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Mondal A, Li A, Edusa S, Gogineni A, Karipineni S, Abdelhafez S, Nalluri SD, Meka GG, Bawa J, Puli S, Venkata VS, Vyas A, Jain A, Desai R. Does Statin Use in Frail Patients Provide Survival Benefits? Insights From a Meta-Analysis. Curr Probl Cardiol 2024; 49:102038. [PMID: 37597795 DOI: 10.1016/j.cpcardiol.2023.102038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 08/21/2023]
Abstract
Frailty is a complex syndrome that increases with age and predisposes older adults to adverse outcomes, including mortality. Statins are proven to lower the risk of atherosclerotic cardiovascular disease, but there is limited data on their survival benefit in frail older people. This meta-analysis was conducted to determine whether statins can lower mortality in frail persons. A comprehensive search of PubMed, Google Scholar, and SCOPUS was conducted until September 2022 to identify studies reporting mortality outcomes with statin therapy in adults aged 75 with a validated frailty assessment. The pooled odds ratio for all-cause mortality was calculated using a random effects model. Leave-one-out method was used for sensitivity analysis. Of 5 studies (2013-2022) included (Total = 14,324, 3 prospective and 2 retrospectives, Males: 49%, Mean follow-up duration: 4.7 years), 41.6% (5971/14,324) were frail. 52.7% of patients were on a moderate-dose/no-statin, while 47.2% took a high-dose statin. Nonstatin users were older (83.35 vs 81.5) than users. Frail patients often had diabetes, hypertension, hyperlipidemia, a history of Stroke/MI, and dementia. High-dose atorvastatin was the most used statin. Pooled analysis revealed that statins lower all-cause mortality in elderly adults, however, the association was not significant (OR 0.67, 95% CI 0.38-1.18; P = 0.17). The meta-analysis demonstrated that using statins to reduce mortality in frail patients does not appear justifiable. Further prospective studies are needed to guide statin use among frail older adults for survival benefits.
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Affiliation(s)
- Avilash Mondal
- Department of Internal Medicine, Nazareth Hospital, Philadelphia, PA
| | - Aobo Li
- Department of Internal Medicine, Beijing Anzhen Hospital, Beijing, China
| | - Samuel Edusa
- Department of Internal Medicine, Samalla Clinic Ltd., New Gbawe - Accra, Ghana
| | - Anurag Gogineni
- Department of Medicine, Nagarjuna Hospital, Vijayawada, Andhra Pradesh, India
| | | | | | | | - Gautham Gosh Meka
- Department of Medicine, Andhra Medical College, Vishakhapatnam, Andhra Pradesh, India
| | - Jerrin Bawa
- Department of Internal Medicine, Flushing Hospital, NY
| | - Srikanth Puli
- Department of Hospital Medicine, Cheshire Medical Center, Dartmouth-Hitchcock, Keene, NH
| | | | - Ankit Vyas
- Vascular Medicine, Ochsner Clinic Foundation, New Orleans, LA
| | - Akhil Jain
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2023; 82:833-955. [PMID: 37480922 DOI: 10.1016/j.jacc.2023.04.003] [Citation(s) in RCA: 72] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2023; 148:e9-e119. [PMID: 37471501 DOI: 10.1161/cir.0000000000001168] [Citation(s) in RCA: 222] [Impact Index Per Article: 222.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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Affiliation(s)
| | | | | | | | | | | | - Dave L Dixon
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | - William F Fearon
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | - Dhaval Kolte
- AHA/ACC Joint Committee on Clinical Data Standards
| | | | | | | | - Daniel B Mark
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | | | | | | | - Mariann R Piano
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
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Shi K, Zhou T, Yuan Y, Li D, Gong B, Gao S, Chen Q, Li Y, Han X. Synergistic mediating effect of edible fungal polysaccharides ( Auricularia and Tremellan) and Crataegus flavonoids in hyperlipidemic rats. Food Sci Nutr 2023; 11:4812-4828. [PMID: 37576054 PMCID: PMC10420763 DOI: 10.1002/fsn3.3459] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 05/03/2023] [Accepted: 05/14/2023] [Indexed: 08/15/2023] Open
Abstract
Both edible fungal polysaccharides (Auricularia and Tremellan) and Crataegus flavonoids promote the balance of dyslipidemia, which have a positive biological regulating effect on intestinal flora. In this study, the extraction of water-soluble polysaccharides from Auricularia and Tremellan was investigated and optimized firstly. Polysaccharides and flavonoids were then combined to study the effects on the mediating role of abnormal blood lipid concentration and intestinal flora in vivo. The rats were divided into 10 groups, the NC (normal control), HM (model), PCI (Simvastatin control), PCII (Fenofibrate control), AAP (Auricularia auricular Polysaccharide), TFP (Tremella fuciformis Polysaccharide), HF (Crataegus Flavonoid), LDC (Low-dose combination), MDC (Medium dose combination), and HDC (High-dose combination), used to explore the impact of polysaccharides and flavonoids complex on state of blood lipid, liver, and intestinal flora of dyslipidemia rats. The results showed that the combination of polysaccharides and flavonoids could significantly decrease the levels of triglyceride (TG), total cholesterol (TC), low-density lipoprotein (LDL-C), and increase the level of high-density lipoprotein cholesterol (HDL-C). It also significantly decreased the levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) and improved liver morphology. What is more, the HDC favorably alters the intestinal microflora balance, promotes intestinal integrity and mobility, and inhibits the growth of harmful bacteria such as Escherichia coli/Shigella and Clostridium compared with HM group. In brief, the combination of polysaccharides and flavonoids had a synergistic effect on the remission of dyslipidemia, and promoted health by improving lipid metabolism, protecting liver tissue, and regulating the intestinal flora in hyperlipidemia rats.
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Affiliation(s)
- Ke Shi
- College of Food Science and BiologyHebei University of Science and TechnologyShijiazhuangChina
| | - Tao Zhou
- College of Food Science and BiologyHebei University of Science and TechnologyShijiazhuangChina
| | - Yu‐fei Yuan
- College of Food Science and BiologyHebei University of Science and TechnologyShijiazhuangChina
| | - Dan‐dan Li
- College of Food Science and BiologyHebei University of Science and TechnologyShijiazhuangChina
| | - Bin‐bin Gong
- College of Biological Science and EngineeringXingtai UniversityXingtaiChina
| | - Shan Gao
- College of Food Science and BiologyHebei University of Science and TechnologyShijiazhuangChina
| | - Qi‐jia Chen
- College of Food Science and BiologyHebei University of Science and TechnologyShijiazhuangChina
| | - Yan‐dong Li
- Hebei Provincial Station of Veterinary Drug and FeedShijiazhuangChina
| | - Xue Han
- College of Food Science and BiologyHebei University of Science and TechnologyShijiazhuangChina
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Custodero C, Veronese N, Topinkova E, Michalkova H, Polidori MC, Cella A, Cruz-Jentoft AJ, von Arnim CAF, Azzini M, Gruner H, Castagna A, Cenderello G, Custureri R, Zieschang T, Padovani A, Sanchez-Garcia E, Pilotto A. The Role of Multidimensional Prognostic Index to Identify Hospitalized Older Adults with COVID-19 Who Can Benefit from Remdesivir Treatment: An Observational, Prospective, Multicenter Study. Drugs Aging 2023:10.1007/s40266-023-01036-2. [PMID: 37310575 DOI: 10.1007/s40266-023-01036-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Data regarding the importance of multidimensional frailty to guide clinical decision making for remdesivir use in older patients with coronavirus disease 2019 (COVID-19) are largely unexplored. OBJECTIVE The aim of this research was to evaluate if the Multidimensional Prognostic Index (MPI), a multidimensional frailty tool based on the Comprehensive Geriatric Assessment (CGA), may help physicians in identifying older hospitalized patients affected by COVID-19 who might benefit from the use of remdesivir. METHODS This was a multicenter, prospective study of older adults hospitalized for COVID-19 in 10 European hospitals, followed-up for 90 days after hospital discharge. A standardized CGA was performed at hospital admission and the MPI was calculated, with a final score ranging between 0 (lowest mortality risk) and 1 (highest mortality risk). We assessed survival with Cox regression, and the impact of remdesivir on mortality (overall and in hospital) with propensity score analysis, stratified by MPI = 0.50. RESULTS Among 496 older adults hospitalized for COVID-19 (mean age 80 years, female 59.9%), 140 (28.2% of patients) were treated with remdesivir. During the 90 days of follow-up, 175 deaths were reported, 115 in hospital. Remdesivir treatment significantly reduced the risk of overall mortality (hazard ratio [HR] 0.54, 95% confidence interval CI 0.35-0.83 in the propensity score analysis) in the sample as whole. Stratifying the population, based on MPI score, the effect was observed only in less frail participants (HR 0.47, 95% CI 0.22-0.96 in propensity score analysis), but not in frailer subjects. In-hospital mortality was not influenced by remdesivir use. CONCLUSIONS MPI could help to identify less frail older adults hospitalized for COVID-19 who could benefit more from remdesivir treatment in terms of long-term survival.
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Affiliation(s)
- Carlo Custodero
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, via del Vespro, 141, 90127, Palermo, Italy.
| | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
| | - Helena Michalkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
| | - Maria Cristina Polidori
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine, University of Cologne, Cologne, Germany
| | - Alberto Cella
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy
| | | | | | - Margherita Azzini
- Geriatrics Unit, "Mater Salutis" Hospital, Legnago ULSS 9 Scaligera, Verona, Italy
| | - Heidi Gruner
- Serviço de Medicina Interna, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central/Universidade Nova de Lisboa, Lisbon, Portugal
| | | | | | - Romina Custureri
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy
| | - Tania Zieschang
- Klinikum Oldenburg AöR, Oldenburg University, Oldenburg, Germany
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Alberto Pilotto
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy
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Gaggini M, Minichilli F, Gorini F, Del Turco S, Landi P, Pingitore A, Vassalle C. FIB-4 Index and Neutrophil-to-Lymphocyte-Ratio as Death Predictor in Coronary Artery Disease Patients. Biomedicines 2022; 11:biomedicines11010076. [PMID: 36672584 PMCID: PMC9855402 DOI: 10.3390/biomedicines11010076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/19/2022] [Accepted: 12/23/2022] [Indexed: 12/30/2022] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD)-associated liver fibrosis is likely related to coronary artery disease (CAD) by the mediation of systemic inflammation. This study aimed at evaluating the predictive value of neutrophil-to-lymphocyte-ratio (NLR) and fibrosis-4 index (FIB-4), indices of inflammation and fibrosis, respectively, on CAD mortality. Data from 1460 CAD patients (1151 males, age: 68 ± 10 years, mean ± SD) were retrospectively analyzed. Over a median follow-up of 26 months (interquartile range (IQR) 12−45), 94 deaths were recorded. Kaplan−Meier survival analysis revealed worse outcomes in patients with elevation of one or both biomarkers (FIB-4 > 3.25 or/and NLR > 2.04, log-rank p-value < 0.001). In multivariate Cox regression analysis, the elevation of one biomarker (NLR or FIB-4) still confers a significant independent risk for mortality (hazard ratio (HR) = 1.7, 95% confidence interval (95% CI): 1.1−2.7, p = 0.023), whereas an increase in both biomarkers confers a risk corresponding to HR = 3.5 (95% CI: 1.6−7.8, p = 0.002). Categorization of patients with elevated FIB-4/NLR could provide valuable information for risk stratification and reduction of residual risk in CAD patients.
