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

Esteve‐Pastor, María Asunción; Martín, E; Alegre, Oriol; Formiga, Francesç; Sanchís, Juan; López-Palop, Ramón; Sellés, Manuel Martínez; Vidán, María Teresa; Bueno, Héctor; Díez‐Villanueva, Pablo; Assi, Emad Abu; Arizá-Solé, Albert; Marı́n, Francisco; Domínguez, Juan Carlos Castillo; investigators, Longevo-Sca registry

doi:10.1111/eci.13505

Cited by 9 publications

(5 citation statements)

References 22 publications

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“…The median length of hospital stay was 8 days (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). Patients in the valvular surgery group had longer hospitalization times in the whole population (median 17 vs. 7 days, p < .001) and for each level of frailty risk.…”

Section: Patient and Hospital Characteristicsmentioning

confidence: 99%

“…Frailty can occur at any time in life, although it is more common in older people 6 . However, it has been described that the presence of frailty is associated with poor outcomes in several clinical scenarios 7‐9 . The prevalence of frailty varies depending on the context.…”

Section: Introductionmentioning

confidence: 99%

“…6 However, it has been described that the presence of frailty is associated with poor outcomes in several clinical scenarios. [7][8][9] The prevalence of frailty varies depending on the context. In the general population, it can be more than 10%, 1 but in a hospital setting, it can be much higher in patients with severe acute pathology and previous medical conditions.…”

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confidence: 99%

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Impact of valvular surgery according to frailty risk in patients with infective endocarditis

Diaz‐Arocutipa,

Moreno,

Vicent

2024

Clinical Cardiology

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BackgroundObservational studies suggest that valvular surgery can reduce mortality in selected patients with infective endocarditis (IE). However, the benefit of this intervention according to frailty levels remains unclear. Our study aims to assess the effect of valvular surgery according to frailty status in this population.MethodsWe performed a retrospective study using the 2016−2019 National Inpatient Sample database. Adult patients with a primary diagnosis of IE were included. Frailty was assessed using the Hospital Frailty Risk Score. Inverse probability of treatment weighting (IPTW) was used to balance baseline differences between groups.ResultsA total of 53,275 patients with IE were included, with 18.3% underwent valvular surgery. The median age was 52 (34−68) years, with 41% females. Overall, 42.7% had low risk of frailty, 53.1% intermediate risk, and 4.2% high risk. After IPTW adjustment, in‐hospital mortality was similar both for the entire cohort between valvular and non‐valvular surgery groups (3.7% vs. 4.1%, p = .483), and low (1% vs. 0.9%, p = .952) or moderate (5.4% vs. 6%, p = .548) risk of frailty. However, patients at high risk of frailty had significantly lower in‐hospital mortality in the valvular surgery group (4.6% vs. 13.9%, p = .016). Renal replacement therapy was similar between groups across frailty status. In contrast, surgery was associated with increased use of mechanical circulatory support and pacemaker implantation.ConclusionsOur findings suggest that there was no difference in survival between valve surgery and medical management in patients at low/intermediate frailty risk, but not for high‐risk individuals.

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Section: Patient and Hospital Characteristicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Impact of valvular surgery according to frailty risk in patients with infective endocarditis

Diaz‐Arocutipa,

Moreno,

Vicent

2024

Clinical Cardiology

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“…However, a high percentage of elderly patients with AF do not receive or receive inadequate doses of anticoagulant therapies. This inappropriate use of a reduced dose has been associated with age itself, concomitant use of antiplatelet therapy, subjective perceptions of the physician and the overestimation of the bleeding risk [ 21 , 22 , 23 , 24 ]. The results of DOACs trials in patients with indication (indications) of chronic anticoagulation and dual antiplatelet therapy are summarized in Table 5 .…”

Section: Antithrombotic Treatment In An Elderly Patient With Acs and ...mentioning

confidence: 99%

Non-ST Elevation Myocardial Infarction in the Elderly. Antithrombotic Therapy and Beyond

Díez‐Villanueva¹,

Jiménez-Méndez²,

Ferreiro³

et al. 2023

Rev. Cardiovasc. Med.

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Non-ST segment elevation myocardial infarction (NSTEMI) is the most frequent type of acute coronary syndrome in the elderly. Antithrombotic therapy is the cornerstone of pharmacological therapy in the setting of an acute ischemic event, a clinical scenario in which thrombotic and bleeding risks ought to be considered, particularly in older patients. In this article, specific aspects of antithrombotic therapy in elderly patients with NSTEMI are reviewed, including pharmacokinetic and pharmacodynamic characteristics and different clinical situations. The role of frailty and other common geriatric conditions, that are associated with worse prognosis in elderly patients with cardiovascular disease, is also addressed.

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“…This strategy can be modified according to ischemic and bleeding risks profile, shortening or extending the duration of triple therapy accordingly [2]. On the other hand, and as later addressed in this paper, impact of geriatric syndromes in management of patients with atrial fibrillation and coronary disease, deserves special attention, as they actually impact on prognosis [29,30]. In the elderly population, special attention should be paid on renal function and dosages should be modified accordingly.…”

Section: Anticoagulationmentioning

confidence: 99%

Non-ST segment elevation myocardial infarction in the elderly

Jiménez-Méndez¹,

Díez‐Villanueva²,

Alfonso³

2021

Rev. Cardiovasc. Med.

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Ischemic heart disease constitutes the leading cause of death in Western countries. The general incidence of acute coronary syndromes (ACS), especially non-ST segment elevation myocardial infarction (NSTEMI), is growing. Advanced age is both a strong risk factor for ACS and an independent predictor of poorer clinical outcomes. Management of this entity is often complex in the elderly, while special attention should be focused on comorbidities and geriatric conditions. This article aims to review clinical presentation, identification and management of NSTEMI in the elderly population.

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

Cited by 9 publications

References 22 publications

Impact of valvular surgery according to frailty risk in patients with infective endocarditis

Impact of valvular surgery according to frailty risk in patients with infective endocarditis

Non-ST Elevation Myocardial Infarction in the Elderly. Antithrombotic Therapy and Beyond

Non-ST segment elevation myocardial infarction in the elderly

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