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Bruoha S, Maller T, Loutati R, Perel N, Tabi M, Taha L, Yosefy C, Jafari J, Braver O, Amsalem I, Hitter R, Manassra M, Levy N, Abu-Alkean I, Hamyil K, Steinmetz Y, Karameh H, Karmi M, Marmor D, Wolak A, Glikson M, Asher E. Nonagenarians admission and prognosis in a tertiary center intensive coronary care unit - a prospective study. BMC Geriatr 2023; 23:152. [PMID: 36941571 PMCID: PMC10029169 DOI: 10.1186/s12877-023-03851-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/27/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND With increasing life expectancy, the prevalence of nonagenarians with cardiovascular disease is steadily growing. However, this population is underrepresented in randomized trials and thus poorly defined, with little quality evidence to support and guide optimal management. The aim of the present study was to evaluate the clinical management, therapeutic approach, and outcomes of nonagenarians admitted to a tertiary care center intensive coronary care unit (ICCU). METHODS We prospectively collected all patients admitted to a tertiary care center ICCU between July 2019 - July 2022 and compared nonagenarians to all other patients. The primary outcome was in-hospital mortality. RESULTS A total of 3807 patients were included in the study. Of them 178 (4.7%) were nonagenarians and 93 (52%) females. Each year the prevalence of nonagenarians has increased from 4.0% to 2019, to 4.2% in 2020, 4.6% in 2021 and 5.3% in 2022. Admission causes differed between groups, including a lower rate of acute coronary syndromes (27% vs. 48.6%, p < 0.001) and a higher rate of septic shock (4.5% vs. 1.2%, p < 0.001) in nonagenarians. Nonagenarians had more comorbidities, such as hypertension, renal failure, and atrial fibrillation (82% vs. 59.6%, 23% vs. 12.9%, 30.3% vs. 14.4% p < 0.001, respectively). Coronary intervention was the main treatment approach, although an invasive strategy was less frequent in nonagenarians in comparison to younger subjects. In-hospital mortality rate was 2-fold higher in the nonagenarians (5.6% vs. 2.5%, p = 0.025). CONCLUSION With increasing life expectancy, the prevalence of nonagenarians in ICCU's is expected to increase. Although nonagenarian patients had more comorbidities and higher in-hospital mortality, they generally have good outcomes after admission to the ICCU. Hence, further studies to create evidence-based practices and to support and guide optimal management in these patients are warranted.
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Affiliation(s)
- Sharon Bruoha
- Department of Cardiology, Barzilai Medical Center, The Ben-Gurion University of the Negev, Hahistadrout 2, Ashkelon, 7830604, Israel.
| | - Tomer Maller
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ranel Loutati
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nimrod Perel
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Meir Tabi
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Louay Taha
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Chaim Yosefy
- Department of Cardiology, Barzilai Medical Center, The Ben-Gurion University of the Negev, Hahistadrout 2, Ashkelon, 7830604, Israel
| | - Jamal Jafari
- Department of Cardiology, Barzilai Medical Center, The Ben-Gurion University of the Negev, Hahistadrout 2, Ashkelon, 7830604, Israel
| | - Omri Braver
- Department of Cardiology, Barzilai Medical Center, The Ben-Gurion University of the Negev, Hahistadrout 2, Ashkelon, 7830604, Israel
| | - Itshak Amsalem
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rafael Hitter
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mohamed Manassra
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nir Levy
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ismael Abu-Alkean
- Department of Cardiology, Barzilai Medical Center, The Ben-Gurion University of the Negev, Hahistadrout 2, Ashkelon, 7830604, Israel
| | - Kamal Hamyil
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yoed Steinmetz
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hani Karameh
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mohamed Karmi
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - David Marmor
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Arik Wolak
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michael Glikson
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Elad Asher
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
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Huang BT, Cheng YH, Yang BS, Zhang YK, Huang FY, Peng Y, Pu XB, Chen M. The influence of pressure injury risk on the association between left ventricular ejection fraction and all-cause mortality in patients with acute myocardial infarction 80 years or older. World J Emerg Med 2023; 14:112-121. [PMID: 36911061 PMCID: PMC9999128 DOI: 10.5847/wjem.j.1920-8642.2023.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 10/21/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND We aimed to investigate whether the pressure injury risk mediates the association of left ventricular ejection fraction (LVEF) with all-cause death in patients with acute myocardial infarction (AMI) aged 80 years or older. METHODS This retrospective cohort study included 677 patients with AMI aged 80 years or older from a tertiary-level hospital. Pressure injury risk was assessed using the Braden scale at admission, and three risk groups (low/minimal, intermediate, high) were defined according to the overall score of six different variables. LVEF was measured during the index hospitalization for AMI. All-cause death after hospital discharge was the primary outcome. RESULTS Over a median follow-up period of 1,176 d (interquartile range [IQR], 722-1,900 d), 226 (33.4%) patients died. Multivariate Cox regression analysis showed that reduced LVEF was associated with an increased risk of all-cause death only in the high-risk group of pressure injury (adjusted hazard ratios [HR]=1.81, 95% confidence interval [CI]: 1.03-3.20; P=0.040), but not in the low/minimal- (adjusted HR=1.29, 95%CI: 0.80-2.11; P=0.299) or intermediate-risk groups (adjusted HR=1.14, 95%CI: 0.65-2.02; P=0.651). Significant interactions were detected between pressure injury risk and LVEF (adjusted P=0.003). The cubic spline with hazard ratio plot revealed a distinct shaped curve relation between LVEF and all-cause death among different pressure injury risk groups. CONCLUSIONS In older patients with AMI, the risk of pressure injury mediated the association between LVEF and all-cause death. The classification of older patients for both therapy and prognosis assessment appears to be improved by the incorporation of pressure injury risk assessment into AMI care management.
