Irvine, CA, USA
| | - Claudia H Kawas
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA; Department of Neurology, University of California, Irvine, CA, USA; Department of Neurobiology and Behavior, University of California, Irvine, CA, USA
| | - Ilana J Bennett
- Department of Psychology, University of California, Riverside, CA, USA
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Derraz I, Benali A, Ahmed R, Cagnazzo F, Dargazanli C, Gascou G, Riquelme C, Corti L, Lefevre PH, Bonafe A, Arquizan C, Costalat V. Impact of endovascular reperfusion therapy in nonagenarians with anterior circulation large-vessel ischaemic stroke. Age Ageing 2021; 50:787-794. [PMID: 33206940 DOI: 10.1093/ageing/afaa243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 10/14/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE The benefit of endovascular thrombectomy (EVT) among nonagenarians (90 years or older) is poorly documented. We aimed to investigate the clinical and imaging factors associated with good outcomes and mortality at 90 days in nonagenarians undergoing EVT for acute ischemic stroke (AIS). METHODS Data from a prospectively maintained institutional registry of consecutive AIS patients treated with EVT from January 2012 to December 2018 were retrospectively analysed. Comorbid conditions were classified with a modified version of the Charlson Comorbidity Index (CCI). The degree of disability was assessed by the modified Rankin Scale (mRS). Outcomes included good functional outcome (mRS scores of 0-3) and mortality at 90 days. RESULTS Among 110 patients (age, 92.3 ± 2.5 years; men, 28.2%) treated with EVT, good outcome was achieved in 39 (35.5%) patients, successful reperfusion (modified Thrombolysis in Cerebral Infarction grades of 2b-3) was achieved in 78 (70.9%) patients and 38 (34.5%) patients died at 90 days. The functional outcome at 3 months was associated with pre-stroke status (CCI and pre-stroke mRS score). Successful reperfusion (adjusted odds ratio [OR], 11.6; 95% CI, 1.3-104.2; P = 0.03) and early neurologic improvement at 24 h (adjusted OR, 16.4; 95% CI, 5.2-51.5; P < 0.001) were independent predictors of a good outcome. Early neurological improvement (adjusted OR, 0.06; 95% CI, 0.02-0.23; P < 0.001) was an independent predictor of 90-day mortality. CONCLUSIONS Successful reperfusion therapy improves the functional outcome of nonagenarians who should not be excluded from EVT. The presence and severity of comorbidities should be considered in the procedural management of this vulnerable population.
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Affiliation(s)
- Imad Derraz
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Amel Benali
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Raed Ahmed
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Federico Cagnazzo
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Cyril Dargazanli
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Gregory Gascou
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Carlos Riquelme
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Lucas Corti
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Pierre-Henri Lefevre
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Alain Bonafe
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Caroline Arquizan
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Vincent Costalat
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
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Derraz I, Ahmed R, Benali A, Corti L, Cagnazzo F, Dargazanli C, Gascou G, Riquelme C, Lefevre PH, Bonafe A, Arquizan C, Costalat V. FLAIR vascular hyperintensities and functional outcome in nonagenarians with anterior circulation large-vessel ischemic stroke treated with endovascular thrombectomy. Eur Radiol 2021; 31:7406-7416. [PMID: 33851277 DOI: 10.1007/s00330-021-07866-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 05/13/2020] [Revised: 03/04/2021] [Accepted: 03/11/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To establish whether imaging assessments of irreversibly injured ischemic core and potentially salvageable penumbral volumes and collateral circulation were associated with functional outcome in nonagenarians (90 years or older) undergoing endovascular thrombectomy (EVT). METHODS Data from a prospectively maintained institutional registry of consecutive stroke patients treated with EVT from January 2012 to December 2018 were retrospectively analyzed. Functional outcome was evaluated with the modified Rankin scale (mRS) at 3 months. mRS score of 0-3 was defined as a good clinical outcome. Ischemic