Bedside assessment of the risk of non-compliance to medication is associated with mortality in elderly patients admitted for acute coronary syndromes

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Briet ◽  
C Lacote ◽  
C Peron ◽  
K Blanchart ◽  
A Lemaitre ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Acute Coronary Syndromes ◽  
Cox Model ◽  
Fold Increase ◽  
Bedside Test ◽  
Tertiary Center ◽  
Coronary Syndromes ◽  
One Year ◽  
Grace Score

Abstract Background Elderly patients are at high risk of mortality in the setting of acute coronary syndromes (ACS). Purpose We investigated whether compliance assessed by Compliance Evaluation Test (CET) in elderly patients admitted for acute coronary syndromes was associated with higher risk of one-year mortality. Methods We used the data from a prospective, open, ongoing cohort of patients ≥75 years old admitted for ACS to a tertiary center. The CET is a validated 6 item test easily performed at bedside. Non-compliance is defined by ≥ “Yes” answers. We used a Cox model, un-adjusted and adjusted on predefined correlates of mortality (age, gender, and GRACE score) to assess the relationship between the risk of non-compliance and 1-year mortality. Results Two hundred fifty-five consecutive patients (age 83±5, female gender 59.6%, GRACE score 175±24) with CET assessment within 48 hours after admission and 1 year follow-up were included in the analysis. 225 (88%) were identified as compliant and 30 (12%) as non-compliant based on the CET. Thirthy-six deaths occurred at 1 year follow-up, 24 (10.6%) and 12 (30%) in compliant and non-compliant patients respectively. There was an almost 4-fold increase in the risk of one-year mortality in association with non-compliance (HR 4.16; 95% CI 2.03 to 8.5, p<0.0001) and adj-HR 3.93; 95% CI 1.87 to 8.3, p=0.003), independent of other covariables. Conclusions In elderly patients admitted for ACS, the risk of non-compliance assessed by the simple bedside test is associated with a 4-fold increase in the risk of 1-year mortality independent of other correlates of mortality. Our results support specific measures to improve compliance in such patients. Survival based on compliance test Funding Acknowledgement Type of funding source: None

Renal function estimation and one-year mortality in elderly patients with non-ST-segment elevation acute coronary syndromes

2014 ◽  
Vol 174 (1) ◽  
pp. 127-128 ◽  
Author(s):  
Nuccia Morici ◽  
Stefano De Servi ◽  
Anna Toso ◽  
Ernesto Murena ◽  
Paola Tamburrini ◽  
...  
Keyword(s):  
Renal Function ◽  
Elderly Patients ◽  
Acute Coronary Syndromes ◽  
Function Estimation ◽  
St Segment Elevation ◽  
St Segment ◽  
Coronary Syndromes ◽  
One Year

CHA2DS2-VASc score in acute coronary syndrome

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
H Santos ◽  
M Santos ◽  
I Almeida ◽  
H Miranda ◽  
C Sa ◽  
...  
Keyword(s):  
Logistic Regression ◽  
High Risk ◽  
Acute Coronary Syndromes ◽  
De Novo ◽  
Mortality Rates ◽  
Kaplan Meier ◽  
Risk Patients ◽  
Coronary Syndromes ◽  
One Year

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf Portuguese Registry of Acute Coronary Syndromes Background Acute coronary syndromes (ACS) are common and several scores were proposed to identify high-risk patients that presented worse prognosis in short and long-term follow up. CHA2DS2-VASc score is the score used to decide the initiation of anticoagulation therapy in atrial fibrillation (AF) patients. It is an easy and convenient score, used by physicians in clinical practice, which is helpful to apply in ACS predicting the high-risk patients. Objective CHA2DS2-VASc score as a prognosis method in ACS. Methods Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. CHA2DS2-VASc test as a predictor of AF with a receiver operating characteristic curve. Logistic regression to access if the score was a predictor of AF. According with a punctuation of CHA2DS2-VASc as 0, 1 and ≥2, was performed a Kaplan-Meier test to establish the survival rates and cardiovascular admission at one year of follow-up. Results 25271 patients had ACS, 1023 patients (4.2%) presented de novo AF. CHA2DS2-VASc score was a median predictor of de novo AF (Area Under Curve: 0.642, confidence interval (CI) 0.625-0.659), with a 66.7% sensibility and 55.1% specificity. Logistic regression revealed that the CHA2DS2-VASc score was a predictor of de novo AF in ACS (odds ratio (OR) 2.07, p < 0.001, CI 1.74-2.47). Mortality rates at one year of follow-up, even showing higher mortality rates associated with higher CHA2DS2-VASc punctuation, do not revealed to be significant, p = 0.099. On the other hand, the score exhibited a significant value, p = 0.050, for re-admission for all causes, according to the classification as 0, 1 or ≥2. Regarding re-admission for cardiovascular causes at one year of follow-up was associated with the score classification, with a Kaplan-Meier test of p = 0.011. Conclusions CHA2DS2-VASc score was a predictor of de novo AF in ACS and can be used as a prognostic method for all causes of re-admission and, in special, for cardiovascular cause of re-admission.