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Affiliation(s)
- Bao-Tao Huang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yi-Heng Cheng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Bo-Sen Yang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yi-Ke Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Fang-Yang Huang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yong Peng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xiao-Bo Pu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China
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Brush JE, Hajduk AM, Greene EJ, Dreyer RP, Krumholz HM, Chaudhry SI. Sex Differences in Symptom Phenotypes Among Older Patients with Acute Myocardial Infarction. Am J Med 2022; 135:342-349. [PMID: 34715061 PMCID: PMC8901454 DOI: 10.1016/j.amjmed.2021.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 09/21/2021] [Accepted: 09/28/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Clinicians make a medical diagnosis by recognizing diagnostic possibilities, often using memories of prior examples. These memories, called "exemplars," reflect specific symptom combinations in individual patients, yet most clinical studies report how symptoms aggregate in populations. We studied how symptoms of acute myocardial infarction combine in individuals as symptom phenotypes and how symptom phenotypes are distributed in women and men. METHODS In this analysis of the SILVER-AMI Study, we studied 3041 patients (1346 women and 1645 men) 75 years of age or older with acute myocardial infarction. Each patient had a standardized in-person interview during the acute myocardial infarction admission to document the presenting symptoms, which enabled a thorough examination of symptom combinations in individuals. Specific symptom combinations defined symptom phenotypes and distributions of symptom phenotypes were compared in women and men using Monte Carlo permutation testing and repeated subsampling. RESULTS There were 1469 unique symptom phenotypes in the entire SILVER-AMI cohort of patients with acute myocardial infarction. There were 831 unique symptom phenotypes in women, as compared with 819 in men, which was highly significant, given the larger number of men than women in the study (P < .0001). Women had significantly more symptom phenotypes than men in almost all acute myocardial infarction subgroups. CONCLUSIONS Older patients with acute myocardial infarction have enormous variation in symptom phenotypes. Women reported more symptoms and had significantly more symptom phenotypes than men. Appreciation of the diversity of symptom phenotypes may help clinicians recognize the less common phenotypes that occur more often in women.
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Affiliation(s)
- John E Brush
- Sentara Healthcare and Eastern Virginia Medical School, Norfolk.
| | - Alexandra M Hajduk
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - Erich J Greene
- Department of Health Policy and Management and Department of Biostatistics, Yale School of Medicine, New Haven, Conn
| | - Rachel P Dreyer
- Section of Cardiovascular Medicine, Department of Internal Medicine and Department of Emergency Medicine, Yale School of Medicine, New Haven, Conn; Yale School of Public Health; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn
| | - Harlan M Krumholz
- Department of Health Policy and Management and Department of Biostatistics, Yale School of Medicine, New Haven, Conn; Section of Cardiovascular Medicine, Department of Internal Medicine and Department of Emergency Medicine, Yale School of Medicine, New Haven, Conn; Yale School of Public Health; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn
| | - Sarwat I Chaudhry
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
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Guo L, Ren L, Shao Y, Li W, Yu S. The Value of Iterative Reconstruction of Algorithm-Based Coronary Artery Computed Tomography Imaging in the Diagnosis of Old Myocardial Infarction. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:4383963. [PMID: 34917306 PMCID: PMC8670922 DOI: 10.1155/2021/4383963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/17/2021] [Accepted: 11/05/2021] [Indexed: 12/03/2022]
Abstract
The objective of this study was to compare the diagnostic value of computed tomography (CT) based on iterative reconstruction algorithm in old myocardial infarction (OMI), thereby providing theoretical guidance and practical basis for clinical treatment. In this study, in order to provide theoretical guidance and practical basis for the diagnosis and treatment of clinical OMI, 10 patients with OMI were selected and divided into two groups, with 5 patients in each group. In addition, an algebraic iterative reconstruction algorithm is constructed, which starts from the initial estimation value, compares, and corrects the estimation results and the measured results continuously until the error between the two results is less than the predetermined value. The experimental group was optimized by algebraic iterative reconstruction algorithm, and the control group was reconstructed by the hospital original method. The image quality parameters under different iteration times were analyzed and compared to obtain the optimal iteration times. The value of iterative reconstruction algorithm in clinical diagnosis was investigated by analyzing the time of drawing and the accuracy of diagnosis after drawing. Through the analysis and comparison of the image quality parameters of the patients from the experimental group, it was found that the image quality firstly increased with the increase in the number of iterations but decreased with the increase of the number of iterations after a certain number of iterations. The results showed that the optimal number of iterations was 13 times. The drawing time of the experimental group and the control group was 54.27 minutes and 117.87 minutes in turn, so the difference between the two groups was significant (P < 0.05). Besides, there was a statistically marked difference in the accuracy rate of the experimental group (93.33%) and the control group (73.33%) (P < 0.05). In conclusion, the time required for coronary artery CT imaging using algebraic iterative reconstruction algorithm was greatly reduced and the diagnostic accuracy was hugely improved. Therefore, the coronary artery CT imaging based on iterative reconstruction algorithm could make more effective use of medical resources and improve the diagnostic accuracy in the diagnosis of OMI.
