Efficacy and safety of Shen-Song-Yang-Xin capsule for treating arrhythmia in the elderly patients with coronary heart disease

Background. Among the combinations of comorbid conditions, a special role belongs to the combination of coronary heart disease (CHD) and chronic obstructive pulmonary disease (COPD). Because COPD is often associated with CHD, most authors believe that there is a direct link between COPD, progression of bronchial obstruction, and pathological conditions of the cardiovascular system, including mortality from myocardial infarction. In elderly patients, according to some researchers, the link between COPD and CHD is most pronounced. Objective. To establish the frequency of COPD in patients with CHD in older age groups. Materials and methods. The studies are based on the results of a comprehensive survey of 635 patients with CHD aged 60-89 years, who were observed for a long time of the State Institution “Chebotarev Institute of Gerontology of the National Academy of Medical Sciences of Ukraine”. Results and discussion. The share of patients with CHD in whom COPD was detected in the group of elderly people is 19.4 %. This is much more than the average population. The frequency of COPD in patients with CHD decreases significantly with further aging. The prevalence of COPD among elderly patients is much lower than among elderly patients. This can most likely be explained by the fact that a significant proportion of patients with CHD with COPD do not live to old age. The analysis revealed that in elderly patients there is bronchial obstruction of more severe stages. This is due to the fact that CHD patients with COPD who live to old age have worsening bronchial patency due to the longer duration of the disease. It has been established that the majority of patients with CHD with COPD, both elderly and senile, are male. This can be explained by the negative effects of smoking. Conclusions. The incidence of COPD in patients with CHD in the elderly is much higher than in the population. At the same time, the incidence of COPD among patients with CHD in the elderly is much lower than among the elderly. In patients of advanced age bronchial obstruction is more expressed.

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Treatment of haemophilia in the elderly

Hämostaseologie ◽

10.1055/s-0037-1617204 ◽

2009 ◽

Vol 29 (S 01) ◽

pp. S29-S31

Author(s):

S. Krekeler ◽

S. Alesci ◽

W. Miesbach

Keyword(s):

Coronary Heart Disease ◽

Chronic Hepatitis ◽

Heart Disease ◽

Retrospective Study ◽

Hepatitis C ◽

Elderly Patients ◽

Chronic Hepatitis C ◽

The Elderly ◽

Haemophilia A

SummaryTreatment of elderly patients with haemophilia is an upcoming challenge in haemophilia care. We included patients with haemophilia A older than 60 years of age, who visited our haemophilia centre between 2006 and 2008. We conducted a retrospective study focussing on the patients’ co-morbidities as well as changes in their bleeding patterns between 2003 and 2008. Results: There is a tendency of increasing bleeding symptoms with increasing age of the patients due to more frequent spontaneous joint bleedings, malignancies or treatment with phenprocoumon or ASS. In consequence, FVIII dosage had to be increased for 8 patients (28%). Chronic hepatitis C, coronary heart disease and malignancies are the most frequent co-morbidities

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Efficacy and Safety of Ruxolitinib in Elderly Patients (> 75 years) with Myelofibrosis

Blood ◽

10.1182/blood.v128.22.4251.4251 ◽

2016 ◽

Vol 128 (22) ◽

pp. 4251-4251 ◽

Cited By ~ 1

Author(s):

Roberto Latagliata ◽

Ambra Di Veroli ◽

Giuseppe Alberto Palumbo ◽

Massimiliano Bonifacio ◽

Alessandro Andriani ◽

...

Keyword(s):

