Relation of Statin Use and Mortality in Community-Dwelling Frail Older Patients With Coronary Artery Disease

Pilotto, Alberto; Gallina, Pietro; Panza, Francesco; Copetti, Massimiliano; Cella, Alberto; Cruz-Jentoft, Alfonso J.; Daragjati, Julia; Ferrucci, Luigi; Maggi, Stefania; Mattace-Raso, Francesco; Pocard, Marc; Polidori, Maria Cristina; Topinková, Eva; Trifirò, Gianluca; Welmer, Anna-Karin; Strandberg, Timo; Marchionni, Niccolò

doi:10.1016/j.amjcard.2016.08.042

Cited by 50 publications

(36 citation statements)

References 26 publications

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“…Very recently, the MPI-SVaMA has been implemented in older people to evaluate whether a different individual prognostic profile was associated with different mortality rates after treatment for specific disorders (ie, statins in older patients with diabetes mellitus 41 or coronary artery disease 42 as well as anticoagulants in older patients with atrial fibrillation). 43 These studies suggested that full access to prognostic information derived from CGA-based predictive tools better equips physicians to make clinical decisions aligned with their patients’ needs in terms of safety and efficacy.…”

Section: Discussionmentioning

confidence: 99%

Association of Antidementia Drugs and Mortality in Community-Dwelling Frail Older Patients With Dementia: The Role of Mortality Risk Assessment

Polidori

Veronese

Giancristofaro

et al. 2018

Journal of the American Medical Directors Association

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Objective: To evaluate whether treatment with antidementia drugs is associated with reduced mortality in older patients with different mortality risk at baseline. Design: Retrospective. Setting: Community-dwelling. Participants: A total of 6818 older people who underwent a Standardized Multidimensional Assessment Schedule for Adults and Aged Persons (SVaMA) evaluation to determine accessibility to homecare services or nursing home admission from 2005 to 2013 in the Padova Health District, Italy were included. Measurements: Mortality risk at baseline was calculated by the Multidimensional Prognostic Index (MPI), based on information collected with the SVaMA. Participants were categorized to have mild (MPI-SVaMA-1), moderate (MPI-SVaMA-2), and high (MPI-SVaMA-3) mortality risk. Propensity score-adjusted hazard ratios (HR) of 2-year mortality were calculated according to antidementia drug treatment. Results: Patients treated with antidementia drugs had a significant lower risk of death than untreated patients (HR 0.82; 95% confidence interval [CI] 0.73–0.92 and 0.56; 95% CI 0.49–0.65 for patients treated less than 2 years and more than 2 years treatment, respectively). After dividing patients according to their MPI-SVaMA grade, antidementia treatment was significantly associated with reduced mortality in the MPI-SVaMA-1 mild (HR 0.71; 95% CI 0.54–0.92) and MPI-SVaMA-2 moderate risk (HR 0.61; 95% CI 0.40–0.91, matched sample), but not in the MPI-SVaMA-3 high risk of death. Conclusions: This large community-dwelling patient study suggests that antidementia drugs might contribute to increased survival in older adults with dementia with lower mortality risk.

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Section: Discussionmentioning

confidence: 99%

Association of Antidementia Drugs and Mortality in Community-Dwelling Frail Older Patients With Dementia: The Role of Mortality Risk Assessment

Polidori

Veronese

Giancristofaro

et al. 2018

Journal of the American Medical Directors Association

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“…Prior studies of older ambulatory populations have reported underuse of secondary prevention medications after AMI . Likewise, studies of NH populations have reported underuse of individual secondary prevention medication classes .…”

Section: Discussionmentioning

confidence: 99%

“…RCTs that have demonstrated that the use of beta‐blocker, statin, and antiplatelet therapy after AMI substantially reduces mortality in individuals younger than 75 support guideline recommendations . Observational studies have extended some of these findings to community‐dwelling people beyond age 85 years . Even frail older NH residents may benefit …”

mentioning

confidence: 93%

Secondary Prevention Medication Use After Myocardial Infarction in U.S. Nursing Home Residents

