scholarly journals Indications for prescription and deprescription in multimorbid independently living elderly outpatients

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Popov ◽  
N V Izmozherova ◽  
E I Gavrilova ◽  
A A Kuryndina ◽  
M A Shambatov ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Elderly Patients ◽  
Age Groups ◽  
Total Serum ◽  
Total Serum Cholesterol ◽  
Coronary Syndrome ◽  
Start Criteria ◽  
Informed Consent Form ◽  
Stopp Criteria ◽  
Group 3

Abstract Introduction Global trend to population ageing is associated with inevitable increase of polypharmacy in multimorbid elderly population. Purpose To estimate the level and structure of comorbidity and pharmacotherapy in independently living patients of different age groups with high and extreme cardiovascular risk, when observed in outpatient clinics Methods 282 consecutive patients of high cardiovascular risk have been enrolled. Inclusion criteria were: SCORE ≥5%, documented history of acute myocardial infarction (AMI), acute or transient cerebrovascular accident (CVD), coronary artery intervention, acute coronary syndrome (ACS), stable angina, intermittent claudication, type 2 diabetes mellitus (DM2) or type 1 DM with diabetic nephropathy, angiogram or ultrasound proved atherosclerotic plaques, total serum cholesterol level ≥8 mmol/L, blood pressure ≥180/110 mmHg and signed voluntary informed consent form. Current clinical conditions, pharmacologic treatment and indications for prescription and deprescription were studied. STOPP criteria for prescribing potentially non-recommended drugs in people over 65 years of age, START criteria for not prescribing necessary drugs in people over 65 years of age, non-recommended in elderly people over 65 drug list were used to assess polypharmacy. According to the WHO age classification, there were three groups: Group 1 (aged 45 to 59), Group 2 (aged 60 to 74) and Group 3 (aged 75 +). Results There were no differences in the frequency of statins administration (p=0.72) and antiplatelet agents (p=0.49) between 3 groups. Polypragmasia (administration of more than 5 drugs) was registered in 150 patients (53%) and was significantly more common in Group 3 (p=0.001). 48 cases of inadequate prescribing were registered in 46 (28%) elderly patients. 24 cases of prescribing potentially unacceptable medications for the elderly were reported. Conclusion Unavoidable polypragmasia was found in 53% multimorbid elderly patients. Irrational drug treatment was detected in 28% elderly patients STOPP criteria were met in 32.1% and START criteria were met in 30.4% cases. Polypragmasia being inevitable in elderly multimorbid patients, administration of any new medication should be performed after a thorough risk-benefits balance assessment. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Predicting 10-year cardiovascular risk using WHO/ISH risk prediction chart among urban population in Salem

2018 ◽  
Vol 5 (12) ◽  
pp. 5228
Author(s):  
K. Premanandh ◽  
R. Shankar
Keyword(s):  
Cardiovascular Risk ◽  
High Risk ◽  
Risk Prediction ◽  
Disease Risk ◽  
Smoking Status ◽  
Cardiovascular Disease Risk ◽  
Total Serum ◽  
Total Serum Cholesterol ◽  
Cvd Risk ◽  
Very High

Background: Coronary vascular disease (CVD) risk estimation tools are a simple means of identifying those at high risk in a community and hence a potentially cost-effective strategy for CVD prevention in resource-poor countries. The WHO /ISH risk prediction charts provide approximate estimates of cardiovascular disease risk in people who do not have established coronary heart disease, stroke or other atherosclerotic disease.Methods: A total of 280 subjects between 40 to 70 years of age were included in this cross sectional study. Eligible households was selected randomly (every 5th household) for the interview using systematic random sampling. Age, gender, smoking status, systolic blood pressure, presence or absence of diabetes and total serum cholesterol were used to compute the total CVD risk using WHO/ISH CVD risk prediction chart. The chart stratify an individual into low (<10%), moderate (10% to <20%), high (20% to <30%), and very high (>30%) risk groups.Results: Moderate and high CVD risk were 12.14% and 7.5% respectively. Of total study participants, 2.5% had very high risk (>40%). High risk (binge drinking) alcohol drinkers (p=0.04) and abdominal obesity (p=0.0001) were significantly associated with higher CVD risk. Higher prevalence of behavioral risk factors was also reported in our study population.Conclusions: A large proportion of the population is at moderate and high cardiovascular risk. Risk stratification and identification of individuals with a high risk for CHD who could potentially benefit from intensive primary prevention efforts are critically important in reducing the burden of CVD in India.

