P1781Burden of significant valvular heart disease in elderly patients presenting with acute coronary syndromes

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Montalto ◽  
G Crimi ◽  
F Fortuni ◽  
A Mandurino Mirizzi ◽  
L A Ferri ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Disease ◽  
Elderly Patients ◽  
Primary Endpoint ◽  
Valvular Heart Disease ◽  
Acute Coronary Syndromes ◽  
Left Ventricular Ejection ◽  
History Of ◽  
Coronary Syndromes ◽  
History Of Cancer

Abstract Background Elderly patients with acute coronary syndromes (ACS) represent a group seldom included in clinical trials and in whom robust data regarding mid-term impact of significant concomitant valvular heart disease are lacking. Purpose Our aim was to evaluate the impact of moderate-to-severe mitral regurgitation (MR), moderate-to-severe aortic stenosis (AS), or both conditions combined on a primary composite endpoint of mortality, myocardial infarction, disabling stroke and re-hospitalization for cardiovascular causes or bleeding within one year in a population of ACS patients included in the Elderly ACS 2 trial. Methods In the multicenter Elderly II ACS Study, 1,443 patients aged >74 y undergoing percutaneous coronary intervention (PCI) for ACS, were randomly assigned to receive prasugrel (5 mg) or clopidogrel (75 mg) and were prospectively followed for 1 year. Amongst these, 1,102 patients received full echocardiographic assessment and were included in the post-hoc analysis (Table 1). Results Survival analysis showed that patients presenting with moderate-to-severe MR, AS or both (Figure 1A), had worse outcome in terms of primary endpoint (p<0.001) as compared to no valve disease. A multivariable Cox regression model revealed that the presence of moderate-to-severe MR, AS or both were independent predictors of primary endpoint (HR 1.84; HR 2.8; HR 2.9 and p<0.001; p=0.004; p=0.01, respectively), regardless of age, gender, left ventricular ejection fraction, diabetes mellitus, history of cancer and total number of diseased vessels (Figure 1B). Table 1 Overall No residual valvular heart disease Moderate-to-severe MR Moderate-to-severe AS Both Age (y) 80.68±4.50 80.40±4.42 81.47±4.45 82.92±5.42 83.23±5.42 Male gender 652 (59.2) 538 (61.6) 92 (48.4) 19 (73.1) 3 (23.1) STE-ACS 420 (38.1) 319 (36.5) 91 (47.9) 6 (23.1) 4 (30.8) Diabetes mellitus 203 (18.4) 158 (18.1) 35 (18.4) 5 (19.2) 5 (38.5) LVEF (%) 48.30±9.58 49.26±9.27 44.61±9.45 48.50±11.22 38.31±10.87 History of cancer 32 (2.9) 26 (3.0) 3 (1.6) 2 (7.7) 1 (7.7) Tot number of diseased vessel 2.31±1.05 2.28±1.04 2.49±1.05 2.04±0.87 2.54±1.13 Data are expressed as mean ± SD or count (valid %). Figure 1 Conclusions Moderate-to-severe MR and AS represent significant predictors of 1-year outcome in elderly patients hospitalized for ACS, even when other well-established prognostic factors are taken into account and after revascularization with PCI. Therefore, these patients should be carefully screened for the presence of valvular heart disease at the time of presentation and the need for surgical or percutaneous correction should be assessed accordingly. Acknowledgement/Funding None

Impact of Diabetes Mellitus and Frailty on Long-Term Outcomes in Elderly Patients with Acute Coronary Syndromes

2020 ◽  
Vol 24 (7) ◽  
pp. 723-729
Author(s):  
O. Rodríguez-Queraltó ◽  
F. Formiga ◽  
A. Carol ◽  
C. Llibre ◽  
M. Martínez-Sellés ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Elderly Patients ◽  
Acute Coronary Syndromes ◽  
Long Term Outcomes ◽  
Coronary Syndromes

258Use of low-dose prasugrel vs. clopidogrel in elderly patients undergoing complex or non-complex PCI for acute coronary syndromes: insights from the Elderly ACS 2 study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Montalto ◽  
G Crimi ◽  
F Fortuni ◽  
A Mandurino Mirizzi ◽  
L Piatti ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Elderly Patients ◽  
Primary Endpoint ◽  
Acute Coronary Syndromes ◽  
Low Dose ◽  
P Value ◽  
Significant Difference ◽  
All Cause Mortality ◽  
Coronary Syndromes ◽  
The Impact