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Affiliation(s)
- Melania Gaggini
- Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy
| | - Fabrizio Minichilli
- Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy
| | - Francesca Gorini
- Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy
| | - Serena Del Turco
- Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy
| | - Patrizia Landi
- Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy
| | | | - Cristina Vassalle
- Fondazione Gabriele Monasterio, CNR-Regione Toscana, 56124 Pisa, Italy
- Correspondence:
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Horikoshi T, Nakamura T, Yoshizaki T, Nakamura J, Watanabe Y, Uematsu M, Makino A, Saito Y, Obata JE, Sawanobori T, Takano H, Umetani K, Watanabe A, Asakawa T, Sato A, Kugiyama K. A Propensity Score Matched Analysis of Statin Effects on Major Adverse Cardiac Events after Percutaneous Coronary Intervention in Patients Over 75 Years Old. Intern Med 2022; 61:2711-2719. [PMID: 35228422 PMCID: PMC9556242 DOI: 10.2169/internalmedicine.8932-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/16/2022] [Indexed: 11/23/2022] Open
Abstract
Objective In an extremely aging society, it is beneficial to reconsider the value of medical treatment for extremely elderly patients. We therefore focused on the efficacy of statin therapy in extremely elderly patients. This study investigated the efficacy of statins for secondary prevention in patients over 75 years old. Methods This prospective multicenter registry included 1,676 consecutive extremely elderly patients with coronary artery disease who underwent successful percutaneous coronary intervention (PCI). The patients were followed up clinically for up to three years or until the occurrence of major adverse cardiac events (MACEs), defined as a composite of all-cause death and non-fatal myocardial infarction. Using propensity score methodology to eliminate selection bias, in a 1:1 matching ratio, we selected 466 pairs of patients for the analysis. Results During the median follow-up period of 25 months, MACEs occurred in 176 patients. The Kaplan-Meier analysis showed that statin treatment correlated with a lower probability of initial MACE occurrences within 30 days compared with no statin treatment (log-rank test, p<0.001). According to a landmark analysis at day 30, statin treatment still showed consistent effectiveness for reducing MACE occurrence during the follow up period (p=0.04). A multivariable Cox hazard analysis showed that statin therapy significantly reduced MACE occurrence (hazard ratio 0.55 [0.40-0.75], p<0.001). In the stratification analysis, statin therapy was especially beneficial in patients without symptomatic heart failure. Conclusion Statins were effective in preventing MACEs in extremely elderly patients after PCI.
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Affiliation(s)
- Takeo Horikoshi
- Department of Internal Medicine II, Faculty of Medicine, University of Yamanashi, Japan
| | - Takamitsu Nakamura
- Department of Internal Medicine II, Faculty of Medicine, University of Yamanashi, Japan
| | - Toru Yoshizaki
- Department of Internal Medicine II, Faculty of Medicine, University of Yamanashi, Japan
| | - Jun Nakamura
- Department of Cardiology, Fujieda Municipal General Hospital, Japan
| | - Yosuke Watanabe
- Department of Internal Medicine II, Faculty of Medicine, University of Yamanashi, Japan
| | - Manabu Uematsu
- Department of Internal Medicine II, Faculty of Medicine, University of Yamanashi, Japan
| | - Aritaka Makino
- Department of Internal Medicine, Yamanashi Prefectural Central Hospital, Japan
| | - Yukio Saito
- Department of Cardiology, Kofu Municipal Hospital, Japan
| | - Jun-Ei Obata
- Department of Internal Medicine II, Faculty of Medicine, University of Yamanashi, Japan
| | | | - Hajime Takano
- Department of Cardiology, Kofu Jonan Hospital, Japan
| | - Ken Umetani
- Department of Internal Medicine, Yamanashi Prefectural Central Hospital, Japan
| | - Akinori Watanabe
- Department of Cardiology, Fujieda Municipal General Hospital, Japan
| | | | - Akira Sato
- Department of Internal Medicine II, Faculty of Medicine, University of Yamanashi, Japan
| | - Kiyotaka Kugiyama
- Department of Internal Medicine II, Faculty of Medicine, University of Yamanashi, Japan
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Zampino M, Polidori MC, Ferrucci L, O’Neill D, Pilotto A, Gogol M, Rubenstein L. Biomarkers of aging in real life: three questions on aging and the comprehensive geriatric assessment. GeroScience 2022; 44:2611-2622. [PMID: 35796977 PMCID: PMC9261220 DOI: 10.1007/s11357-022-00613-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 06/19/2022] [Indexed: 01/07/2023] Open
Abstract
Measuring intrinsic, biological age is a central question in medicine, which scientists have been trying to answer for decades. Age manifests itself differently in different individuals, and chronological age often does not reflect such heterogeneity of health and function. We discuss here the value of measuring age and aging using the comprehensive geriatric assessment (CGA), cornerstone of geriatric medicine, and operationalized assessment tools for prognosis. Specifically, we review the benefits of employing the multidimensional prognostic index (MPI), which collects information about eight domains relevant for the global assessment of the older person (functional and cognitive status, nutrition, mobility and risk of pressure sores, multi-morbidity, polypharmacy, and co-habitation), in the evaluation of the functional status, and in the prediction of health outcomes for older adults. Further integration of biological markers of aging into multidimensional prognostic tools is warranted, as well as actions which could facilitate prognostic assessments for older persons in all healthcare settings.
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Affiliation(s)
- Marta Zampino
- grid.94365.3d0000 0001 2297 5165Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD USA
| | - M. Cristina Polidori
- grid.6190.e0000 0000 8580 3777Aging Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany ,grid.6190.e0000 0000 8580 3777Cologne Excellence Cluster On Cellular Stress- Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Luigi Ferrucci
- grid.94365.3d0000 0001 2297 5165Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD USA
| | - Desmond O’Neill
- grid.413305.00000 0004 0617 5936Tallaght University Hospital and Trinity College Dublin, Tallaght University Hospital, Trinity Centre for Health Sciences, Dublin, Ireland
| | - Alberto Pilotto
- grid.450697.90000 0004 1757 8650Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy ,grid.7644.10000 0001 0120 3326Department of Interdisciplinary Medicine, University of Bari, Bari, Italy
| | - Manfred Gogol
- grid.10423.340000 0000 9529 9877Trauma Department, Orthogeriatric Unit, Hannover Medical School, Hannover, Germany ,grid.7700.00000 0001 2190 4373Institute of Gerontology, University of Heidelberg, Heidelberg, Germany
| | - Laurence Rubenstein
- grid.266900.b0000 0004 0447 0018Department of Geriatric Medicine, University of Oklahoma, Oklahoma City, OK USA
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Pilotto A, Topinkova E, Michalkova H, Polidori MC, Cella A, Cruz-Jentoft A, von Arnim CAF, Azzini M, Gruner H, Castagna A, Cenderello G, Custureri R, Custodero C, Zieschang T, Padovani A, Sanchez-Garcia E, Veronese N. Can the Multidimensional Prognostic Index Improve the Identification of Older Hospitalized Patients with COVID-19 Likely to Benefit from Mechanical Ventilation? An observational, prospective, multicenter study. J Am Med Dir Assoc 2022; 23:1608.e1-1608.e8. [PMID: 35934019 PMCID: PMC9247233 DOI: 10.1016/j.jamda.2022.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 06/13/2022] [Accepted: 06/25/2022] [Indexed: 11/18/2022]
Abstract
Objective Data on prognostic tools for indicating mechanical ventilation in older people with COVID-19 are still limited. The aim of this research was to evaluate if the Multidimensional Prognostic Index (MPI), based on the Comprehensive Geriatric Assessment (CGA), may help physicians in identifying older hospitalized patients affected by COVID-19 who might benefit from mechanical ventilation. Design Longitudinal, multicenter study. Settings and Participants 502 older people hospitalized for COVID-19 in 10 European hospitals. Methods MPI was calculated using 8 different domains typical of the CGA. A propensity score, Cox's regression analysis was used for assessing the impact of mechanical ventilation on rehospitalization/mortality for 90 days' follow-up, stratified by MPI = 0.50. The accuracy of MPI in predicting negative outcomes (ie, rehospitalization/mortality) was assessed using the area under the curve (AUC), and the discrimination with several indexes like the Net Reclassification Improvement (NRI) and the Integrated Discrimination Improvement (IDI). Results Among 502 older people hospitalized for COVID-19 (mean age: 80 years), 152 were treated with mechanical ventilation. In the propensity score analysis, during the 90-day follow-up period, there were 44 rehospitalizations and 95 deaths. Mechanical ventilation in patients with MPI values ≥ 0.50, indicating frailer participants, was associated with a higher risk of rehospitalization/mortality (hazard ratio 1.56, 95% CI 1.09-2.23), whereas in participants with MPI values < 0.50 this association was not significant. The accuracy of the model including age, sex, respiratory parameters, and MPI was good (AUC = 0.783) as confirmed by an NRI of 0.2756 (P < .001) and an IDI of 0.1858 (P < .001), suggesting a good discrimination of the model in predicting negative outcomes. Conclusions and Implications MPI could be useful for better individualizing older people hospitalized by COVID-19 who could benefit from mechanical ventilation.
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Affiliation(s)
- Alberto Pilotto
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy; Department of Interdisciplinary Medicine, "Aldo Moro" University of Bari, Bari, Italy
| | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic; Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
| | - Helena Michalkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic; Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
| | - Maria Cristina Polidori
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine, University of Cologne, Cologne, Germany
| | - Alberto Cella
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy
| | - Alfonso Cruz-Jentoft
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | | | - Margherita Azzini
- Geriatrics Unit, "Mater Salutis" Hospital, Legnago ULSS 9 Scaligera, Verona, Italy
| | - Heidi Gruner
- Serviço de Medicina Interna, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central / Universidade Nova de Lisboa Lisbon, Portugal
| | | | | | - Romina Custureri
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy
| | - Carlo Custodero
- Department of Interdisciplinary Medicine, "Aldo Moro" University of Bari, Bari, Italy
| | - Tania Zieschang
- Klinikum Oldenburg AöR, Oldenburg University, Oldenburg, Germany
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | | | - Nicola Veronese
- Department of Internal Medicine and Geriatrics, University of Palermo, Italy.