P1558Clinical utility of the PRECISE-DAPT score in the prediction of hemorrhagic events in elderly patients with acute coronary syndrome

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Rioboo ◽  
E Abuassi Alnakeeb ◽  
S Raposeiras Roubin ◽  
I Munoz Pousa ◽  
M Cespon Fernandez ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
High Risk ◽  
Elderly Patients ◽  
Age Groups ◽  
Bleeding Event ◽  
Bleeding Risk ◽  
The Elderly ◽  
Coronary Syndrome ◽  
Risk Of Bleeding ◽  
Risk Patients

Abstract Introduction The clinical utility and validity of the PRECISE-DAPT bleeding risk score for elderly patients with acute coronary syndrome (ACS) is unknown. We investigated the previous aspect in a contemporary population treated with percutaneous coronary intervention (PCI) and dual antiplatelet therapy (DAPT) at discharge. Methods Retrospectively, from 2010 to 2016, we studied 3,814 consecutive patients with the diagnosis of ACS. All patients were treated with in-hospital PCI and DAPT at discharge. Elderly was defined if patients aged ≥75 years. Patients were categorized into three risk strata according to their PRECISE-DAPT score (very low-low: <17 points, moderate: 18–24 points, and high risk: ≥25 points). We included the first bleeding event occurred during the first year after discharge. Bleeding events were defined according to the BARC classification system, and divided into two subgroups: BARC 2–5 and BARC 3–5. The ability to separate high bleeding risk patients from lower bleeding risk patients was checked by the cumulative incidence function curves and compared using the Fine-Gray test, thus adjusting for death (non-bleeding related) as a competing risk. Discrimination (C statistic) and calibration (Hosmer-Lemeshow test) were used to test the predictive capacity of the score in pts aged ≥75 years and <75 years. Results 25.2% (n=961/3814) were ≥75 years old, 38.4% of them were women. DAPT duration was 11.5 (interquartile range [IQR] 2.5–13.7) vs. 12.0 (RIQ 8.2–14.1) months in the elderly vs. younger; (p<0.001). 92.5% (n=889) of the elderly were at high risk of bleeding (PRECISE-DAPT≥25 points), compared to 21.3% (n=607) of the youngest. The incidence of BARC 2–5 and BARC 3–5 was 7.4% and 2.7% in the elderly compared to 5.1% and 1.4% among the younger patients (p<0.001). The figure shows the ability of the PRECISE-DAPT score at capturing the risk of BARC 2–5 bleeding (panel A and B), in both age groups. Using the cut-off point ≥25, the effect in the prediction of BARC 2–5 bleeding and BARC 3–5 did not differ significantly between the elderly and those <75 years: sHR = 1.9 (95% CI: 1.2–6.00) in the elderly vs. 1.8 (95% CI: 1.3–2.5) in the other group (p=0.99) and sHR = 3.3 (95% CI: 1.9–6.0) vs. 3.6 (95% CI: 1.9–6.7) (p=0.83), respectively. There were no significant differences between the elderly and those under 75 years in terms of statistical C values either for BARC 2–5 bleeding (0.60 vs. 0.58) or BARC 3–5 bleeding (0.64 vs. 0.67). The score performed well in term of calibration in both groups (all p-values >0.3). Conclusion Although the use of PRECISE-DAPT resulted in classifying the majority of elderly patients at high risk of bleeding and despite exhibiting modest discriminative power, it performed well at classifying patients according to their risk of 1-year out-of-hospital bleeding in both age groups. PRECISE-DAPT appears to identify the truly low risk patients among the elderly, as compared to the younger group.