core and penumbral volumes were calculated using the RAPID software. Quantification of collateral circulation was performed using a fluid-attenuated inversion recovery vascular hyperintensity (FVH)-Alberta Stroke Program Early CT Score (ASPECTS) rating system. RESULTS Among 85 patients (age, 92.4 ± 2.6 years; men, 30.6%) treated with EVT, good outcome (mRS 0-3) was achieved in 29 (34.1%) patients and 31 (36.5%) patients died at 90 days. The median estimated ischemic core volume was 15 mL (IQR, 7-27 mL). The median mismatch volume was 83 mL (IQR, 43-120 mL). The median FVH score was 4 (IQR, 3-4). FVH score was independently associated with good functional outcome (adjusted OR = 1.96 [95% CI, 1.16-3.32]; p = 0.01 per 1-point increase) and mortality (adjusted OR = 0.54 [95% CI, 0.34-0.85]; p = 0.007 per 1-point increase). Ischemic core and mismatch volumes were associated with neither good outcome nor mortality. CONCLUSIONS In nonagenarians with anterior circulation large-vessel ischemic stroke, good collaterals as measured by the FVH-ASPECTS rating system are independently associated with improved outcomes and may help select patients for reperfusion therapy in this frail population. KEY POINTS • Endovascular thrombectomy can allow at least 1 in 3 patients older than 90 years of age to achieve good functional outcome (modified Rankin scale of 0-3) at 3 months. • Functional outcome at 3 months is associated with pre-stroke status (number and severity of patients' comorbidities). • A higher FVH score (as reflected by higher FLAIR vascular hyperintensity [FVH]-Alberta Stroke Program Early CT Score [ASPECTS] values) is independently associated with better 3-month functional outcome and mortality in nonagenarians with anterior circulation ischemic stroke.
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Affiliation(s)
- Imad Derraz
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France.
| | - Raed Ahmed
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Amel Benali
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Lucas Corti
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Federico Cagnazzo
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Cyril Dargazanli
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Gregory Gascou
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Carlos Riquelme
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Pierre-Henri Lefevre
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Alain Bonafe
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Caroline Arquizan
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Vincent Costalat
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
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Thinggaard M, Jeune B, Osler M, Vaupel JW, McGue M, Christensen K. Are Advances in Survival Among the Oldest Old Seen Across the Spectrum of Health and Functioning? J Gerontol A Biol Sci Med Sci 2021; 75:2354-2360. [PMID: 31930341 DOI: 10.1093/gerona/glaa009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Mortality rates have been reduced by half over the last 60 years for nonagenarians, and the progress is continuing. The greater survival might be due to overtreatment of severely physically and cognitively disabled individuals, which is a big concern for societies and individuals. METHODS The study population comprised two Danish birth cohorts: the 1905 Cohort and the 1915 Cohort. At age 95, all from the two cohorts who were still alive and living in Denmark were invited to participate in a health survey that used the same assessment instrument. A total of 2,670 (56.8%) persons participated in the two surveys and survival was assessed through a 7.3-year follow-up period during which 2,497 (93.5%) had died, and with virtually no loss to follow-up. RESULTS Despite the increasing chance of surviving to age 95, the 1915 Cohort had significantly better health and functioning than the 1905 Cohort. The survival advantage in the 1915 Cohort continued in the follow-up period after age 95: Median survival length was 2.4 months longer, p = .011. This advantage was not statistically associated with different levels of activities of daily living, physical performance, cognitive functioning, self-rated health and life satisfaction. However, the advantage tended to be more pronounced among people with better health. CONCLUSIONS Life span and health increases among the oldest old. The improvement in survival for 95-year olds born in 1915 compared with 1905 was seen across the whole spectrum of health and functioning, with a tendency towards bigger improvement among those in good health.