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10
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Horikoshi T, Nakamura T, Yoshizaki T, Nakamura J, Makino A, Saito Y, Obata JE, Sawanobori T, Takano H, Umetani K, Watanabe A, Asakawa T, Kugiyama K. Stratification Analysis of Statin Effect on Major Adverse Cardiac Events After Percutaneous Coronary Intervention in Patients on Hemodialysis. J Cardiovasc Pharmacol 2022; 79:168-176. [PMID: 34654788 DOI: 10.1097/fjc.0000000000001152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/16/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT The statin use in patients on hemodialysis remains controversial, and no beneficial effects of statin on the reduction of adverse cardiovascular events have been reported in these patients. This study used stratification analysis to examine the clinical factors in patients on hemodialysis who could benefit from statin for secondary prevention. This prospective multicenter study included 234 consecutive patients on hemodialysis with coronary artery disease who underwent successful reperfusion therapy with percutaneous coronary intervention. The patients were followed up for up to 3 years or until the occurrence of major adverse cardiac events (MACEs; defined as a composite of all-cause death and nonfatal myocardial infarction). Inverse probability of treatment weighting adjustment was used to remove the selection bias. During the median follow-up period of 30 months, MACEs occurred in 55 patients. Patients with MACEs had significantly lower statin therapy (P < 0.001). Multivariable Cox proportional hazards analysis showed that the patients on statins had a significantly reduced rate of MACE occurrence [adjusted hazard ratio 0.30 (0.11-0.81), P = 0.02]. The stratification analysis of outcomes according to the presence of clinical factors showed that beneficial effects of statin were associated with man, elderly, lower body mass index, lower abdominal circumference, hypertension, diabetes, higher C-reactive protein, symptomatic heart failure, lower left ventricular function, nonacute coronary syndrome, and shorter stent length. Statin was effective for the prevention of MACEs in patients on hemodialysis who underwent percutaneous coronary intervention. We identified specific clinical factors affecting statin effectiveness for secondary prevention.
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Affiliation(s)
- Takeo Horikoshi
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Yamanashi, Japan
| | - Takamitsu Nakamura
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Yamanashi, Japan
| | - Toru Yoshizaki
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Yamanashi, Japan
| | - Jun Nakamura
- Department of Cardiology, Fujieda Municipal General Hospital, Shizuoka, Japan
| | - Aritaka Makino
- Department of Internal Medicine, Yamanashi Prefectural Central Hospital, Yamanashi, Japan
| | - Yukio Saito
- Department of Cardiology, Kofu Municipal Hospital, Yamanashi, Japan ; and
| | - Jun-Ei Obata
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Yamanashi, Japan
| | - Takao Sawanobori
- Department of Cardiology, Kofu Municipal Hospital, Yamanashi, Japan ; and
| | - Hajime Takano
- Department of Cardiology, Kofu Municipal Hospital, Yamanashi, Japan ; and
| | - Ken Umetani
- Department of Cardiology, Kofu Municipal Hospital, Yamanashi, Japan ; and
| | - Akinori Watanabe
- Department of Cardiology, Fujieda Municipal General Hospital, Shizuoka, Japan
| | - Tetsuya Asakawa
- Department of Cardiology, Yamanashi Kosei Hospital, Yamanashi, Japan
| | - Kiyotaka Kugiyama
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Yamanashi, Japan
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11
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Lopez D, Nedkoff L, Briffa T, Preen DB, Etherton-Beer C, Flicker L, Sanfilippo FM. Effect of frailty on initiation of statins following incident acute coronary syndromes in patients aged ≥75 years. Maturitas 2021; 153:13-18. [PMID: 34654523 DOI: 10.1016/j.maturitas.2021.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Statin use for preventing recurrent acute coronary syndromes (ACS) is low in older people due to many clinical factors, including frailty. Using the recently developed hospital frailty risk score, which allows ascertainment of frailty from real-world data, we examined the association between frailty and initiation of statin treatment following incident ACS in patients aged ≥75 years. Our secondary aim was to determine whether non-initiation of statins was associated with more conservative treatment, defined as non-receipt of evidence-based medicines and/or coronary artery procedures. METHODS We used person-linked hospital administrative and Pharmaceutical Benefits Scheme data to identify incident ACS admissions between 2005 and 2008 in Western Australia and prescription medicine use, respectively. Outcomes were receipt of any statin, high-dose statin, beta-blockers, renin-angiotensin system inhibitors (RASI), antiplatelets and coronary artery procedures within six months of the incident ACS and were analysed using multivariable generalised linear regression models. RESULTS In 1,558 patients (52.4% female, mean age 82.6 years), initiation of any statin or high-dose statin decreased with increasing frailty. The adjusted risk ratios for any statin were 0.89 (95% CI: 0.82-0.97) and 0.67 (95% CI: 0.54-0.85) for the intermediate- and high-frailty categories compared with the low-frailty category, respectively. Compared with patients who received statins, those not receiving statins were less likely (p<0.001) to receive beta-blockers (80.8% vs 51.5%), RASI (86.9% vs 62.1%), antiplatelets (90.9% vs 65.1%) or a coronary artery procedure (65.9% vs 21.1%). CONCLUSIONS Increasing frailty is inversely associated with initiation of statins and generally leads to a more conservative approach to treatment of older patients with ACS.
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Affiliation(s)
- Derrick Lopez
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia.
| | - Lee Nedkoff
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Tom Briffa
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - David B Preen
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Christopher Etherton-Beer
- Western Australian Centre for Health and Ageing, Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Leon Flicker
- Western Australian Centre for Health and Ageing, Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Frank M Sanfilippo
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
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12
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Cammalleri V, Bonanni M, Bueti FM, Matteucci A, Cammalleri L, Stifano G, Muscoli S, Romeo F. Multidimensional Prognostic Index (MPI) in elderly patients with acute myocardial infarction. Aging Clin Exp Res 2021. [PMID: 33001403 DOI: 10.1007/s40520-020-01718-6/figures/2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Management of elderly patients with acute myocardial infarction (AMI) is challenging due to lack of knowledge about the link between fragility, outcomes and interventional procedures. AIMS The aim of this study was to establish the prognostic role of the Multidimensional Prognostic Index (MPI) in elderly with AMI. METHODS A total of 241 patients ≥ 65 years old with AMI were continuously enrolled in this prospective study and divided into three groups according to the MPI score. The primary endpoint was 30-day mortality. Secondary endpoints were 6-month mortality and rate of adverse events. RESULTS In-hospital overall mortality rate was higher in MPI-3 (p = 0.009). Patients of MPI-3 had a significantly higher mortality rate regarding the primary endpoint with 30-day survival of 78.9%, compared to 97.4% and 97.2%, in MPI-1, MPI-2 (p < 0.001), respectively. The survival rate progressively decreased in the three MPI classes of risk with a 6-month survival of 96.5%, 96.3%, 73.7% in groups MPI-1, MPI-2, and MPI-3 (p < 0.001). Longer length of in-hospital stay was observed in MPI-3 group. In-hospital complications were more frequent in higher MPI score. DISCUSSION Our findings are in agreement with the results of other studies that evaluated the risk of in-hospital complications and mortality in older patients. In our "real-world" population of elderly hospitalized for AMI we observed poorer outcomes in patients belonged to higher MPI groups. CONCLUSIONS In the setting of AMI, MPI may be very useful in the daily clinical practice to manage older patients and predict the risk of in-hospital and follow-up complications.
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Affiliation(s)
- Valeria Cammalleri
- Department of Cardiovascular Disease, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy.
| | - Michela Bonanni
- Department of Cardiovascular Disease, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy
| | - Francesca Maria Bueti
- Department of Cardiovascular Disease, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy
| | - Andrea Matteucci
- Department of Cardiovascular Disease, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy
| | - Lisa Cammalleri
- Department of OrthoGeriatrics, Rehabilitation and Stabilization, Galliera Hospital, Genova, Italy
| | - Giuseppe Stifano
- Department of Cardiovascular Disease, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy
| | - Saverio Muscoli
- Department of Cardiovascular Disease, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy
| | - Francesco Romeo
- Department of Cardiovascular Disease, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy
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13
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Cammalleri V, Bonanni M, Bueti FM, Matteucci A, Cammalleri L, Stifano G, Muscoli S, Romeo F. Multidimensional Prognostic Index (MPI) in elderly patients with acute myocardial infarction. Aging Clin Exp Res 2021; 33:1875-1883. [PMID: 33001403 PMCID: PMC8249274 DOI: 10.1007/s40520-020-01718-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/16/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Management of elderly patients with acute myocardial infarction (AMI) is challenging due to lack of knowledge about the link between fragility, outcomes and interventional procedures. AIMS The aim of this study was to establish the prognostic role of the Multidimensional Prognostic Index (MPI) in elderly with AMI. METHODS A total of 241 patients ≥ 65 years old with AMI were continuously enrolled in this prospective study and divided into three groups according to the MPI score. The primary endpoint was 30-day mortality. Secondary endpoints were 6-month mortality and rate of adverse events. RESULTS In-hospital overall mortality rate was higher in MPI-3 (p = 0.009). Patients of MPI-3 had a significantly higher mortality rate regarding the primary endpoint with 30-day survival of 78.9%, compared to 97.4% and 97.2%, in MPI-1, MPI-2 (p < 0.001), respectively. The survival rate progressively decreased in the three MPI classes of risk with a 6-month survival of 96.5%, 96.3%, 73.7% in groups MPI-1, MPI-2, and MPI-3 (p < 0.001). Longer length of in-hospital stay was observed in MPI-3 group. In-hospital complications were more frequent in higher MPI score. DISCUSSION Our findings are in agreement with the results of other studies that evaluated the risk of in-hospital complications and mortality in older patients. In our "real-world" population of elderly hospitalized for AMI we observed poorer outcomes in patients belonged to higher MPI groups. CONCLUSIONS In the setting of AMI, MPI may be very useful in the daily clinical practice to manage older patients and predict the risk of in-hospital and follow-up complications.
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Affiliation(s)
- Valeria Cammalleri
- Department of Cardiovascular Disease, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy.
| | - Michela Bonanni
- Department of Cardiovascular Disease, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy
| | - Francesca Maria Bueti
- Department of Cardiovascular Disease, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy
| | - Andrea Matteucci
- Department of Cardiovascular Disease, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy
| | - Lisa Cammalleri
- Department of OrthoGeriatrics, Rehabilitation and Stabilization, Galliera Hospital, Genova, Italy
| | - Giuseppe Stifano
- Department of Cardiovascular Disease, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy
| | - Saverio Muscoli
- Department of Cardiovascular Disease, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy
| | - Francesco Romeo
- Department of Cardiovascular Disease, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy
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Veronese N, Vianello S, Danesin C, Tudor F, Pozzobon G, Pilotto A. Multidimensional Prognostic Index and Mortality in Intermediate Care Facilities: A Retrospective Study. J Clin Med 2021; 10:2632. [PMID: 34203781 PMCID: PMC8232637 DOI: 10.3390/jcm10122632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/04/2021] [Accepted: 06/09/2021] [Indexed: 11/17/2022] Open
Abstract
Multidimensional prognostic index (MPI) is a frailty assessment tool used for stratifying prognosis in older hospitalized people, but data regarding older people admitted to intermediate care facilities (ICFs) are missing. The aim of this study is to evaluate whether MPI can predict mortality in older patients admitted to the ICFs. MPI was calculated using different domains explored by a standard comprehensive geriatric assessment and categorized into tertiles (MPI-1 ≤ 0.20, MPI-2 0.20-0.34, MPI-3 > 0.34). A Cox's regression analysis, taking mortality as the outcome, was used, reporting the results as hazard ratios (HRs) with 95% confidence intervals (CIs). In total, 653 older patients were enrolled (mean age: 82 years, 59.1% females). Patients in MPI-2 (HR = 3.66; 95%CI: 2.45-5.47) and MPI-3 (HR = 6.22; 95%CI: 4.22-9.16) experienced a higher risk of mortality, compared to MPI-1. The accuracy of MPI in predicting mortality was good (area under the curve (AUC) = 0.74, 95%CI: 0.70-0.78). In conclusion, our study showed that prognostic stratification, as assessed by the MPI, was associated with a significantly different risk of mortality in older patients admitted to the ICFs, indicating the necessity of using a CGA-based tool for better managing older people in this setting as well.