Assessment of Cardiovascular Risk in Hospitalized Patients with Hypertension Aged 40 and Over

2017 ◽  
Vol 10 (1) ◽  
pp. 50-57
Author(s):  
Joana I. Simeonova ◽  
Snejanka T. Tisheva-Gospodinova ◽  
Yoana M. Todorova ◽  
Petkana A. Hristova ◽  
Asia N. Yanakieva ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Risk Estimation ◽  
Absolute Risk ◽  
Premature Death ◽  
Cross Sectional Study ◽  
Total Serum ◽  
Total Serum Cholesterol ◽  
Cross Sectional ◽  
The Mean

SummaryThe aim of the cross-sectional study was to estimate the absolute 10-year risk for fatal cardiovascular disease (CVD) in patients with hypertension by Systematic Coronary Risk Estimation (SCORE). The study was carried out in 2016 as part of Project No 4/2016. Ninety-one patients aged 40-89 years were included. The mean age of the sample was 66.0±11.0, and 44.0% were males. Information of the patients’ risk profile included about age, gender, blood pressure, smoking and total cholesterol. The patients with hypertension were stratified according to a 10-year absolute risk of CVD. Data were processed by Statistical Package for Social Science versions 19.0 (SPSS.v.19.0). Over two-thirds of the patients had 1 stage hypertension (31.9%) and 2 stage hypertension (37.4%). Median systolic blood pressure on admission to the clinics was 160 mg Hg, and median diastolic blood pressure was 90 mm Hg. Total serum cholesterol values exceeded 4.9 mmol/L in 64.0% of the patients. Smokers accounted for about one-fourth of the patients, most of them having smoked for 40 years. The mean number of risk factors for CVD was 3.0. Over 65% of the patients were found to be at a very high 10-year absolute risk of fatal CVD by SCORE. Cardiovascular risk assessment has important role in prevention of morbidity, premature death and disability of CVD.

scholarly journals Higher Frequency of Undetected Acute Coronary Syndrome in Elderly Patients with Chest Pain Who Visited the Emergency Department: A Large-Cohort Retrospective Study

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Ki Hun Hong ◽  
Sung Jin Bae ◽  
Dong Hoon Lee ◽  
Choung Ah. Lee ◽  
Sang Hyun Park ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Elderly Patients ◽  
Age Groups ◽  
Diagnostic Tools ◽  
Baseline Characteristic ◽  
University Hospitals ◽  
Old Patients ◽  
Coronary Syndrome

Background. Acute coronary syndrome (ACS) is a critical disease encountered in the emergency department (ED). Despite the development of diagnostic tools, it may be difficult to diagnose ACS because of atypical symptoms and equivocal test results. We investigated the difference in the rates of revisit and undetected ACS between adult and elderly patients who visited the ED with chest pain. Method. Data from 11,323 patients who visited the ED with chest pain at university hospitals in Korea were retrospectively analyzed. The cohort was categorized into two age groups: the adult (30–64 years) and elderly (>65 years). Baseline characteristic data (age, sex, vital signs, triage category, etc.) were obtained. We selected patients who revisited the ED within 30 d and investigated whether ACS was diagnosed. Result. The revisit rate was higher in the elderly (12%) than in the adult group (8.3%). The rate of undetected ACS among the revisited patients was 2.91% (18/7,186) in adults and 6.08% (16/1,998) in elderly patients. Conclusion. Elderly patients with chest pain had an increased rate of ED revisits and undetected ACS than adult patients. We recommend that old patients should be hospitalized to observe the progression of cardiac complaints or receive short-term follow-up.

scholarly journals How safe are elective craniotomies in elderly patients in neurosurgery today? A prospective cohort study of 1452 consecutive cases

2020 ◽  
pp. 1-9
Author(s):  
Ralph T. Schär ◽  
Shpend Tashi ◽  
Mattia Branca ◽  
Nicole Söll ◽  
Debora Cipriani ◽  
...  
Keyword(s):  
Cohort Study ◽  
Blood Loss ◽  
Elderly Patients ◽  
Age Groups ◽  
Head Ct ◽  
Estimated Blood Loss ◽  
Group 3 ◽  
Group 2 ◽  
The Impact ◽  
Group 1