Bedside mental status and outcome in elderly patients admitted for acute coronary syndromes

Heart ◽  
2019 ◽  
Vol 105 (21) ◽  
pp. 1635-1641 ◽  
Author(s):  
Clément Briet ◽  
Katrien Blanchart ◽  
Adrien Lemaître ◽  
Isabelle Roux ◽  
Kelly Lavergne ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Mental Status ◽  
Mental State ◽  
Acute Coronary Syndromes ◽  
Cox Model ◽  
Assessment Method ◽  
Increased Risk ◽  
Coronary Syndromes ◽  
Bedside Tests ◽  
Simple Bedside

ObjectiveWe investigated whether mental status assessed by simple bedside tests in elderly patients admitted for acute coronary syndromes (ACS) was associated with higher risk of mortality.MethodsWe used the data from a prospective, open, ongoing cohort of patients≥75 years old admitted for ACS to a tertiary centre. Cognitive impairment (CogI) was defined by delirium detected by the Confusion Assessment Method or an abnormal Mini Mental State Examination score. A Cox model adjusted on predefined correlates of mortality was used to assess the relationship between CogI and 1-year mortality.ResultsSix-hundred consecutive patients with mental status assessment within 48 hours after admission were included. CogI was identified in 172 (29%) patients among whom 153 (25.5%) had an abnormal Mini Mental State Evaluation and 19 (3.2%) delirium. Death occurred in 49 (28.6%) patients with and 43 (10.5%) patients without CogI at 1 year. There was a significant association between CogI and 1-year mortality (adjusted-HR 2.4, 95% CI 1.53 to 3.62), p<0.001) independent of other covariables. CogI was also independently associated with higher rates of in-hospital bleeding and mortality as well as 3-month rates of all-cause, cardiovascular-related and heart failure-related rehospitalisation.ConclusionsCogI detected by simple bedside tests in patients≥75 admitted for ACS is associated with an increased risk of 1-year mortality and 3 month rehospitalisation independent of other correlates of poor outcome.

P2525Relationship of Charlson Comorbidity Index with adverse events in elderly patients with Acute Coronary Syndromes: an analysis from LONGEVO-SCA Registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M A Esteve Pastor ◽  
E Martin ◽  
O Alegre ◽  
J C Castillo Dominguez ◽  
F Formiga ◽  
...  
Keyword(s):  
Adverse Events ◽  
Elderly Patients ◽  
Acute Coronary Syndromes ◽  
Risk Of Mortality ◽  
All Cause Mortality ◽  
Coronary Syndromes ◽  
Comorbidity Index ◽  
The Relationship ◽  
Worse Prognosis

Abstract Background Elderly patients with Acute Coronary Syndromes (ACS) are under-represented in clinical trials and they have higher risk of new due their comorbidities. Charlson Comorbidity Index (CCI) is an established tool for evaluating the burden of comorbidity status and a high score of CCI is related with an increased risk of death. Purpose The aim of this study was to analyze the relationship of CCI in adverse outcomes at short-term follow-up in elderly patients admitted by an ACS. Methods The prospective multicenter LONGEVO-SCA included unselected elderly patients (≥80 years old) hospitalized after non-STACS. In this substudy, we analyze the influence of comorbidities, comparing the relationship between quartiles of CCI and adverse events at 6 months follow-up of CCI. Results We analyzed 520 patients (mean age 84.4±3.6 years; 320 (61.5%) male). 196 (37.6%) were classified into Q1, 105 (20.2%) into Q2, 93 (17.9%) into Q3 and 126 (24.2%) into Q4. No differences were observed in treatment at discharge across different quartiles for aspirin (p=0.648), beta-blockers (p=0.908) or statins (p=0.756). We observed a significant increase for all-cause mortality [9 (4.8%) vs 10 (10.2%) vs 11 (12.0%) vs 32 (26.0%); p<0.001] and readmissions [36 (18.4%) vs 21 (20%) vs 33 (35.5%) vs 48 (38.1%); p<0.001] respectively from Q1 to Q4. After Cox multivariate regression analysis, CCI was independently associated with mortality or readmissions [HR 1.15, 95% CI (1.06–1.26); p=0.001] and patients into high quartile had 6-fold risk of mortality [HR 6.19, 95% CI (2.95–12.99); p<0.001]. Kaplan Meier analysis showed that patients in the highest quartiles had significantly worse prognosis during the follow-up with high risk of all-cause mortality and readmissions (both p<0.001). Event Free Survival according Charlson Conclusions In LONGEVO-SCA registry, we validated for the first time CCI as an independent factor related with adverse events. Patients into high quartiles of CCI had significantly worse prognosis during the follow-up and elderly patients into Q4 had 6-fold risk of mortality compared to Q1 patients.

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