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Affiliation(s)
- Nicola Veronese
- Azienda ULSS (Unità Locale Socio Sanitaria) 3 “Serenissima”, 30174 Venice, Italy; (S.V.); (C.D.); (F.T.); (G.P.)
- Geriatrics Section, Department of Medicine, University of Palermo, 90127 Palermo, Italy
| | - Stefano Vianello
- Azienda ULSS (Unità Locale Socio Sanitaria) 3 “Serenissima”, 30174 Venice, Italy; (S.V.); (C.D.); (F.T.); (G.P.)
| | - Claudia Danesin
- Azienda ULSS (Unità Locale Socio Sanitaria) 3 “Serenissima”, 30174 Venice, Italy; (S.V.); (C.D.); (F.T.); (G.P.)
| | - Florina Tudor
- Azienda ULSS (Unità Locale Socio Sanitaria) 3 “Serenissima”, 30174 Venice, Italy; (S.V.); (C.D.); (F.T.); (G.P.)
| | - Gianfranco Pozzobon
- Azienda ULSS (Unità Locale Socio Sanitaria) 3 “Serenissima”, 30174 Venice, Italy; (S.V.); (C.D.); (F.T.); (G.P.)
| | - Alberto Pilotto
- Department Geriatric Care, Orthogeriatrics and Rehabilitation, Frailty Area, E.O. Galliera Hospital, 16128 Genova, Italy;
- Department of Interdisciplinary Medicine, Aldo Moro University of Bari, 70121 Bari, Italy
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15
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Mattace-Raso F, Pilotto A. The challenge of the multifaceted prognosis in the older people and the Multidimensional Prognostic Index. Eur Geriatr Med 2021; 12:223-226. [PMID: 33620704 PMCID: PMC7900797 DOI: 10.1007/s41999-021-00457-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Francesco Mattace-Raso
- Division of Geriatric Medicine, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Alberto Pilotto
- Geriatric Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, EO Galliera Hospital, Genova, Italy. .,Department of Interdisciplinary Medicine, University of Bari, Bari, Italy.
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16
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Rea F, Mancia G, Corrao G. Statin treatment reduces the risk of death among elderly frail patients: evidence from a large population-based cohort. Eur J Prev Cardiol 2020; 28:1885-1894. [PMID: 33624076 DOI: 10.1093/eurjpc/zwaa126] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/30/2020] [Accepted: 11/05/2020] [Indexed: 11/15/2022]
Abstract
AIMS To assess the protective effect of statins in a large and unselected cohort of frail elderly subjects. METHODS AND RESULTS The 460 460 Lombardy residents (Italy), aged ≥65 years, who received ≥3 consecutive prescriptions of a statin during 2011-2012 were identified. A case-control study was performed, the cases being the cohort members who died during 2011-2018. Logistic regression was used to model the outcome risk associated with statin adherence. Adherence to drug therapy was measured by the proportion of the follow-up covered by prescriptions. The analysis was stratified according to four clinical categories (good, medium, poor, and very poor clinical status), based on different life expectancies, as assessed by a prognostic score which had been found to sensitively predict the risk of death. The 7-year death probability increased from 11% (good) to 52% (very poor clinical status). In each clinical status, there was a significant reduction of all-cause mortality as adherence to statin treatment increased. The reduction in the adjusted risk of mortality from the lowest to the highest adherence level was greatest among patients with a good clinical status (-56%) and progressively less among other cohort members, i.e. -48%, -44% and -47% in medium, poor, and very poor groups, respectively. Similar findings were obtained for the risk of cardiovascular mortality. CONCLUSION In a real-life setting, adherence to statin treatment reduced the death risk also in frail elderly patients. However, in these patients, the benefit of statin treatment may be lower than in those in good clinical conditions.
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Affiliation(s)
- Federico Rea
- National Centre for Healthcare Research & Pharmacoepidemiology, at the University of Milano-Bicocca Milan, Via Bicocca degli Arcimboldi, 8, 20126 Milan, Italy.,Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Via Bicocca degli Arcimboldi, 8, 20126 Milan, Italy
| | - Giuseppe Mancia
- University of Milano-Bicocca (Emeritus Professor), Piazza dei Daini, 4, 20126 Milan, Italy.,Policlinico di Monza, Via Carlo Amati, 111, 20900 Monza, Italy
| | - Giovanni Corrao
- National Centre for Healthcare Research & Pharmacoepidemiology, at the University of Milano-Bicocca Milan, Via Bicocca degli Arcimboldi, 8, 20126 Milan, Italy.,Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Via Bicocca degli Arcimboldi, 8, 20126 Milan, Italy
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17
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Association between Statins Prescribed for Primary and Secondary Prevention and Major Adverse Cardiac Events among Older Adults with Frailty: A Systematic Review. Drugs Aging 2020; 37:787-799. [PMID: 32929609 DOI: 10.1007/s40266-020-00798-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Statins reduce the risk of major adverse cardiovascular events (MACE), however their clinical benefit for primary and secondary prevention among older adults with frailty is uncertain. This systematic review investigates whether statins prescribed for primary and secondary prevention are associated with reduced MACE among adults aged ≥ 65 years with frailty. METHODS We conducted a systematic review of studies published between 1 January 1952 and 1 January 2019 in the MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Library and International Pharmaceutical Abstracts databases. Studies that investigated the effect of statins on MACE among adults ≥ 65 years of age with a validated frailty assessment were included. Data were extracted from the papers as per a prepublished protocol, PROSPERO: CRD42019127486. Risk of bias was assessed using the Cochrane Risk of Bias in Non-Randomised Studies of Interventions tool. RESULTS Six cohort studies fulfilled the inclusion criteria; there were no randomised clinical trials. Among studies evaluating the association between statins for primary and secondary prevention and mortality, one study found statins were associated with reduced mortality (hazard ratio [HR] 0.58, 95% confidence interval [CI] 0.37-0.93), while another study found they were not (HR 0.81, 95% CI 0.61-1.08). Furthermore, one study of statins used for secondary prevention found they were associated with reduced mortality (HR 0.28, 95% CI 0.21-0.39). No studies investigated the effect of statins for primary prevention or the effect of statins on the frequency of MACE. CONCLUSION This review identified only observational evidence that among older people with frailty, statins are associated with reduced mortality when prescribed for secondary prevention, and an absence of evidence evaluating statin therapy for primary prevention. Randomised trial data are needed to better inform the use of statins among older adults living with frailty.
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18
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Pilotto A, Custodero C, Maggi S, Polidori MC, Veronese N, Ferrucci L. A multidimensional approach to frailty in older people. Ageing Res Rev 2020; 60:101047. [PMID: 32171786 PMCID: PMC7461697 DOI: 10.1016/j.arr.2020.101047] [Citation(s) in RCA: 168] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 02/13/2020] [Accepted: 03/10/2020] [Indexed: 12/13/2022]
Abstract
Frailty is an important factor determining a higher risk of adverse health outcomes in older adults. Although scientific community in the last two decades put a lot of effort for its definition, to date no consensus was reached on its assessment. The mainstream thinking describes frailty as a loss of physical functions or as accumulation of multiple deficits. Recently, a novel conceptual model of frailty has emerged based on the loss of harmonic interaction between multiple domains (also referred as dimensions) including genetic, biological, functional, cognitive, psychological and socio-economic domain that ultimately lead to homeostatic instability. Therefore, the multidimensional aspects of frailty condition could be captured by the comprehensive geriatric assessment (CGA) and its derived Multidimensional Prognostic Index (MPI). This instrument has been applied in different clinical settings and in several cohorts of older adults with specific acute and chronic diseases, showing always excellent accuracy in stratifying population according the mortality risk and other negative health outcomes, i.e. hospitalization, institutionalization or admission to homecare services. This MPI "plasticity" provides a single numerical prognostic index which could be helpful in clinical decision making for the management of frail older adults.
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Affiliation(s)
- Alberto Pilotto
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Bari, Italy; Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Ospedali Galliera, Genova, Italy.
| | - Carlo Custodero
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Stefania Maggi
- National Research Council (CNR), Aging Section, Padova, Italy
| | | | - Nicola Veronese
- Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Ospedali Galliera, Genova, Italy; Azienda ULSS 3 Serenissima, Primary Care Department, District 3, Venice, Italy
| | - Luigi Ferrucci
- National Institute on Aging, NIH, Baltimore, MD, United States
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Cruz-Jentoft AJ, Daragjati J, Fratiglioni L, Maggi S, Mangoni AA, Mattace-Raso F, Paccalin M, Polidori MC, Topinkova E, Ferrucci L, Pilotto A. Using the Multidimensional Prognostic Index (MPI) to improve cost-effectiveness of interventions in multimorbid frail older persons: results and final recommendations from the MPI_AGE European Project. Aging Clin Exp Res 2020; 32:861-868. [PMID: 32180170 DOI: 10.1007/s40520-020-01516-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/14/2020] [Indexed: 02/06/2023]
Abstract
MPI_AGE is a European Union co-funded research project aimed to use the Multidimensional Prognostic Index (MPI), a validated Comprehensive Geriatric Assessment (CGA)-based prognostic tool, to develop predictive rules that guide clinical and management decisions in older people in different European countries. A series of international studies performed in different settings have shown that the MPI is useful to predict mortality and risk of hospitalization in community-dwelling older subjects at population level. Furthermore, studies performed in older people who underwent a CGA before admission to a nursing home or receiving homecare services showed that the MPI successfully identified groups of persons who could benefit, in terms of reduced mortality, of specific therapies such as statins in diabetes mellitus and coronary artery disease, anticoagulants in atrial fibrillation and antidementia drugs in cognitive decline. A prospective trial carried out in nine hospitals in Europe and Australia demonstrated that the MPI was able to predict not only in-hospital and long-term mortality, but also institutionalization, re-hospitalization and receiving homecare services during the one-year follow-up after hospital discharge. The project also explored the association between MPI and mortality in hospitalized older patients in need of complex procedures such as transcatheter aortic valve implantation or enteral tube feeding. Evidence from these studies has prompted the MPI_AGE Investigators to formulate recommendations for healthcare providers, policy makers and the general population which may help to improve the cost-effectiveness of appropriate health care interventions for older patients.