OBJECTIVEWith global aging, elective craniotomies are increasingly being performed in elderly patients. There is a paucity of prospective studies evaluating the impact of these procedures on the geriatric population. The goal of this study was to assess the safety of elective craniotomies for elderly patients in modern neurosurgery.METHODSFor this cohort study, adult patients, who underwent elective craniotomies between November 1, 2011, and October 31, 2018, were allocated to 3 age groups (group 1, < 65 years [n = 1008], group 2, ≥ 65 to < 75 [n = 315], and group 3, ≥ 75 [n = 129]). Primary outcome was the 30-day mortality after craniotomy. Secondary outcomes included rate of delayed extubation (> 1 hour), need for emergency head CT scan and reoperation within 48 hours after surgery, length of postoperative intensive or intermediate care unit stay, hospital length of stay (LOS), and rate of discharge to home. Adjustment for American Society of Anesthesiologists Physical Status (ASA PS) class, estimated blood loss, and duration of surgery were analyzed as a comparison using multiple logistic regression. For significant differences a post hoc analysis was performed.RESULTSIn total, 1452 patients (mean age 55.4 ± 14.7 years) were included. The overall mortality rate was 0.55% (n = 8), with no significant differences between groups (group 1: 0.5% [95% binominal CI 0.2%, 1.2%]; group 2: 0.3% [95% binominal CI 0.0%, 1.7%]; group 3: 1.6% [95% binominal CI 0.2%, 5.5%]). Deceased patients had a significantly higher ASA PS class (2.88 ± 0.35 vs 2.42 ± 0.62; difference 0.46 [95% CI 0.03, 0.89]; p = 0.036) and increased estimated blood loss (1444 ± 1973 ml vs 436 ± 545 ml [95% CI 618, 1398]; p <0.001). Significant differences were found in the rate of postoperative head CT scans (group 1: 6.65% [n = 67], group 2: 7.30% [n = 23], group 3: 15.50% [n = 20]; p = 0.006), LOS (group 1: median 5 days [IQR 4; 7 days], group 2: 5 days [IQR 4; 7 days], and group 3: 7 days [5; 9 days]; p = 0.001), and rate of discharge to home (group 1: 79.0% [n = 796], group 2: 72.0% [n = 227], and group 3: 44.2% [n = 57]; p < 0.001).CONCLUSIONSMortality following elective craniotomy was low in all age groups. Today, elective craniotomy for well-selected patients is safe, and for elderly patients, too. Elderly patients are more dependent on discharge to other hospitals and postacute care facilities after elective craniotomy.Clinical trial registration no.: NCT01987648 (clinicaltrials.gov).

scholarly journals Population Based Survey Study Associated With Prevalence Of Cardiovascular Risk Factors In India

2020 ◽  
Vol 3 (1) ◽  
pp. 144-148
Author(s):  
Mandheer Kaur ◽  
Sahil Sharma ◽  
Chaitanayajit Singh ◽  
Ankit Magotra ◽  
Preeti Devi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Age Groups ◽  
Heart Rhythm ◽  
Population Based ◽  
Blood Cholesterol ◽  
Survey Study ◽  
Level Of Knowledge ◽  
Group 3

The present study was conducted on 204 individuals of different regions of Chandigarh, Mohali, Panchkula, Himachal Pradesh and Haryana, India, to assess the level of knowledge and awareness of risk factors associated with cardiovascular disease (CVD) in targeted population. Population survey based study was carried out in people grouped in three age groups (Group 1: <18 years, Group 2: Between 18-40 years, Group 3: Above 40). Cardiovascular risk assessment questionnaire was used to assess the level of knowledge and awareness of risk factors via goggle forms and manually filling the same forms. Among risk factors 8.8 percent persons from our targeted population encountered with heart attack, angina, abnormal Heart Rhythm with significant hike in CVD cases was observed in group 3 individuals. Incidence of high blood pressure was observed in 32.4%, 4.9% are normal and 62.7% are unaware of their blood pressure status. Similarly, majority of the population 42.6% are not aware of their blood cholesterol level. The participants were not aware about regular physical activity and exercise, food intake to lower risk factors for the heart disease. There is an urgent need to increase awareness among the population utilizing community based education programs.

scholarly journals Dietary Interventions Reduce Traditional and Novel Cardiovascular Risk Markers by Altering the Gut Microbiome and Their Metabolites

2021 ◽  
Vol 8 ◽  
Author(s):  
Amrita Vijay ◽  
Stuart Astbury ◽  
Louca Panayiotis ◽  
Francine Marques ◽  
Tim D. Spector ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Gut Microbiome ◽  
Major Adverse Cardiovascular Events ◽  
Total Serum ◽  
Total Serum Cholesterol ◽  
Dietary Interventions ◽  
Triglyceride Fraction ◽  
Microbiome Composition ◽  
Incidence And Mortality