Heart Disease ◽

Elderly Patients ◽

Acute Leukemia ◽

Median Time ◽

Research Funding ◽

The Elderly ◽

Efficacy And Safety ◽

Free Survival ◽

Symptom Response ◽

Systemic Symptoms

Abstract Background. Ruxolitinib (RUX) is the first commercially available JAK1/2 inhibitor that may control splenomegaly and systemic symptoms related to myelofibrosis (MF). Despite MF occur frequently in elderly patients (pts), no data are yet available on RUX efficacy and safety in this particularly frail population. Methods We report on 100 pts [M/F 57/43, median age at diagnosis 75.7 years, interquartile range (IQR) 72.3 - 78.0, median age at baseline of RUX treatment 77.7 years, IQR 76.2 - 80.3] with WHO-defined MF treated with RUX when aged ≥ 75 years. Data were extracted from the whole cohort of 408 pts of any age collected in a database involving 22 Italian Centers. Comorbidities were recorded at the time of diagnosis and classified according to the Charlson Comorbidity Index (CCI). Response to RUX was evaluated according to IWG-MRT criteria. Results Main clinical features after stratification according to age at RUX start are reported in Table 1. Compared to younger pts, elderly pts carried a higher number of co-morbidities and had lower hemoglobin and platelet values, thus starting RUX with lower doses. Time from diagnosis to RUX start was comparable among the two cohorts (median 15.5 months, IQR 4.6 - 66.7, vs 20.8 months, IQR 4.1 - 66.0, p=0.74). According to IWG criteria, a spleen response was achieved by 37 out of 90 (41.1%) evaluable elderly pts compared to 115 out of 272 (42.2%) pts <75y (p=0.85) while symptom response was achieved by 88/99 (88.8%) elderly pts compared to 271/304 (89.1%) younger pts (p=0.94). Drug-related anemia (Hb <10 g/dl in pts with baseline Hb ≥10 g/dl) was observed in 30/68 (44.1%) evaluable elderly pts compared with 100/240 (41.6%) evaluable younger subjects (p=0.72). The percentage of pts that decreased RUX dose over time was comparable in the two groups (29% and 29.8%, respectively). Overall, 47% elderly and 32% younger pts finally discontinued RUX (p=0.008) after a median time of 12.3 and 21.6 months, respectively (p=0.03). Evolution into acute leukemia occurred in 8 (8.0%) elderly pts and in 22 (7.1%) younger pts, respectively (p=0.78), with a similar evolution-free survival from RUX initiation (p=0.35). As expected, 43 (43.0%) elderly pts and 53 (17.3%) younger pts died (p<0.001) after a median time from RUX start of 14.2 and 24.2, respectively (p=0.03). Causes of death in elderly pts were: progression of myelofibrosis (32.5%), heart disease (16.3%), infections (14%), acute leukemia (7%), hemorrhage/thrombosis (7%), other unrelated causes (23.2%). Compared to elderly, younger pts died less frequently due to heart disease (3.6%) (p=0.03), and more frequently due to acute leukemia (23.2%) (p=0.03). The 4-year cumulative Event-Free Survival (taking into account: RUX discontinuation, blastic evolution and death for any cause) was 30.1% (95% CI: 16.2 - 44.0) in elderly pts and 46.1% (95% CI 37.3 - 54.9) in younger subjects, respectively (p=0.002). Conclusions. Despite the elderly carried a higher number of comorbidities and were treated with lower starting and titrated doses of RUX,RUX was feasible and effective in this setting, achieving clinical responses similar to younger subjects, with comparable toxicity rates. Thus, the study do not support to restrain the use of RUX based on older age and comorbidities. Figure Figure. Disclosures Latagliata: Novartis: Consultancy, Honoraria; Bristol Myers Squibb: Honoraria; Celgene: Honoraria; Janssen: Consultancy, Honoraria; Shire: Honoraria. Bonifacio:Ariad Pharmaceuticals: Consultancy; Amgen: Consultancy; Bristol Myers Squibb: Consultancy; Pfizer: Consultancy; Novartis: Research Funding. Tiribelli:Novartis: Consultancy, Speakers Bureau; Ariad Pharmaceuticals: Consultancy, Speakers Bureau; Bristol-Myers Squibb: Consultancy, Speakers Bureau. Cavo:Bristol-Myers Squibb: Honoraria; Amgen: Honoraria; Janssen: Honoraria, Research Funding; Takeda: Honoraria; Celgene: Honoraria, Research Funding. Breccia:Novartis: Consultancy, Honoraria; Bristol Myers Squibb: Honoraria; Celgene: Honoraria; Ariad: Honoraria; Pfizer: Honoraria.

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Efficacy and Safety of Catheter Ablation of Ventricular Tachycardia in Elderly Patients with Coronary Heart Disease

Heart Rhythm ◽

10.1016/j.hrthm.2009.09.057 ◽

2009 ◽

Vol 6 (11) ◽

pp. 1695

Author(s):

Keiichi Inada ◽

Kurt C. Roberts-Thomson ◽

Daniel Steven ◽

Jens Seiler ◽

Bruce A. Koplan ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Ventricular Tachycardia ◽

Catheter Ablation ◽

Elderly Patients ◽

Efficacy And Safety

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Medikamentöse Therapie kardiologischer Erkrankungen im Alter

DMW - Deutsche Medizinische Wochenschrift ◽

10.1055/s-0043-108475 ◽

2018 ◽

Vol 143 (04) ◽

pp. 236-243

Author(s):

Robert Schwinger

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Coronary Heart Disease ◽

Heart Disease ◽

Elderly Patients ◽

Coronary Intervention ◽

The Elderly ◽

Lipid Lowering ◽

Lipid Lowering Agents ◽

Reduced Kidney Function

AbstractElderly people show increased probability to develop atherosclerotic diseases; in consequence heart failure – most often following coronary heart disease – as well as atrial fibrillation is more common. Following guidelines may lead to polypharmacy, i. e. use of more than 5 drugs daily. Thus, drug interactions as well as side effects become more likely; especially in elderly patients reduced kidney function has to be taken into account. Only drugs which have shown to prolong life or to reduce symptoms in controlled clinical trials should be used. There is little evidence to use low dose aspirin or lipid lowering agents in primary prevention especially in elderly. ACE inhibitors, β blocker and MRA are effective to improve symptoms and outcome in HFrEF but not in HFmEF or HFpEF. This also holds true for the elderly. Withdrawal of long term diuretic treatment in the elderly patients may lead to symptoms of heart failure or increase in blood pressure to hypertensive values often. In coronary heart disease ß blocker may be used to control symptoms as well as to reduce the need for coronary intervention following 1 year after myocardial infarction. Because the risk of stroke increases with age more than the risk of bleeding, the absolute benefit of oral anticoagulation in atrial fibrillation patients is highest in the elderly. NOAK appear to be safer and at least as efficacious as warfarin.

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