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Luotola K, Jyväkorpi S, Urtamo A, Pitkälä KH, Kivimäki M, Strandberg TE. Statin treatment, phenotypic frailty and mortality among community-dwelling octogenarian men: the HBS cohort. Age Ageing 2020; 49:258-263. [PMID: 31755909 DOI: 10.1093/ageing/afz138] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/19/2019] [Accepted: 10/01/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND statin treatment has increased also among people aged 80 years and over, but adverse effects potentially promoting frailty and loss of resilience are frequent concerns. METHODS in the Helsinki Businessmen Study, men born in 1919-34 (original n = 3,490) have been followed up since the 1960s. In 2011, a random subcohort of home-living survivors (n = 525) was assessed using questionnaires and clinical (including identification of phenotypic frailty) and laboratory examinations. A 7-year mortality follow-up ensued. RESULTS we compared 259 current statin users (median age 82 years, interquartile range 80-85 years) with 266 non-users (83; 80-86 years). Statin users had significantly more multimorbidity than non-users (prevalencies 72.1% and 50.4%, respectively, P < 0.0001) and worse glucose status than non-users (prevalencies of diabetes 19.0% and 9.4%, respectively, P = 0.0008). However, there was no difference in phenotypic frailty (10.7% versus 11.2%, P = 0.27), and statin users had higher plasma prealbumin level than non-users (mean levels 257.9 and 246.3 mg/L, respectively, P = 0.034 adjusted for age, body mass index and C-reactive protein) implying better nutritional status. Despite morbidity difference, age-adjusted 7-year mortality was not different between the two groups (98 and 103 men among users and non-users of statins, respectively, hazard ratio 0.96, 95% confidence interval 0.72-1.30). CONCLUSIONS our study suggests that male octogenarian statin users preserved resilience and survival despite multimorbidity, and this may be associated with better nutritional status among statin users.
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Affiliation(s)
- Kari Luotola
- University of Helsinki, Clinicum, and Helsinki University Hospital, Helsinki, Finland
| | - Satu Jyväkorpi
- University of Helsinki, Clinicum, and Helsinki University Hospital, Helsinki, Finland
| | - Annele Urtamo
- University of Helsinki, Clinicum, and Helsinki University Hospital, Helsinki, Finland
| | - Kaisu H Pitkälä
- University of Helsinki, Clinicum, and Helsinki University Hospital, Helsinki, Finland
| | - Mika Kivimäki
- University of Helsinki, Clinicum, and Helsinki University Hospital, Helsinki, Finland
- Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Timo E Strandberg
- University of Helsinki, Clinicum, and Helsinki University Hospital, Helsinki, Finland
- University of Oulu, Center for Life Course Health Research, Oulu, Finland
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21
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Amano H, Noike R, Yabe T, Watanabe I, Okubo R, Koizumi M, Toda M, Ikeda T. Frailty and coronary plaque characteristics on optical coherence tomography. Heart Vessels 2019; 35:750-761. [DOI: 10.1007/s00380-019-01547-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 12/13/2019] [Indexed: 12/20/2022]
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22
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Bryant K, Sorich MJ, Woodman RJ, Mangoni AA. Validation and Adaptation of the Multidimensional Prognostic Index in an Older Australian Cohort. J Clin Med 2019; 8:E1820. [PMID: 31683820 PMCID: PMC6912422 DOI: 10.3390/jcm8111820] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/29/2019] [Accepted: 10/29/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND AIMS The Multidimensional Prognostic Index (MPI), an objective and quantifiable tool based on the Comprehensive Geriatric Assessment, has been shown to predict adverse outcomes in European cohorts. We conducted a validation study of the original MPI, and of adapted versions that accounted for the use of specific drugs and cultural diversity in the assessment of cognition, in older Australians. METHODS The capacity of the MPI to predict 12-month mortality was assessed in 697 patients (median age: 80 years; interquartile range: 72-86) admitted to a metropolitan teaching hospital between September 2015 and February 2017. RESULTS In simple logistic regression analysis, the MPI was associated with 12-month mortality (Low risk: OR reference group; moderate risk: OR 2.50, 95% CI: 1.67-3.75; high risk: OR 4.24, 95% CI: 2.28-7.88). The area under the receiver operating characteristic curve (AUC) for the unadjusted MPI was 0.61 (0.57-0.65) and 0.64 (95% CI: 0.59-0.68) with age and sex adjusted. The adapted versions of the MPI did not significantly change the AUC of the original MPI. CONCLUSION The original and adapted MPI were strongly associated with 12-month mortality in an Australian cohort. However, the discriminatory performance was lower than that reported in European studies.
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Affiliation(s)
- Kimberley Bryant
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University and Flinders Medical Centre, Bedford Park, 5042, South Australia, Australia.
| | - Michael J Sorich
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University and Flinders Medical Centre, Bedford Park, 5042, South Australia, Australia.
| | - Richard J Woodman
- Flinders Centre for Epidemiology and Biostatistics, College of Medicine and Public Health, Flinders University, Bedford Park, 5042, South Australia, Australia.
| | - Arduino A Mangoni
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University and Flinders Medical Centre, Bedford Park, 5042, South Australia, Australia.
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23
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Strandberg TE, Urtamo A, Kähärä J, Strandberg AY, Pitkälä KH, Kautiainen H. Statin Treatment Is Associated With a Neutral Effect on Health-Related Quality of Life Among Community-Dwelling Octogenarian Men: The Helsinki Businessmen Study. J Gerontol A Biol Sci Med Sci 2019; 73:1418-1423. [PMID: 29659717 DOI: 10.1093/gerona/gly073] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Indexed: 11/14/2022] Open
Abstract
Background Statin treatment is common among 80+ people, but little is known about statin effects on health-related quality of life (HRQoL) in this oldest age group. Methods In the Helsinki Businessmen Study (HBS), men born from 1919 to 1934 (original n = 3,490), have been followed-up since the 1960s. In 2015, a questionnaire about lifestyle, diseases, and medications, and including RAND-36/SF-36 HRQoL instrument was mailed to survivors. About 612 men (72.6%) responded, 530 of them reporting their medications (98% community-living). Propensity score analysis was used to compare statin users and nonusers for HRQoL. Results We compared 229 current statin users (median age 85 years, interquartile range 84-88 years) with 301 nonusers (86; 84-89 years). Current statin users had had significantly higher serum cholesterol level in midlife (p < .001), but current lifestyle-related characteristics were similar in users and nonusers. Statin users reported more hypertension (61.1%, p < .001), diabetes (23.6%, p <.001), and atherosclerotic cardiovascular disease (ASCVD, 33.6%, p <.001), than nonusers. Statin users reported higher mean scores than nonusers in all eight RAND-36 subscales, but after adjustments for multiplicity and a propensity score we found no significant differences between statin users and nonusers. Stratification for primary (no ASCVD) and secondary (with CVD) prevention supported the main results. Conclusions Our study suggests that statin treatment has no significant effect on health-related quality of life among octogenarian, community-dwelling men. The results contradict concerns about statin treatment in the oldest-old, and may caution against deprescribing of statins due to old age alone.
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Affiliation(s)
- Timo E Strandberg
- University of Helsinki, Clinicum, and Helsinki University Hospital, Finland.,Center for Life Course Health Research, University of Oulu, Finland
| | - Annele Urtamo
- University of Helsinki, Clinicum, and Helsinki University Hospital, Finland
| | - Juuso Kähärä
- University of Helsinki, Clinicum, and Helsinki University Hospital, Finland
| | - Arto Y Strandberg
- University of Helsinki, Clinicum, and Helsinki University Hospital, Finland
| | - Kaisu H Pitkälä
- University of Helsinki, Clinicum, and Helsinki University Hospital, Finland
| | - Hannu Kautiainen
- Kuopio University Hospital, Finland.,Folkhälsan Research Centre, Helsinki, Finland
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Veronese N, Cella A, Cruz-Jentoft AJ, Polidori MC, Mattace-Raso F, Paccalin M, Topinkova E, Greco A, Mangoni AA, Daragjati J, Siri G, Pilotto A. Enteral tube feeding and mortality in hospitalized older patients: A multicenter longitudinal study. Clin Nutr 2019; 39:1608-1612. [PMID: 31378515 DOI: 10.1016/j.clnu.2019.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 05/07/2019] [Accepted: 07/09/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND & AIMS The literature regarding enteral nutrition and mortality in older frail people is limited and still conflicting. Moreover, the potential role of comprehensive geriatric assessment is poorly explored. We therefore aimed to investigate whether the Multidimensional Prognostic Index (MPI), an established tool that assesses measures of frailty and predicts mortality, may help physicians in identifying patients in whom ETF (enteral tube feeding) is effective in terms of reduced mortality. METHODS Observational, longitudinal, multicenter study with one year of follow-up. Data regarding ETF were recorded through medical records. A standardized comprehensive geriatric assessment was used to calculate the MPI. Participants were divided in low (MPI-1), moderate (MPI-2) or severe (MPI-3) risk of mortality. Data regarding mortality were recorded through administrative information. RESULTS 1064 patients were included, with 79 (13 in MPI 1-2 and 66 in MPI-3 class) receiving ETF. In multivariable analysis, patients receiving ETF experienced a higher risk of death (odds ratio, OR = 2.00; 95% confidence intervals, CI: 1.19-3.38). However, after stratifying for their MPI at admission, mortality was higher in MPI-3 class patients (OR = 2.03; 95%CI: 1.09-3.76), but not in MPI 1-2 class patients (OR = 1.51; 95%CI: 0.44-5.25). The use of propensity score confirmed these findings. CONCLUSIONS ETF is associated with a higher risk of death. However, this is limited to more frail patients, suggesting the importance of the MPI in the prognostic evaluation of ETF.
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Affiliation(s)
- Nicola Veronese
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Geriatric Unit, E.O. Galliera Hospital, Genova, Italy; Azienda ULSS 3 Serenissima, Primary Care Department, District 3, Venice, Italy.
| | - Alberto Cella
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Geriatric Unit, E.O. Galliera Hospital, Genova, Italy
| | | | | | - Francesco Mattace-Raso
- Section of Geriatric Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Marc Paccalin
- Geriatrics Department University Hospital Poitiers, France
| | - Eva Topinkova
- First Faculty of Medicine, Charles University in Prague, Czech Republic
| | - Antonio Greco
- Geriatrics Unit, IRCCS CSS, San Giovanni Rotondo, Italy
| | - Arduino A Mangoni
- Department of Clinical Pharmacology, College of Medicine and Public Health, Flinders University and Flinders Medical Centre, Adelaide, Australia
| | - Julia Daragjati
- Geriatrics Unit, AULSS 6 Euganea, San Antonio Hospital, Padova, Italy
| | - Giacomo Siri
- Scientific Coordination Unit, E.O. Galliera Hospital, Genova, Italy
| | - Alberto Pilotto
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Geriatric Unit, E.O. Galliera Hospital, Genova, Italy; Department of Interdisciplinary Medicine, 'Aldo Moro' University of Bari, Italy
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Eilat-Tsanani S, Mor E, Schonmann Y. Statin Use Over 65 Years of Age and All-Cause Mortality: A 10-Year Follow-Up of 19 518 People. J Am Geriatr Soc 2019; 67:2038-2044. [PMID: 31287932 DOI: 10.1111/jgs.16060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/05/2019] [Accepted: 06/05/2019] [Indexed: 01/29/2023]
Abstract
OBJECTIVES As life expectancy continues to rise, the burden of cardiovascular disease among older people is expected to increase, making cardiovascular prevention in older people an issue of growing interest and public health importance. We aimed to explore the long-term effects of adherence to statins on mortality and cardiovascular morbidity among older adults. DESIGN A historical population-based cohort study using routinely collected data. SETTING Clalit Health Services Northern District. PARTICIPANTS We followed members of Clalit Health Services aged 65 years or older who were eligible for primary cardiovascular prevention for a period of 10 years. MEASUREMENTS We fitted Cox regression models to assess the association between the adherence to statin therapy and all-cause mortality and cardiovascular morbidity, adjusting for cardiovascular risk factors and associated morbidity as time-updated variables. RESULTS The analysis included 19 518 older adults followed during 10 years (median = 9.7 y). All-cause mortality rates were 34% lower among those who had adhered to statin treatment, compared with those who had not (hazard ratio [HR] = .66; 95% confidence interval [CI] = .56-.79). Adherence to statins was also associated with fewer atherosclerotic cardiovascular disease events (HR = .80; 95% CI = .71-.81). The benefit of statin use did not diminish among beyond age 75 and was evident for both women and men. CONCLUSION Adherence to statins may be associated with reduced mortality and cardiovascular morbidity among older adults, regardless of age and sex. J Am Geriatr Soc 67:2038-2044, 2019.
