Outcomes of Nonagenarians Admitted to the Cardiac Intensive Care Unit by the Elders Risk Assessment Score for Long-Term Mortality Risk Stratification

Rosenbaum, Andrew; Naksuk, Niyada; Gharacholou, S. Michael; Brenes-Salazar, Jorge A.

doi:10.1016/j.amjcard.2017.07.028

Cited by 10 publications

(12 citation statements)

References 27 publications

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Section: Discussionmentioning

confidence: 99%

“…The proposed pathophysiological basis for the relationship between age and outcomes is multifactorial, including decreased tissue regenerative capacity, limited physical reserve, co-morbidities, frailty, and psychosocial factors. 1, [37][38][39] Frailty has gained recent interest as a predictor of poor outcomes in hospitalized patients with cardiac disease, including CICU patients. 39 Nguyen et al recently demonstrated that frailty was associated with increased adverse outcomes in ACS patients.…”

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confidence: 99%

“…1, [37][38][39] Frailty has gained recent interest as a predictor of poor outcomes in hospitalized patients with cardiac disease, including CICU patients. 39 Nguyen et al recently demonstrated that frailty was associated with increased adverse outcomes in ACS patients. 40 In the present study, we adjusted for the Braden Skin Score as a marker of frailty, as this has been previously demonstrated to predict worse outcomes in CICU patients.…”

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confidence: 99%

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Age and shock severity predict mortality in cardiac intensive care unit patients with and without heart failure

et al. 2020

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Aims Age is an important risk factor for mortality among patients with cardiogenic shock and heart failure (HF). We sought to assess the extent to which age modified the performance of the Society for Cardiovascular Angiography and Interventions (SCAI) shock stage for in-hospital and 1 year mortality in cardiac intensive care unit (CICU) patients with and without HF. Methods and results We retrospectively reviewed unique admissions to the Mayo Clinic CICU during 2007-2015 and stratified patients by age and SCAI shock stage. The association between age and in-hospital mortality was analysed using multivariable logistic regression, and 1 year mortality was analysed using Cox proportional hazards analysis, both in the entire cohort and among patients with an admission diagnosis of HF or acute coronary syndrome (ACS). The final study population included 10 004 unique patients with a mean age of 67 ± 15 years, including 46.1% with HF and 43.1% with ACS. Older patients more frequently had HF and had more extensive co-morbidities, higher illness severity, more organ failure, and differential use of critical care therapies. The percentage of patients with SCAI shock stages A, B, C, D, and E were 46%, 30%, 16%, 7%, and 1%, respectively. Patients with HF were older, had greater severity of illness and higher SCAI shock stage, and had higher rates of death at all time points. In-hospital mortality occurred in 908 (9%) patients, including 549 (12%) patients with HF (61% of all hospital deaths). Age was independently associated with hospital mortality (adjusted odds ratio per 10 years 1.3, 95% confidence interval 1.2-1.4, P < 0.001) and 1 year mortality (adjusted hazard ratio per 10 years 1.2, 95% confidence interval 1.2-1.3, P < 0.001) in the overall cohort. The associations of age with both hospital mortality (adjusted odds ratio 1.6 vs. 1.3 per 10 years older) and 1 year mortality (adjusted hazard ratio 1.5 vs. 1.3 per 10 years older) were higher for patients with ACS compared with patients with HF. Older age was associated with higher adjusted hospital mortality and 1 year mortality in each SCAI shock stage (all P < 0.05). Additive increases in both hospital mortality and 1 year mortality were observed with increasing age and SCAI shock stage. Conclusions Age is an independent risk factor for mortality that modifies the relationship between the SCAI shock stage and mortality risk in CICU patients, providing robust risk stratification for in-hospital and 1 year mortality. Although patients with HF had a higher risk of dying, age was more strongly associated with mortality among patients with ACS.

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Section: Discussionmentioning

confidence: 99%

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Age and shock severity predict mortality in cardiac intensive care unit patients with and without heart failure

et al. 2020

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“…Multimorbidity (≥ 2 simultaneously active chronic conditions) is almost universal among the elderly accounting for approximately 80% of patients over 75 years old (19) . The high comorbidity burden not only contribute to poor outcomes (20) , but also limits the use of more aggressive therapies with higher risk for complications. Nevertheless, contemporary evidence that speci cally included nonagenarians with ACS has shown bene ts of an early invasive approach (21,22) .…”

Section: Discussionmentioning

confidence: 99%

Nonagenarians Admission and Prognosis in a Tertiary Center Intensive Coronary Care Unit – a prospective study.

Bruoha

Maller

Loutati

et al. 2023

Preprint

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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% in 2019, to 4.2% in 2020, 4.6% in 2021 and 5.3% in 2022. Admission causes were similar in both groups except for a lower rate of ST segment myocardial infarction (STEMI) (12.9% vs. 27.3%, 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). In-hospital mortality rate was 2-fold higher in the nonagenarians (5.6% vs. 2.5%, p = 0.025). Conclusions 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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“…However, disposition after surgical/endovascular intervention should be assessed critically. There may be factors/variables at play that cloud our assessment regarding the patient's degree of independence prior to intervention that are uncovered once hospitalized; which have been reported and subsequently studied . We can foresee the use of such tools as the Elders Risk Assessment to aid us in the identification of vulnerable patients at risk of adverse outcomes and further avoid either unnecessary interventions or encourage the use of alternative modes of treatment such as SET, which is today a paid benefit by the Centers for Medicare and Medicaid Services (https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=287).…”

Section: Discussionmentioning

confidence: 99%

Increased mortality in octogenarians treated for lifestyle limiting claudication

Erben

Mena‐Hurtado

Miller

et al. 2018

Cathet Cardio Intervent

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Outcomes of Nonagenarians Admitted to the Cardiac Intensive Care Unit by the Elders Risk Assessment Score for Long-Term Mortality Risk Stratification

Cited by 10 publications

References 27 publications

Age and shock severity predict mortality in cardiac intensive care unit patients with and without heart failure

Age and shock severity predict mortality in cardiac intensive care unit patients with and without heart failure

Nonagenarians Admission and Prognosis in a Tertiary Center Intensive Coronary Care Unit – a prospective study.

Increased mortality in octogenarians treated for lifestyle limiting claudication

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