Impact of Different Geriatric Conditions on Choice of Therapy and In-Hospital Outcomes in Elderly Patients with Acute Coronary Syndrome
Received 10 February 2020
Accepted for publication 9 April 2020
Published 25 May 2020 Volume 2020:15 Pages 723—731
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 4
Editor who approved publication: Dr Richard Walker
Harald Rittger,1,* Christoph Stadelmaier,1,* Thomas Kieschnick,1 Duygu Büber,1 Kristina Rank,1 Laura Vitali-Serdoz,1 Dirk Bastian,1 Matthias Waliszewski2,3
1Medizinische Klinik 1, Klinikum Fürth, Fürth, Germany; 2Medical Scientific Affairs, B. Braun Melsungen AG, Berlin, Germany; 3Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany
*These authors contributed equally to this work
Correspondence: Harald Rittger
Klinikum Fuerth, Medizinische Klinik 1, Jakob-Henle-Strasse 1, Fuerth 90766, Germany
Introduction: The clinical benefit of invasive therapy in elderly patients with acute coronary syndrome (ACS) remains unclear. Furthermore, the decision-making process to treat this growing patient group is also debatable. The purpose of this study was to assess the association between elderly ACS patients, the treatment choice and their in-hospital outcomes after non-ST-elevation (NSTE)-ACS in a consecutive series of patients > 75 years of age.
Methods and Results: Consecutive patients > 75 years presenting with NSTE-ACS in our hospital between July 2017 and July 2018 were included during the first 2 days of hospital admission. Demographic data, prior medical history and present medical condition were documented. During day 0 and day 2, geriatric assessments (Clinical Frailty Scale [CFS], Barthel index, Charlson comorbidity index, “timed up and go” test [TUG], Mini-Mental Status Test [MMS], Geriatric Depression Scale [GDS], SF-36 for quality of life, instrumental activities of daily living [IADL], Killip-score, Grace-score and Euro-score) were conducted. After 6 months, patients were re-evaluated. In 106 patients (mean age 81.9± 5.3 years, 57% male gender), 68 patients (64%) were treated interventionally, and 38 patients had conservative treatment (36%). Patients treated with intervention were significantly younger (80.9± 4.7 years vs 83.5± 6.0 years, p=0.015), had a lower rate of prior cerebral events (17.6% vs 26.3%; p=ns) and suffered more often from chronic obstructive pulmonary disease (17.6% vs 34.2%; p=0.050). All other demographic variables were comparable between both groups. The composite clinical endpoint (death, re-infarction, bleeding) was reached in 7 patients (10.3%) of the invasive and in 2 patients (5.3%) of the conservative group. They were not significantly different between both groups. A frailty index, consisting of commonly used parameters of functional impairment in elderly patients, namely, MMS ≤ 2 at baseline, IADL ≤ 7, CFS ≥ 7 and age ≥ 85 years, significantly predicted conservative treatment.
Conclusion: Effective revascularization techniques are still underused in patients of older age in the case of ACS. For decision-making, geriatric tests alone may not predict treatment in those patients, but the combination of different tests may better predict treatment and perhaps the clinical outcomes in those patients. Furthermore, frail patients are at higher risk for not receiving guideline recommended therapy.
Keywords: acute coronary syndromes, elderly patients, frailty, interventional treatment
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