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Affiliation(s)
- Sophia Eilat-Tsanani
- Department of Family Medicine, Clalit Health Services Northern District, Israel.,Department of Family Medicine, Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Elad Mor
- Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel
| | - Yochai Schonmann
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Department of Family Medicine, Clalit Health Services, Rabin Medical Center, Petah Tikva, Israel.,Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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26
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Villain C, Liabeuf S, Metzger M, Combe C, Fouque D, Frimat L, Jacquelinet C, Laville M, Briançon S, Pisoni RL, Mansencal N, Stengel B, Massy ZA. Impact of age on cardiovascular drug use in patients with chronic kidney disease. Clin Kidney J 2019; 13:199-207. [PMID: 32296525 PMCID: PMC7147308 DOI: 10.1093/ckj/sfz063] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 04/18/2019] [Indexed: 01/21/2023] Open
Abstract
Background Elderly patients with chronic kidney disease (CKD) are often excluded from clinical trials; this may affect their use of essential drugs for cardiovascular complications. We sought to assess the impact of age on cardiovascular drug use in elderly patients with CKD. Methods We used baseline data from the Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) cohort including 3033 adult patients with CKD Stages 3 and 4. We studied the use of recommended drugs for coronary artery disease (CAD), stroke and atrial fibrillation by age, after adjusting for socio-demographic and clinical conditions. Results The patients’ mean age was 66.8 years (mean estimated glomerular filtration rate 32.9 mL/min/1.73 m2). The prevalence of CAD was 24.5% [81.3% receiving antiplatelet agents, 75.6% renin–angiotensin system (RAS) blockers, 65.4% β-blockers and 81.3% lipid-lowering therapy], that of stroke 10.0% (88.8% receiving antithrombotic drugs) and that of atrial fibrillation 11.1% (69.5% receiving oral anticoagulants). Compared with patients aged <65 years, older age (≥65 years) was associated with greater use of antithrombotic drugs in stroke [adjusted odds ratio (aOR) (95% confidence interval) = 2.83 (1.04–7.73) for patients aged (75–84 years)] and less use of RAS blockers [aOR = 0.39 (0.16–0.89) for patients aged ≥85 years], β-blockers [aOR = 0.31 (0.19–0.53) for patients aged 75–84 years] and lipid-lowering therapy [aOR = 0.39 (0.15–1.02) for patients aged ≥85 years, P for trend = 0.01] in CAD. Older age was not associated with less use of antiplatelet agents in CAD or oral anticoagulants in atrial fibrillation. Conclusions In patients with CKD, older age per se was not associated with the underuse of antithrombotic drugs but was for other major drugs, with a potential impact on cardiovascular outcomes.
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Affiliation(s)
- Cédric Villain
- Service de Néphrologie-Dialyse, CHU Ambroise Paré, APHP, Boulogne-Billancourt, France
- CESP, INSERM Unité 1018, Equipe 5 EpRec, Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France
| | - Sophie Liabeuf
- CESP, INSERM Unité 1018, Equipe 5 EpRec, Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France
- Service de Pharmacologie Clinique, Département de Recherche Clinique, CHU d’Amiens, Université de Picardie Jules Verne, INSERM U-1088, Amiens, France
| | - Marie Metzger
- CESP, INSERM Unité 1018, Equipe 5 EpRec, Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France
| | - Christian Combe
- Service de Néphrologie Transplantation Dialyse Aphérèses, CHU de Bordeaux, Bordeaux, France
- INSERM Unité 1026, Université de Bordeaux, Bordeaux, France
| | - Denis Fouque
- Université de Lyon, Service de Néphrologie, CarMeN INSERM 1060, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | - Luc Frimat
- CHRU Nancy-Brabois, Vandœuvre-lès-Nancy, France
- INSERM CIC-EC CIE6 - EA 4360 Apemac, Nancy Université, Vandœuvre-lès-Nancy, France
| | - Christian Jacquelinet
- CESP, INSERM Unité 1018, Equipe 5 EpRec, Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France
- Agence de Biomédecine, La Plaine Saint-Denis, France
| | - Maurice Laville
- Université de Lyon, Service de Néphrologie, CarMeN INSERM 1060, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | - Serge Briançon
- INSERM CIC-EC CIE6 - EA 4360 Apemac, Nancy Université, Vandœuvre-lès-Nancy, France
| | | | - Nicolas Mansencal
- CESP, INSERM Unité 1018, Equipe 5 EpRec, Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France
- Service de Cardiologie, CHU Ambroise Paré, APHP, Boulogne-Billancourt, France
| | - Bénédicte Stengel
- CESP, INSERM Unité 1018, Equipe 5 EpRec, Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France
| | - Ziad A Massy
- Service de Néphrologie-Dialyse, CHU Ambroise Paré, APHP, Boulogne-Billancourt, France
- CESP, INSERM Unité 1018, Equipe 5 EpRec, Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France
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Abstract
Purpose of Review Hypercholesterolemia and statin treatment are nowadays common among people older than 75 years, but clinical heterogeneity in this increasing age group is wide, and treatment decisions may differ from those in younger patients. Aim is to discuss the presentation, modifying factors, and treatment decisions of hypercholesterolemia (usually with statins) in older persons and focusing on primary prevention. Recent Findings There are no randomized controlled trials in persons older than 80 years at baseline. Randomized controlled trial findings in younger patients and 75+ subgroups and in observational studies support treatment in secondary prevention of atherosclerotic cardiovascular disease (ASCVD), but trial evidence in primary prevention is less clear. Available data do not imply specific harms in older patients, and, therefore, also, judicious primary prevention is possible. However, persons older than 75 years are biologically a very heterogeneous group with frequent frailty, comorbid conditions, and multiple concomitant drugs. All these, as well as personal preferences, must be taken into account in treatment decisions. Summary Statin treatment is only one way to prevent ASCVD in older people. Treatment of hypercholesterolemia should be started far before 75–80 years, and there is no need to discontinue statin treatment due to chronological age alone. After 75 years, treatment should be started in patients with ASCVD and judiciously in primary prevention. Like all prevention, statin treatment should be discontinued when palliative treatment is started. Ongoing and planned trials in 70+ individuals will give more information about primary prevention in older persons.
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28
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Bertolotti M, Lancellotti G, Mussi C. Management of high cholesterol levels in older people. Geriatr Gerontol Int 2019; 19:375-383. [PMID: 30900369 DOI: 10.1111/ggi.13647] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 01/23/2019] [Accepted: 01/31/2019] [Indexed: 12/22/2022]
Abstract
The management of hypercholesterolemia in older adults still represents a challenge in clinical medicine. The pathophysiological alterations of cholesterol metabolism associated with aging are still incompletely understood, even if epidemiological evidence suggests that serum cholesterol levels increase with ongoing age, possibly with a plateau after the age of 80 years. Age is also one of the main determinants of cardiovascular disease, according to all cardiovascular risk estimate tools. Cholesterol-lowering treatment, therefore, would be expected to bring significant protection, even in these patients. Unfortunately, direct experimental evidence is extremely limited, particularly in the very old age strata of the population; a clinical benefit still seems to be present, but the risk for drug-related adverse events is clearly higher. At any rate, at the present time, definite guidelines for the correct management of hypercholesterolemia in older patients are not available. Therefore, the decision whether or not a pharmacological treatment should be set up, and the choice of the drug, need to be tailored to the individual patient, and requires accurate clinical judgment. The specific aspects of frailty and disability, along with the actual age of the patients, have to be considered together, with a comprehensive assessment approach. The present review summarizes the evidence regarding the modifications of cholesterol metabolism in older patients, the impact of lipid-lowering drugs on cardiovascular outcomes and focuses on the considerations that can help to define the most appropriate treatment strategy, in view of the individual functional profile. Geriatr Gerontol Int 2019; 19: 375-383.
