Nonagenarians admission and prognosis in a tertiary center intensive coronary care unit – a prospective study

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.

Outcomes of Octogenarians and Nonagenarians in a Contemporary Cardiac Care Unit ― Insights From 2,242 Patients Admitted Between 2019 and 2021 ―

“…Previous studies 6 , 16 have reported in-hospital mortality rates for nonagenarians admitted to the CCU of 5.6% and 15%, with 1-year mortality rates of 30% and 47%; in the present study, these percentages were 5.6% and 19%, respectively. The independent predictors of long-term outcomes among nonagenarians have been reported to be pulmonary hypertension, diabetes, Elder Risk Assessment score, the Acute Physiology, Age, and Chronic Health Evaluation (APACHE) III score, diastolic blood pressure, blood urea nitrogen, inotrope use, and a recent emergency department visit.…”

“…14 Although issues regarding elderly patients in the ICU/CCU are universal, there are few studies to date that have directly addressed octo- and nonagenarians in the CCU. 6 , 15 , 16 As such, details, outcomes, predictors, and the cost-effectiveness of treating elderly patients in the CCU require further investigation. Bruoha et al reported that, among nonagenarians, there was a higher proportion of females and patients with hypertension, cerebrovascular accident, congestive heart failure, AF, and anemia, and lower BMI and albumin values, 6 which is consistent with our findings.…”

“… 6 , 15 , 16 As such, details, outcomes, predictors, and the cost-effectiveness of treating elderly patients in the CCU require further investigation. Bruoha et al reported that, among nonagenarians, there was a higher proportion of females and patients with hypertension, cerebrovascular accident, congestive heart failure, AF, and anemia, and lower BMI and albumin values, 6 which is consistent with our findings. Females have longer lifespans than males, and aging is a risk factor for hypertension, congestive heart failure, and AF.…”

“… 7 , 17 The main reasons for CCU admission among nonagenarians have been reported to be AHF 16 and ACS. 6 In contrast to effective interventions, including intensive lipid-lowering therapy and smoking cessation for ACS, the heart failure pandemic has increased the proportion of patients with AHF as a cause of CCU admission. 18 …”

“… 3 In this context, more octo- and nonagenarians have been admitted to intensive care units (ICUs) and cardiac care units (CCUs). 4 – 6 However, elderly individuals tend to have low physical reserves, poor nutritional status, and multiple comorbidities, and there is controversy regarding the efficacy and cost-effectiveness of therapeutic interventions in this group of patients. 7 , 8 Although several minimally invasive treatments, such as intervention for structural heart disease and percutaneous ventricular assist devices, have been introduced in modern cardiology, 9 cardiovascular diseases consume a large amount of medical resouces.…”