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Affiliation(s)
- Liang Guo
- Cardiovascular Medicine, Baoji City Center Hospital, Baoji 721008, Shaanxi, China
| | - Lu Ren
- Cardiovascular Medicine, Baoji City Center Hospital, Baoji 721008, Shaanxi, China
| | - Yajun Shao
- Department of Imaging, Baoji City Center Hospital, Baoji 721008, Shaanxi, China
| | - Wei Li
- Department of Cardiology, Ankang Hospital of Traditional Chinese Medicine, Ankang 725000, Shaanxi, China
| | - Shangxian Yu
- Department of Cardiology, Ankang Hospital of Traditional Chinese Medicine, Ankang 725000, Shaanxi, China
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Janke AT, Jain S, Hwang U, Rosenberg M, Biese K, Schneider S, Goyal P, Venkatesh AK. Emergency department visits for emergent conditions among older adults during the COVID-19 pandemic. J Am Geriatr Soc 2021; 69:1713-1721. [PMID: 33955546 PMCID: PMC8242842 DOI: 10.1111/jgs.17227] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/12/2021] [Accepted: 04/16/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND/OBJECTIVE Emergency department (ED) visits have declined while excess mortality, not attributable to COVID-19, has grown. It is not known whether older adults are accessing emergency care differently from their younger counterparts. Our objective was to determine patterns of ED visit counts for emergent conditions during the COVID-19 pandemic for older adults. DESIGN Retrospective, observational study. SETTING Observational analysis of ED sites enrolled in a national clinical quality registry. PARTICIPANTS One hundred and sixty-four ED sites in 33 states from January 1, 2019 to November 15, 2020. MAIN OUTCOME AND MEASURES We measured daily ED visit counts for acute myocardial infarction (AMI), stroke, sepsis, fall, and hip fracture, as well as deaths in the ED, by age categories. We estimated Poisson regression models comparing early and post-early pandemic periods (defined by the Centers for Disease Control and Prevention) to the pre-pandemic period. We report incident rate ratios to summarize changes in visit incidence. RESULTS For AMI, stroke, and sepsis, the older (75-84) and oldest old (85+ years) had the greatest decline in visit counts initially and the smallest recovery in the post-early pandemic periods. For falls, visits declined early and partially recovered uniformly across age categories. In contrast, hip fractures exhibited less change in visit rates across time periods. Deaths in the ED increased during the early pandemic period, but then fell and were persistently lower than baseline, especially for the older (75-84) and oldest old (85+ years). CONCLUSIONS The decline in ED visits for emergent conditions among older adults has been more pronounced and persistent than for younger patients, with fewer deaths in the ED. This is concerning given the greater prevalence and risk of poor outcomes for emergent conditions in this age group that are amenable to time-sensitive ED diagnosis and treatment, and may in part explain excess mortality during the COVID-19 era among older adults.
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Affiliation(s)
- Alexander T. Janke
- Department of Emergency MedicineYale University School of MedicineNew HavenConnecticutUSA
| | - Snigdha Jain
- Section of Geriatrics and Section of Pulmonary, Critical Care and Sleep MedicineYale University School of MedicineNew HavenConnecticutUSA
| | - Ula Hwang
- Department of Emergency MedicineYale University School of MedicineNew HavenConnecticutUSA
- Geriatrics Research, Education and Clinical CenterJames J. Peters VAMCBronxNew YorkUSA
| | - Mark Rosenberg
- St. Joseph's HealthPatersonNew JerseyUSA
- American College of Emergency PhysiciansIrvingTexasUSA
| | - Kevin Biese
- Department of Emergency MedicineUniversity of North Carolina School of MedicineChapel HillNorth CarolinaUSA
| | | | - Pawan Goyal
- American College of Emergency PhysiciansIrvingTexasUSA
| | - Arjun K. Venkatesh
- Department of Emergency MedicineYale University School of MedicineNew HavenConnecticutUSA
- Center for Outcomes Research and EvaluationYale University School of MedicineNew HavenConnecticutUSA
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