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Affiliation(s)
- Marco Bertolotti
- Department of Biomedical, Metabolic and Neural Sciences, Center for Gerontological Evaluation and Research, University of Modena and Reggio Emilia, Modena, Italy.,Division of Geriatric Medicine, City Hospital Sant'Agostino-Estense of Modena, Modena, Italy
| | - Giulia Lancellotti
- Department of Biomedical, Metabolic and Neural Sciences, Center for Gerontological Evaluation and Research, University of Modena and Reggio Emilia, Modena, Italy.,Division of Geriatric Medicine, City Hospital Sant'Agostino-Estense of Modena, Modena, Italy
| | - Chiara Mussi
- Department of Biomedical, Metabolic and Neural Sciences, Center for Gerontological Evaluation and Research, University of Modena and Reggio Emilia, Modena, Italy.,Division of Geriatric Medicine, City Hospital Sant'Agostino-Estense of Modena, Modena, Italy
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Strandberg TE. Challenges of a Statin Trial in Older People. J Am Geriatr Soc 2019; 67:856-857. [PMID: 30688358 DOI: 10.1111/jgs.15763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 11/26/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Timo E Strandberg
- University of Helsinki, Clinicum, and Helsinki University Hospital, Helsinki, Finland.,Center for Life Course Health Research, University of Oulu, Oulu, Finland
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30
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Sultana J, Leal I, de Wilde M, de Ridder M, van der Lei J, Sturkenboom M, Trifiro’ G. Identifying Data Elements to Measure Frailty in a Dutch Nationwide Electronic Medical Record Database for Use in Postmarketing Safety Evaluation: An Exploratory Study. Drug Saf 2019; 42:713-719. [DOI: 10.1007/s40264-018-00785-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Fialová D, Laffon B, Marinković V, Tasić L, Doro P, Sόos G, Mota J, Dogan S, Brkić J, Teixeira JP, Valdiglesias V, Costa S. Medication use in older patients and age-blind approach: narrative literature review (insufficient evidence on the efficacy and safety of drugs in older age, frequent use of PIMs and polypharmacy, and underuse of highly beneficial nonpharmacological strategies). Eur J Clin Pharmacol 2019; 75:451-466. [PMID: 30610276 DOI: 10.1007/s00228-018-2603-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 11/22/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The importance of rational drug therapy is increasing with the aging of the population. Since one of the main reasons for inappropriate drug prescribing is also the "age-blind" approach, which results in ageist practices, this narrative literature review focuses on the description of the main barriers related to insufficient individualization of drug regimens associated with such age-blind approaches. METHODOLOGY A narrative literature review using the PubMed, WoS, Embase, and Scopus databases was conducted by the EU COST Action IS1402. Experts in different scientific fields from six countries (the Czech Republic, Spain, Portugal, Hungary, Serbia, and Turkey) worked in four specific areas: (1) underrepresentation of older adults in clinical trials and clinical and ethical consequences; (2) insufficient consideration of age-related changes and geriatric frailty in the evaluation of the therapeutic value of drugs; (3) frequent prescribing of potentially inappropriate medications (PIMs); and (4) frequent underuse of highly beneficial nonpharmacological strategies (e.g., exercise). RESULTS Older patients are underrepresented in clinical trials. Therefore, rigorous observational geriatric research is needed in order to obtain evidence on the real efficacy and safety of frequently used drugs, and e.g. developed geriatric scales and frailty indexes for claims databases should help to stimulate such research. The use of PIMs, unfortunately, is still highly prevalent in Europe: 22.6% in community-dwelling older patients and 49.0% in institutionalized older adults. Specific tests to detect the majority of age-related pharmacological changes are usually not available in everyday clinical practice, which limits the estimation of drug risks and possibilities to individualize drug therapy in geriatric patients before drug prescription. Moreover, the role of some nonpharmacological strategies is highly underestimated in older adults in contrast to frequent use of polypharmacy. Among nonpharmacological strategies, particularly physical exercise was highly effective in reducing functional decline, frailty, and the risk of falls in the majority of clinical studies. CONCLUSION Several regulatory and clinical barriers contribute to insufficient knowledge on the therapeutic value of drugs in older patients, age-blind approach, and inappropriate prescribing. New clinical and observational research is needed, including data on comprehensive geriatric assessment and frailty, to document the real efficacy and safety of frequently used medications.
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Affiliation(s)
- Daniela Fialová
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Prague, Czech Republic. .,Department of Geriatrics and Gerontology, 1st Faculty of Medicine in Prague, Charles University, Prague, Czech Republic.
| | - Blanca Laffon
- DICOMOSA Group, Department of Psychology, Area of Psychobiology, Universidade da Coruña, A Coruña, Spain
| | - Valentina Marinković
- Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Ljiljana Tasić
- Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Peter Doro
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Gyӧngyver Sόos
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Jorge Mota
- Centro de Investigação em Actividade Fìsica, Saúde e Lazer (CIAFEL), University of Porto, Porto, Portugal
| | - Soner Dogan
- Department of Medical Biology, School of Medicine, Yeditepe University, Istanbul, Turkey
| | - Jovana Brkić
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Prague, Czech Republic
| | - João Paulo Teixeira
- Department of Environmental Health, Portuguese National Institute of Health, Porto, Portugal.,EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Vanessa Valdiglesias
- DICOMOSA Group, Department of Psychology, Area of Psychobiology, Universidade da Coruña, A Coruña, Spain
| | - Solange Costa
- Department of Environmental Health, Portuguese National Institute of Health, Porto, Portugal.,EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
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[Dyslipidemia management in geriatric patients: new guidelines 2017]. Nihon Ronen Igakkai Zasshi 2019; 56:417-426. [PMID: 31761845 DOI: 10.3143/geriatrics.56.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Mostaza JM, Lahoz C, Salinero-Fort MA, Cardenas J. Cardiovascular disease in nonagenarians: Prevalence and utilization of preventive therapies. Eur J Prev Cardiol 2018; 26:356-364. [DOI: 10.1177/2047487318813723] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Aims Nonagenarians are a fast growing segment of industrialized countries' populations. Despite a greater risk of cardiovascular disease, there are limited data about their use of preventive therapies and factors guiding decisions regarding their prescription. The aim of this study was to evaluate the prevalence of cardiovascular diseases and the patterns of use of cardiovascular treatments in subjects ≥90 years old. Methods Population-based, cross-sectional study, in all nonagenarians residing in the Community of Madrid (Spain). Data were obtained from their electronic clinical records in primary care. Results Data were available from 59,423 subjects (mean age 93.3 years, 74.2% female, 13.5% with dementia). Prevalence of cardiovascular disease was 24.1% (10.9% with coronary artery disease (CAD), 13.1% with cerebrovascular disease (CVD) and 2.7% with peripheral artery disease(PAD)). In primary prevention, the use of statins and antiplatelet agents was 21.9% and 26.7%, respectively. Of subjects with vascular disease 27.7% were receiving a combined preventive strategy (use of antithrombotics, plus statins, plus blood pressure below 140/90 mmHg). Factors favourably associated with a combined preventive strategy were: female sex (odds ratio (OR) 1.29; 95% confidence interval (CI): 1.11–1.49), being independent versus totally dependent (OR 1.94; 95% CI: 1.43–2.65), diabetes (OR 1.42; 95% CI: 1.20–1.68), and negatively, age (OR 0.87; 95% CI: 0.85–0.90), CVD versus CAD (OR 0.41; 95% CI: 0.35–0.47), PAD versus CAD (OR 0.23; 95% CI: 0.18–0.30), dementia (OR 0.61; 95% CI: 0.49–0.76) and nursing home residency (OR 0.73; 95% CI: 0.57–0.93). Conclusion Nonagenarians have a great burden of cardiovascular diseases and receive a great number of preventive therapies, even in primary prevention, despite their unproven efficacy at these ages.
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Affiliation(s)
- Jose M Mostaza
- Department of Internal Medicine. Hospital Carlos III, Madrid, Spain
| | - Carlos Lahoz
- Department of Internal Medicine. Hospital Carlos III, Madrid, Spain
| | | | - Juan Cardenas
- Dirección Técnica de Sistemas de Información Sanitaria, Gerencia Adjunta de Procesos Asistenciales, Gerencia Asistencial de Atención Primaria, Madrid, Spain
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No modifying effect of nutritional status on statins therapy in relation to all-cause death in older patients with coronary artery disease. Aging Clin Exp Res 2018; 30:1071-1077. [PMID: 29260400 DOI: 10.1007/s40520-017-0881-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 12/11/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Statins therapy in the secondary prevention of coronary artery disease (CAD) is associated with a lower risk of adverse cardiovascular events. However, little is known regarding the association of elderly patients with nutritional risk on statin therapy. AIMS To investigate whether older patients with CAD who were at nutritional risk gain similar survival benefit from statins therapy as their counterparts without nutritional risk. METHODS We conducted a retrospective hospital-based cohort study among 1705 patients with CAD who were older than 65 years of age, using coronary heart disease database from 2008 to 2012. Nutritional status of included patients was gauged using the geriatric nutritional risk index. After stratification by nutritional status, the hazard of all-cause death was compared between those with or without statins therapy. RESULTS Of the 1705 patients included in the study (mean age 72 years; 73% male), all-cause death occurred in 146 (9.2%) patients with statins use and in 33 (26.2%) patients without statins use. The rate of all-cause death was higher in patients not receiving statins irrespective of nutritional status. After adjustments for potential confounders, the HR with statins use was 0.33 (95% CI 0.20-0.55) in patients without nutritional risk and 0.47 (95% CI 0.22-1.00) in patients with nutritional risk. No interaction effect was detected between nutritional status and statins use in relation to all-cause death (P value for interaction effect 0.516). CONCLUSION Despite of the patient's nutritional status, statins therapy as a secondary prevention in elderly CAD patients was associated with decreased risk of all-cause death.
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Korhonen MJ, Ilomäki J, Sluggett JK, Brookhart MA, Visvanathan R, Cooper T, Robson L, Bell JS. Selective prescribing of statins and the risk of mortality, hospitalizations, and falls in aged care services. J Clin Lipidol 2018; 12:652-661. [PMID: 29574073 DOI: 10.1016/j.jacl.2018.02.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/26/2018] [Accepted: 02/20/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Compared to randomized controlled trials, nonexperimental studies often report larger survival benefits but higher rates of adverse events for statin use vs nonuse. OBJECTIVE We compared characteristics of statin users and nonusers living in aged care services and evaluated the relationships between statin use and all-cause mortality, all-cause and fall-related hospitalizations, and number of falls during a 12-month follow-up. METHODS A prospective cohort study of 383 residents aged ≥65 years was conducted in six Australian aged care services. Data were obtained from electronic medical records and medication charts and through a series of validated assessments. RESULTS The greatest differences between statin users and nonusers were observed in activities of daily living, frailty, and medication use (absolute standardized difference >0.40), with users being less dependent and less frail but using a higher number of medications. Statin use was associated with a decreased risk of all-cause mortality (adjusted hazard ratio [HR] 0.58, 95% confidence interval [CI] 0.37-0.93) and hospitalizations (HR 0.67, 95% CI 0.46-0.98). After exclusion of residents unable to sit or stand, statin use was associated with a nonsignificant increase in the risk of fall-related hospitalizations (HR 1.47, 95% CI 0.80-2.68) but with a lower incidence of falls (incidence rate ratio 0.67, 95% CI 0.47-0.96). CONCLUSIONS The observed associations between statin use and the outcomes may be largely explained by selective prescribing and deprescribing of statins and variation in likelihood of hospitalization based on consideration of each resident's clinical and frailty status. Randomized deprescribing trials are needed to guide statin prescribing in this setting.
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Affiliation(s)
- Maarit J Korhonen
- NHMRC Centre for Research Excellence in Frailty and Healthy Ageing, Adelaide, South Australia, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia; Institute of Biomedicine, University of Turku, Turku, Finland.