Abstract Background Prasugrel was superior to clopidogrel in the setting of acute coronary syndromes (ACS) and recent data highlighted its possible role in the setting of complex percutaneous coronary intervention (PCI). Nonetheless, evidence supporting its use in high bleeding risk population are lacking. Purpose The aim of this post-hoc subgroup analysis was to evaluate the impact of prasugrel administration in elderly patients undergoing complex PCI for ACS. A primary composite endpoint of composite of mortality, myocardial infarction, disabling stroke and re-hospitalization for cardiovascular causes or bleeding within one year and secondary endpoints of all-cause mortality and any bleeding at 1 year were analyzed. Methods In the multicenter Elderly ACS 2 Study 1,443 patients aged >74 y were randomly assigned to receive low-dose prasugrel (5 mg) or clopidogrel (75 mg) and were prospectively followed for 1 year (Table 1). Complex PCI was defined if ≥3 lesions were treated, if ≥3 stents were deployed, or if any bifurcation, trifurcation, chronic total obstruction or moderate-to-severe calcified lesions were treated. Results Patients undergoing complex PCI (n=607) did not experience worse outcome, as compared to those with simpler PCI, in terms of primary endpoint (p=0.21, Figure 1A). Furthermore, in this subgroup, no significant difference was observed with prasugrel vs clopidogrel with regard to the primary endpoint (HR 1.17; CI 0.819–1.67; p=0.39, Figure 1A), all-cause death and bleeding (Figure 1C and 1D). No significant interaction was observed between treatment and PCI complexity (interaction p=0.34). Table 1 Overall Non-complex PCI Complex PCI p value Age (y) 80.60±4.46 80.00 [77.00, 84.00] 80.00 [77.00, 83.00] 0.215 STE-ACS 595 (41.2) 272 (32.5) 323 (53.4) <0.001 Diabetes mellitus 253 (17.5) 159 (19.0) 94 (15.5) 0.104 LVEF 48.27±9.59 49.08±9.55 47.26±9.54 0.002 Total number of diseased vessels 2.29±1.06 2.22±1.06 2.38±1.05 0.005 Previous Myocardial Infarction 274 (19.0) 171 (20.4) 103 (17.0) 0.122 Randomized to prasugrel 713 (49.4) 404 (48.2) 404 (48.2) 0.307 Data are expressed as mean ± SD or [IQR] and count/valid %). Figure 1 Conclusions In elderly patients presenting with ACS low-dose prasugrel was comparable to clopidogrel in terms of all-cause mortality and any bleeding at 1 year. Acknowledgement/Funding None

scholarly journals Predisposing and Precipitating Risk Factors for Delirium in Elderly Patients Admitted to a Cardiology Ward: An Observational Cohort Study in 1,042 Patients

2021 ◽  
Vol 8 ◽  
Author(s):  
Carl Moritz Zipser ◽  
Florian Freimut Hildenbrand ◽  
Bernhard Haubner ◽  
Jeremy Deuel ◽  
Jutta Ernst ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Heart Disease ◽  
Elderly Patients ◽  
Valvular Heart Disease ◽  
Pressure Ulcers ◽  
Observational Cohort Study ◽  
Cardiac Diseases ◽  
History Of ◽  
Observational Cohort

Aim: Although the risk factors for delirium in general medicine are well-established, their significance in cardiac diseases remains to be determined. Therefore, we evaluated the predisposing and precipitating risk factors in patients hospitalized with acute and chronic heart disease.Methods and Results: In this observational cohort study, 1,042 elderly patients (≥65 years) admitted to cardiology wards, 167 with and 875 without delirium, were included. The relevant sociodemographic and cardiac- and medical-related clusters were assessed by simple and multiple regression analyses and prediction models evaluating their association with delirium. The prevalence of delirium was 16.0%. The delirious patients were older (mean 80 vs. 76 years; p &lt; 0.001) and more often institutionalized prior to admission (3.6 vs. 1.4%, p = 0.05), hospitalized twice as long (12 ± 10 days vs. 7 ± 7 days; p &lt; 0.001), and discharged more often to nursing homes (4.8 vs. 0.6%, p &lt; 0.001) or deceased (OR, 2.99; 95% CI, 1.53–5.85; p = 0.003). The most relevant risk factor was dementia (OR, 18.11; 95% CI, 5.77–56.83; p &lt; 0.001), followed by history of stroke (OR, 6.61; 95% CI 1.35–32.44; p = 0.020), and pressure ulcers (OR, 3.62; 95% CI, 1.06–12.35; p = 0.040). The predicted probability for developing delirium was highest in patients with reduced mobility and institutionalization prior to admission (PP = 31.2%, p = 0.001). Of the cardiac diseases, only valvular heart disease (OR, 1.57; 95% CI, 1.01–2.44; p = 0.044) significantly predicted delirium. The patients undergoing cardiac interventions did not have higher rates of delirium (OR, 1.39; 95% CI 0.91–2.12; p = 0.124).Conclusion: In patients admitted to a cardiology ward, age-related functional and cognitive impairment, history of stroke, and pressure ulcers were the most relevant risk factors for delirium. With regards to specific cardiological factors, only valvular heart disease was associated with risk for delirium. Knowing these factors can help cardiologists to facilitate the early detection and management of delirium.