Aims: The current study investigates the role of diet in mediating the gut microbiome-cardiovascular association which has not yet been explored in humans.Methods and Results: Using a two-arm dietary intervention study in healthy participants (N = 70), we assessed the effects of omega-3 and fibre supplementation on gut microbiome composition and short-chain fatty acid (SCFA) production. We then investigated how changes in gut microbiome composition correlated with changes in traditional cardiovascular risk factors (cholesterol, triglycerides, blood pressure), cytokines, and novel validated markers such as GlycA and ceramides, previously linked to CVD incidence and mortality. Both interventions resulted in significant drops in blood pressure, cholesterol, proinflammatory cytokines, GlycA and ceramides (all P &lt; 0.05). Decreases in the atherogenic low-density lipoprotein triglyceride fraction, in total serum cholesterol were correlated with increases in butyric acid-production [β(SE) = −0.58 (0.06), P &lt; 0.001; −0.53 (0.04), P &lt; 0.001] and nominally associated with increases in some butyrogenic bacteria. Drops in GlycA were linked to increases in Bifidobacterium [β(SE) = −0.32 (0.04), P = 0.02] and other SCFAs including acetic acid [β(SE) = −0.28 (0.04), P = 0.02] and propionic acid [β(SE) = −0.3 (0.04), P = 0.02]. Additionally, we report for the first-time reductions in specific ceramide ratios that have been shown to predict CVD mortality and major adverse cardiovascular events such as d18:1/16:0, d18:0/24:0, and d18:1/24:1 which were associated with the reduction in the abundance in Colinsella and increases in Bifidobacteriuim and Coprococcus 3 and SCFAs (all P &lt; 0.05).Conclusion: Overall, these findings support the potential of using simple dietary interventions to alter validated biomarkers linked to cardiovascular risk via the gut microbiome composition and its metabolic functions.

scholarly journals Possibilities of Using Rivaroxaban in Elderly Patients with Atrial Fibrillation: Data from Randomized Studies and Real Clinical Practice

2018 ◽  
Vol 14 (4) ◽  
pp. 575-582
Author(s):  
N. M. Vorobyeva ◽  
O. N. Kacheva
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Elderly Patients ◽  
Major Bleeding ◽  
Age Groups ◽  
Minor Bleeding ◽  
Systemic Embolism ◽  
Risk Of Death ◽  
Coronary Syndrome ◽  
Real Clinical Practice

The possibility of rivaroxaban using in elderly patients with non-valvular atrial fibrillation is discussed in the review. The results of ROCKET-AF randomized trial, including subgroup analysis in patients older than 75 years, are presented. The problem of unreasonable prescription of low doses of anticoagulants in real clinical practice and questions of adherence of patients to anticoagulant therapy are discussed. The results of two recent studies of actual clinical practice performed in patients over the age of 80 and 85 years, respectively, are presented as well as favorable profile of the efficacy and safety of rivaroxaban in these age groups. Rivaroxaban reduced the risk of stroke/systemic embolism by 38% and ischemic stroke by 41% with a comparable risk of major bleeding in patients older than 80 years. In another study, in patients older than 85 years in the rivaroxaban group, a 11% reduction in the risk of death from all causes, a reduction in the risk of major bleeding by 10% and an acute coronary syndrome by 14%, with similar risk of stroke/systemic embolism, clinically significant minor bleeding and a combined endpoint (stroke/systemic embolism, large bleeding, death from all causes) have been found.

scholarly journals Establishing Reference Total Serum Cholesterol Values for Saudi Children

1994 ◽  
Vol 31 (4) ◽  
pp. 347-350 ◽  
Author(s):  
Ziad S Rafii ◽  
Abdul Aziz Al Nasser ◽  
Afif Budair ◽  
Mohammed Tufail
Keyword(s):  
Serum Cholesterol ◽  
Statistical Difference ◽  
Dietary Habits ◽  
Age Groups ◽  
Total Serum ◽  
Total Serum Cholesterol ◽  
Age Group ◽  
Lower Serum ◽  
Lower Serum Cholesterol ◽  
American Children

Total serum cholesterol was measured in 1320 normal Saudi children aged 0–14 years. The result was 3·88 (0·83) mmol/L [mean (SD)] and there was no statistical difference between girls and boys. Results were lowest in the 0–4 year age group and highest in the 5–9 year age group. Percentile values were established for three age groups and compared with those published for American children; no statistical differences were observed. Unlike other developing countries Saudi children do not have lower serum cholesterol than their western counterparts. We believe that these findings reflect changing dietary habits and increasing affluence in Saudi Arabia.

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