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Janet K Sluggett
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia; NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
| | - M Alan Brookhart
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Renuka Visvanathan
- NHMRC Centre for Research Excellence in Frailty and Healthy Ageing, Adelaide, South Australia, Australia; School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
| | - Tina Cooper
- Resthaven Incorporated, Adelaide, South Australia, Australia
| | - Leonie Robson
- Resthaven Incorporated, Adelaide, South Australia, Australia
| | - J Simon Bell
- NHMRC Centre for Research Excellence in Frailty and Healthy Ageing, Adelaide, South Australia, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia; NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; Sansom Institute, University of South Australia, Adelaide, South Australia, Australia
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Zullo AR, Sharmin S, Lee Y, Daiello LA, Shah NR, John Boscardin W, Dore DD, Lee SJ, Steinman MA. Secondary Prevention Medication Use After Myocardial Infarction in U.S. Nursing Home Residents. J Am Geriatr Soc 2017; 65:2397-2404. [PMID: 29044457 DOI: 10.1111/jgs.15144] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES Secondary prevention medications are recommended for older adults after acute myocardial infarction (AMI), but little is known about whether nursing home (NH) residents receive these medications. The objective was to evaluate new use of secondary prevention medications after AMI in NH residents who were previously nonusers and to evaluate what factors were associated with use. DESIGN Retrospective cohort using linked national Minimum Data Set assessments; Online Survey, Certification and Reporting records; and Medicare claims. SETTING U.S. NHs. PARTICIPANTS National cohort of 11,192 NH residents aged 65 and older who were hospitalized for an AMI between May 2007 and March 2010, had no beta-blocker or statin use for 4 months or longer before the hospitalization, and survived 14 days or more after NH readmission. MEASUREMENTS The outcome was the number of secondary prevention medications initiated within 30 days of NH readmission. RESULTS Thirty-seven percent of residents had no secondary prevention medications initiated after AMI, 41% had 1 initiated, and 22% had 2 initiated. After covariate adjustment, fewer secondary prevention medications were used in older residents (proportional odds ratio (POR) = 0.48, 95% confidence interval (CI) = 0.40-0.57 for ≥95 vs 65-74); women (POR = 0.88, 95% CI = 0.80-0.96);and those with a do-not-resuscitate (DNR) order (POR = 0.90, 95% CI = 0.83-0.98), functional impairment (dependent or totally dependent vs independent to limited assistance, POR = 0.77, 95% CI = 0.69-0.86), and cognitive impairment (moderate to severe vs no impairment, POR = 0.79, 95% CI = 0.70-0.89). CONCLUSION More than one-third of older NH residents in the United States do not have any secondary prevention medications initiated after AMI, with fewer medications initiated in older residents; women; and those with, DNR orders, poor physical function, and cognitive impairment. A lack of evidence about the safety and effectiveness of secondary preventions medications in the NH population and unmeasured person-centered goals of care are plausible explanations for these findings.
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Affiliation(s)
- Andrew R Zullo
- Department of Health Services, Policy, and Practice, School of Public Health, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Sadia Sharmin
- Department of Health Services, Policy, and Practice, School of Public Health, Warren Alpert Medical School, Brown University, Providence, Rhode Island.,Department of Epidemiology, School of Public Health, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Yoojin Lee
- Department of Health Services, Policy, and Practice, School of Public Health, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Lori A Daiello
- Department of Health Services, Policy, and Practice, School of Public Health, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Nishant R Shah
- Department of Health Services, Policy, and Practice, School of Public Health, Warren Alpert Medical School, Brown University, Providence, Rhode Island.,Division of Cardiology, Department of Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - W John Boscardin
- Division of Geriatrics, University of California, San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, California.,Division of Biostatistics, University of California, San Francisco, San Francisco, California
| | - David D Dore
- Department of Health Services, Policy, and Practice, School of Public Health, Warren Alpert Medical School, Brown University, Providence, Rhode Island.,Optum Epidemiology, Boston, Massachusetts
| | - Sei J Lee
- Division of Geriatrics, University of California, San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Michael A Steinman
- Division of Geriatrics, University of California, San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, California
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Association of Antidementia Drugs and Mortality in Community-Dwelling Frail Older Patients With Dementia: The Role of Mortality Risk Assessment. J Am Med Dir Assoc 2017; 19:162-168. [PMID: 29031515 DOI: 10.1016/j.jamda.2017.08.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 08/22/2017] [Accepted: 08/22/2017] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To evaluate whether treatment with antidementia drugs is associated with reduced mortality in older patients with different mortality risk at baseline. DESIGN Retrospective. SETTING Community-dwelling. PARTICIPANTS A total of 6818 older people who underwent a Standardized Multidimensional Assessment Schedule for Adults and Aged Persons (SVaMA) evaluation to determine accessibility to homecare services or nursing home admission from 2005 to 2013 in the Padova Health District, Italy were included. MEASUREMENTS Mortality risk at baseline was calculated by the Multidimensional Prognostic Index (MPI), based on information collected with the SVaMA. Participants were categorized to have mild (MPI-SVaMA-1), moderate (MPI-SVaMA-2), and high (MPI-SVaMA-3) mortality risk. Propensity score-adjusted hazard ratios (HR) of 2-year mortality were calculated according to antidementia drug treatment. RESULTS Patients treated with antidementia drugs had a significant lower risk of death than untreated patients (HR 0.82; 95% confidence interval [CI] 0.73-0.92 and 0.56; 95% CI 0.49-0.65 for patients treated less than 2 years and more than 2 years treatment, respectively). After dividing patients according to their MPI-SVaMA grade, antidementia treatment was significantly associated with reduced mortality in the MPI-SVaMA-1 mild (HR 0.71; 95% CI 0.54-0.92) and MPI-SVaMA-2 moderate risk (HR 0.61; 95% CI 0.40-0.91, matched sample), but not in the MPI-SVaMA-3 high risk of death. CONCLUSIONS This large community-dwelling patient study suggests that antidementia drugs might contribute to increased survival in older adults with dementia with lower mortality risk.
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Sacha J, Sacha M, Soboń J, Borysiuk Z, Feusette P. Is It Time to Begin a Public Campaign Concerning Frailty and Pre-frailty? A Review Article. Front Physiol 2017; 8:484. [PMID: 28744225 PMCID: PMC5504234 DOI: 10.3389/fphys.2017.00484] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 06/23/2017] [Indexed: 01/06/2023] Open
Abstract
Frailty is a state that encompasses losses in physical, psychological or social domains. Therefore, frail people demonstrate a reduced potential to manage external stressors and to respond to life incidents. Consequently, such persons are prone to various adverse consequences such as falls, cognitive decline, infections, hospitalization, disability, institutionalization, and death. Pre-frailty is a condition predisposing and usually preceding the frailty state. Early detection of frailty (i.e., pre-frailty) may present an opportunity to introduce effective management to improve outcomes. Exercise training appears to be the basis of such management in addition to periodic monitoring of food intake and body weight. However, various nutritional supplements and other probable interventions, such as treatment with vitamin D or androgen, require further investigation. Notably, many societies are not conscious of frailty as a health problem. In fact, people generally do not realize that they can change this unfavorable trajectory to senility. As populations age, it is reasonable to begin treating frailty similarly to other population-affecting disorders (e.g., obesity, diabetes or cardiovascular diseases) and implement appropriate preventative measures. Social campaigns should inform societies about age-related frailty and pre-frailty and suggest appropriate lifestyles to avoid or delay these conditions. In this article, we review current information concerning therapeutic interventions in frailty and pre-frailty and discuss whether a greater public awareness of such conditions and some preventative and therapeutic measures may decrease their prevalence.
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Affiliation(s)
- Jerzy Sacha
- Faculty of Physical Education and Physiotherapy, Opole University of TechnologyOpole, Poland
- Department of Cardiology, University Hospital of the University of OpoleOpole, Poland
| | | | - Jacek Soboń
- Faculty of Physical Education and Physiotherapy, Opole University of TechnologyOpole, Poland
| | - Zbigniew Borysiuk
- Faculty of Physical Education and Physiotherapy, Opole University of TechnologyOpole, Poland
| | - Piotr Feusette
- Department of Cardiology, University Hospital of the University of OpoleOpole, Poland
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Veronese N, Stubbs B, Noale M, Solmi M, Pilotto A, Vaona A, Demurtas J, Mueller C, Huntley J, Crepaldi G, Maggi S. Polypharmacy Is Associated With Higher Frailty Risk in Older People: An 8-Year Longitudinal Cohort Study. J Am Med Dir Assoc 2017; 18:624-628. [PMID: 28396180 PMCID: PMC5484754 DOI: 10.1016/j.jamda.2017.02.009] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 02/10/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To investigate whether polypharmacy is associated with a higher incidence of frailty in a large cohort of North Americans during 8 years of follow-up. DESIGN Longitudinal study, follow-up of 8 years. PARTICIPANTS A total of 4402 individuals at high risk or having knee osteoarthritis free from frailty at baseline. MEASUREMENTS Details regarding medication prescription were captured and categorized as 0-3, 4-6, and ≥7. Frailty was defined using the Study of Osteoporotic Fracture index as the presence of ≥2 out of (1) weight loss ≥5% between baseline and the subsequent follow-up visit; (2) inability to do 5 chair stands; and (3) low energy level according to the Study of Osteoporotic Fracture definition. Cox's regression models calculating a hazard ratio (HR) with 95% confidence intervals (CIs), adjusted for potential confounders, were undertaken. RESULTS During the 8-year follow-up, from 4402 participants at baseline, 361 became frail. Compared with participants taking 0-3 medications, the incidence of frailty was approximately double in those taking 4-6 medications and 6 times higher in people taking ≥7 medications. After adjusting for 11 potential baseline confounders, participants using 4-6 medications had a higher risk of frailty of 55% (HR = 1.55; 95% CI 1.22-1.96; P < .0001), whereas those using more than 7 drugs were at approximately 147% (HR = 2.47; 95% CI 1.78-3.43; P < .0001). Each additional drug used at the baseline increased the risk of frailty at the follow-up of 11% (HR = 1.11; 95% CI 1.07-1.15; P < .0001). CONCLUSIONS Polypharmacy is associated with a higher incidence of frailty over 8-year follow-up period. Our data suggest evidence of a dose response relationship. Future research is required to confirm our findings and explore underlying mechanisms.
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Affiliation(s)
- Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Padua, Italy; Institute for clinical Research and Education in Medicine, IREM, Padua, Italy; Department of Geriatric Care, OrthoGeriatrics and Rehabilitation, E.O. Galliera Hospital, Genova, Italy.
| | - Brendon Stubbs
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, United Kingdom; Faculty of Health, Social care and Education, Anglia Ruskin University, Chelmsford, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience (IoPPN) King's College London, London, United Kingdom
| | - Marianna Noale
- National Research Council, Neuroscience Institute, Aging Branch, Padua, Italy
| | - Marco Solmi
- Institute for clinical Research and Education in Medicine, IREM, Padua, Italy; Department of Neurosciences, University of Padova, Padova, Italy
| | - Alberto Pilotto
- Department of Geriatric Care, OrthoGeriatrics and Rehabilitation, E.O. Galliera Hospital, Genova, Italy
| | - Alberto Vaona
- Primary Care Department, Azienda ULSS20 Verona, Verona, Italy
| | - Jacopo Demurtas
- Primary Care Department, Azienda USL Toscana Sud Est, Grosseto, Italy
| | - Christoph Mueller
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience (IoPPN) King's College London, London, United Kingdom
| | - Jonathan Huntley
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience (IoPPN) King's College London, London, United Kingdom
| | - Gaetano Crepaldi
- National Research Council, Neuroscience Institute, Aging Branch, Padua, Italy
| | - Stefania Maggi
- National Research Council, Neuroscience Institute, Aging Branch, Padua, Italy
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Pilotto A, Cella A, Pilotto A, Daragjati J, Veronese N, Musacchio C, Mello AM, Logroscino G, Padovani A, Prete C, Panza F. Three Decades of Comprehensive Geriatric Assessment: Evidence Coming From Different Healthcare Settings and Specific Clinical Conditions. J Am Med Dir Assoc 2017; 18:192.e1-192.e11. [DOI: 10.1016/j.jamda.2016.11.004] [Citation(s) in RCA: 235] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/04/2016] [Accepted: 11/07/2016] [Indexed: 12/27/2022]
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