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Affiliation(s)
- Mikael Thinggaard
- Danish Aging Research Center, Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense C
| | - Bernard Jeune
- Danish Aging Research Center, Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense C
| | - Merete Osler
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Denmark
| | - James W Vaupel
- Interdisciplinary Center on Population Dynamics, University of Southern Denmark, Odense C
| | - Matt McGue
- Danish Aging Research Center, Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense C.,Department of Psychology, University of Minnesota, Minneapolis
| | - Kaare Christensen
- Danish Aging Research Center, Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense C.,Department of Clinical Genetics and Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Denmark
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Latif A, Ahsan MJ, Lateef N, Kapoor V, Mirza MM, Anwer F, Del Core M, Kanmantha Reddy A. Outcomes of surgical versus transcatheter aortic valve replacement in nonagenarians- a systematic review and meta-analysis. J Community Hosp Intern Med Perspect 2021; 11:128-134. [PMID: 33552435 PMCID: PMC7850375 DOI: 10.1080/20009666.2020.1843235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Introduction: Since the approval of transcatheter aortic valve replacement (TAVR), nonagenarian group patients are being increasingly considered for TAVR. Therefore, we compared the clinical outcomes of surgical aortic valve replacement (SAVR) vs TAVR in nonagenarians with severe aortic stenosis. Methods: A literature search was performed using MEDLINE, Embase, Web of Science, Cochrane, and Clinicaltrials.gov for studies reporting the comparative outcomes of TAVR versus SAVR in nonagenarians. The primary endpoint was short-term mortality. Secondary endpoints were post-operative incidences of stroke or transient ischemic attack (TIA), vascular complications, acute kidney injury (AKI), transfusion requirement, and length of hospital stay. Results: Four retrospective studies qualified for inclusion with a total of 8,389 patients (TAVR = 3,112, SAVR = 5,277). Short-term mortality was similar between the two groups [RR = 0.91 (95% CI: 0.76–1.10), p = 0.318]. The average length of hospital stay was shorter by 3 days in the TAVR group (p = 0.037). TAVR was associated with a significantly lower risk of AKI [RR = 0.72 (95% CI: 0.62–0.83), p < 0.001] and a lower risk of transfusion [RR = 0.71 (95% CI: 0.62–0.81), p < 0.001]. There was no difference in risk of stroke/TIA[RR = 1.01 (95% CI: 0.70–1.45), p = 0.957]. The risk of vascular complications was significantly higher in the TAVR group [RR = 3.39 (95% CI: 2.65–4.333), p < 0.001]. Conclusion: In this high-risk population, TAVR compared to SAVR has similar short-term mortality benefit but has lower risks of perioperative complications and a higher number of patients being discharged to home.
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Affiliation(s)
- Azka Latif
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Muhammad Junaid Ahsan
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Noman Lateef
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Vikas Kapoor
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Mohsin Mansoor Mirza
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | | | - Michael Del Core
- Department of Cardiology, CHI Health Heart and Vascular Institute, Omaha, Nebraska
| | - Arun Kanmantha Reddy
- Department of Cardiology, CHI Health Heart and Vascular Institute, Omaha, Nebraska
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Noguchi M, Ueyama H, Ando T, Takagi H, Toshiki K. Clinical outcomes in nonagenarians undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis. Cardiovasc Interv Ther 2021; 37:202-208. [PMID: 33428156 DOI: 10.1007/s12928-021-00755-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/04/2021] [Indexed: 11/25/2022]
Abstract
To compare the risk of procedural complications and mortality after transcatheter aortic valve implantation (TAVI) in nonagenarians (age ≥ 90 years) compared to younger patients (< 90 years). Although TAVI could be considered as a treatment option in nonagenarians, several previous studies have shown conflicting outcomes between nonagenarians and younger patients who underwent TAVI. We conducted a comprehensive literature search through PubMed and EMBASE to investigate the clinical outcomes of nonagenarians after TAVI. The outcomes of interest were short- and long-term mortality and procedural complications. Our study identified 16 observational studies including a total of 179,565 patients (21,674 nonagenarian patients and 157,891 younger patients. Nonagenarians had a significantly higher rate of short- (hazard ratio [HR], 95% confidence interval [CI]: 1.48, 1.38-1.59; P < 0.001) and long-term mortality (HR, 95% CI: 1.34, 1.24-1.44; P < 0.001) than younger patients after TAVI. Furthermore, there were significant differences in major and/or life-threatening bleeding (risk ratio [RR], 95% CI: 1.21, 1.05-1.39; P = 0.008), stroke (HR, 95% CI: 1.24, 1.11-1.40; P < 0.001), and major vascular complication (RR, 95% CI: 2.15, 1.35-3.42; P = 0.001) between nonagenarians and younger patients after TAVI. Minor vascular complication, myocardial infarction and permanent pacemaker implantation rate were similar between the two groups. Nonagenarians had significantly higher rate of short- and long-term mortality, major and/or life-threatening bleeding, stroke, and major vascular complication after TAVI. Although TAVI is a treatment option in nonagenarians, careful and appropriate selection of patients is essential to improve clinical outcomes.
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Affiliation(s)
- Masahiko Noguchi
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Uyarasu, Japan
| | - Hiroki Ueyama
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
| | - Tomo Ando
- Department of Cardiology, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Hisato Takagi
- Division of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Kuno Toshiki
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA.
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