Diabetes mellitus, frailty and prognosis in very elderly patients with acute coronary syndromes

2019 ◽  
Vol 31 (11) ◽  
pp. 1635-1643 ◽  
Author(s):  
Miquel Gual ◽  
◽  
Francesc Formiga ◽  
Albert Ariza-Solé ◽  
Ramon López-Palop ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Elderly Patients ◽  
Acute Coronary Syndromes ◽  
Very Elderly ◽  
Coronary Syndromes

Impact of frailty and atrial fibrillation in elderly patients with acute coronary syndromes

2021 ◽  
Vol 51 (5) ◽  
Author(s):  
María Asunción Esteve‐Pastor ◽  
Ernesto Martín ◽  
Oriol Alegre ◽  
Francesc Formiga ◽  
Juan Sanchís ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Elderly Patients ◽  
Acute Coronary Syndromes ◽  
Coronary Syndromes

scholarly journals Preliminary results of the acute Heart Failure registry in the DELTA region of Egypt (DELTA-HF): a database and a quality initiative project

2019 ◽  
Vol 71 (1) ◽  
Author(s):  
Abdelfatah Elasfar ◽  
Sherif Shaheen ◽  
Wafaa El-Sherbeny ◽  
Hatem Elsokkary ◽  
Suzan Elhefnawy ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Acute Heart Failure ◽  
Valvular Heart Disease ◽  
Beta Blockers ◽  
Left Ventricular Ejection ◽  
Systemic Hypertension ◽  
Delta Region ◽  
Device Therapy ◽  
Short Term

Abstract Background Data about heart failure in Egypt is scarce. We aimed to describe the clinical characteristics and diagnostic and treatment options in patients with acute heart failure in the Delta region of Egypt and to explore the gap in the management in comparison to the international guidelines. Results DELTA-HF is a prospective observational cohort registry for all consecutive patients with acute heart failure (AHF) who were admitted to three tertiary care cardiac centers distributed in the Delta region of Egypt. All patients were recruited in the period from April 2017 to May 2018, during which, data were collected and short-term follow-up was done. A total of 220 patients (65.5% were males with a median age of 61.5 years and 50.9% had acute decompensation on top of chronic heart failure) was enrolled in our registry. The risk factors for heart failure included rheumatic valvular heart disease (10.9%), smoking (65.3%), hypertension (48.2%), diabetes mellitus (42.7%), and coronary artery disease (28.2%). Left ventricular ejection fraction (LVEF) was less than 40% in 62.6%. Etiologies of heart failure included ischemic heart disease (58.1%), valvular heart disease (16.3%), systemic hypertension (9.1%), and dilated non-ischemic cardiomyopathy (15.5%). Exacerbating factors included infections (28.1%), acute coronary syndromes (25.5%), non-compliance to HF medications (19.6%), and non-compliance to diet (23.2%) in acute decompensated heart failure (ADHF) patients. None of our patients had been offered heart failure device therapy and only 50% were put on beta-blockers upon discharge. In-hospital, 30 days and 90 days all-cause mortality were 18.2%, 20.7%, and 26% respectively. Conclusions There is a clear gap in the management of patients with acute heart failure in the Delta region of Egypt with confirmed under-utilization of heart failure device therapy and under-prescription of guideline-directed medical therapies particularly beta-blockers. The short-term mortality is high if compared with Western and other local registries. This could be attributed mainly to the low-resource health care system in this region and the lack of formal heart failure management programs.

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