Zullo

Sharmin

Lee

et al. 2017

J American Geriatrics Society

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BACKGROUND Secondary prevention medications are recommended for older adults after acute myocardial infarction (AMI), but little is known about whether nursing home (NH) residents receive these medications. OBJECTIVES To evaluate new use of secondary prevention medications after AMI in NH residents who were previously non-users, and to evaluate which factors were associated with use. DESIGN Retrospective cohort using linked national Minimum Data Set assessments; Online Survey, Certification and Reporting (OSCAR) records; and Medicare claims. SETTING U.S. NHs. PARTICIPANTS National cohort of 11,192 residents aged ≥65 years who were hospitalized for an AMI May 2007-March 2010, had no beta-blocker or statin usage for ≥4 months prior, and survived ≥14 days after NH readmission. MEASUREMENTS The outcome was the number of secondary prevention medications initiated within 30 days of NH readmission. RESULTS Thirty-seven percent of residents initiated no secondary prevention medications after AMI, 41% initiated one, and 22% two. After covariate adjustment, use of more secondary prevention medications declined with advancing age (down to proportional odds ratio (POR)=0.48, 95% confidence interval (CI)=0.40–0.57 for ≥95 versus 65–74 years), female sex (POR=0.88, 95% CI=0.80–0.96), do not resuscitate (DNR) order presence (POR=0.90, 95% CI=0.83–0.98), functional impairment (dependent or totally dependent versus independent to limited assistance, POR=0.77, 95% CI=0.69–0.86) and cognitive impairment (moderate to severe dementia versus cognitively intact, POR=0.79, 95% CI=0.70–0.89). CONCLUSION More than one-third of older NH residents in the U.S. do not initiate any secondary prevention medications after AMI, with fewer medications initiated among residents with older age, female sex, DNR orders, poor physical functioning, and cognitive impairment. A lack of evidence for the NH population and unmeasured patient-centered goals of care are both plausible explanations for these findings.

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“…On the one hand, frailty is associated with increased cardiovascular risk; on the other hand, frail and comorbid patients are more susceptible to adverse drug reactions and pharmacological interactions. In general, though, frail individuals are less likely to be treated …”

Section: Clues To Optimal Treatment Choicementioning

confidence: 99%

Management of high cholesterol levels in older people

Bertolotti

Lancellotti

Mussi

2019

Geriatrics Gerontology Int

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The management of hypercholesterolemia in older adults still represents a challenge in clinical medicine. The pathophysiological alterations of cholesterol metabolism associated with aging are still incompletely understood, even if epidemiological evidence suggests that serum cholesterol levels increase with ongoing age, possibly with a plateau after the age of 80 years. Age is also one of the main determinants of cardiovascular disease, according to all cardiovascular risk estimate tools. Cholesterol‐lowering treatment, therefore, would be expected to bring significant protection, even in these patients. Unfortunately, direct experimental evidence is extremely limited, particularly in the very old age strata of the population; a clinical benefit still seems to be present, but the risk for drug‐related adverse events is clearly higher. At any rate, at the present time, definite guidelines for the correct management of hypercholesterolemia in older patients are not available. Therefore, the decision whether or not a pharmacological treatment should be set up, and the choice of the drug, need to be tailored to the individual patient, and requires accurate clinical judgment. The specific aspects of frailty and disability, along with the actual age of the patients, have to be considered together, with a comprehensive assessment approach. The present review summarizes the evidence regarding the modifications of cholesterol metabolism in older patients, the impact of lipid‐lowering drugs on cardiovascular outcomes and focuses on the considerations that can help to define the most appropriate treatment strategy, in view of the individual functional profile. Geriatr Gerontol Int 2019; 19: 375–383.

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Relation of Statin Use and Mortality in Community-Dwelling Frail Older Patients With Coronary Artery Disease

Cited by 50 publications

References 26 publications

Association of Antidementia Drugs and Mortality in Community-Dwelling Frail Older Patients With Dementia: The Role of Mortality Risk Assessment

Association of Antidementia Drugs and Mortality in Community-Dwelling Frail Older Patients With Dementia: The Role of Mortality Risk Assessment

Secondary Prevention Medication Use After Myocardial Infarction in U.S. Nursing Home Residents

Management of high cholesterol levels in older people

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