Frailty and Cardiovascular Disease

Cardiovascular disease (CVD) comprises a vast spectrum of disease states ranging from hypertension (HTN) to valvular heart disease (VHD). CVD is known to be the leading cause of morbidity, mortality, and health‐care expenditure throughout the world. According to the World Health Organization, coronary artery disease (CAD) and stroke, both subsets of CVD, are the world’s biggest killers, accounting for a combined 15 million deaths in 2015. These diseases have remained the leading causes of death globally in the last 15 years. In 2010, CAD alone was projected to cost the U.S. $108.9 billion including the cost of health‐care services, medications, and lost productivity. The presence of frailty significantly worsens outcomes for patients suffering from CAD. With just this one example of how frailty affects CVD, it is clear that understanding the impact of frailty upon patients afflicted with the spectrum of cardiovascular disease is integral for the care of this very significant patient population

Post-graduation migration intentions of students of Lebanese medical schools: a survey study

<p>Abstract</p> <p>Background</p> <p>The international migration of physicians is a global public health problem. Lebanon is a source country with the highest emigration factor in the Middle East and North Africa and the 7th highest in the World. Given that residency training abroad is a critical step in the migration of physicians, the objective of this study was to survey students of Lebanese medical schools about their intentions to train abroad and their post training plans.</p> <p>Methods</p> <p>Our target population consisted of all students of Lebanese medical schools in the pre-final and final years of medical school. We developed the survey questionnaire based on the results of a qualitative study assessing the intentions and motives for students of Lebanese medical schools to train abroad. The questionnaire inquired about student's demographic and educational characteristics, intention to train abroad, the chosen country of abroad training, and post-training intention of returning to Lebanon.</p> <p>Results</p> <p>Of 576 eligible students, 425 participated (73.8% response rate). 406 (95.5%) respondents intended to travel abroad either for specialty training (330 (77.6%)) or subspecialty training (76 (17.9%)). Intention to train abroad was associated with being single compared with being married. The top 4 destination countries were the US (301(74.1%)), France (49 (12.1%)), the United Kingdom (31 (7.6%)) and Canada (17 (4.2%)). One hundred and two (25.1%) respondents intended to return to Lebanon directly after finishing training abroad; 259 (63.8%) intended to return to Lebanon after working abroad temporarily for a varying number or years; 43 (10.6%) intended to never return to Lebanon. The intention to stay indefinitely abroad was associated male sex and having a 2^ndcitizenship. It was inversely associated with being a student of one of the French affiliated medical schools and a plan to train in a surgical specialty.</p> <p>Conclusion</p> <p>An alarming percentage of students of Lebanese medical schools intend to migrate for post graduate training, mainly to the US. A minority intends to return directly to Lebanon after finishing training abroad.</p

TCT CONNECT-228 In-hospital Outcomes of CTO PCI in Octogenarians and Nonagenarians: Insights From the PROGRESS-CTO Registry

Background: The outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in octogenarians and nonagenarians have received limited study. Methods: We compared in-hospital outcomes of CTO PCI between patients ≥80 years and \u3c80-years-old in 6,233 CTO PCIs performed in 6,050 patients between 2012 and 2020 at 33 U.S. and international centers. Results: There were 415 octogenarians and nonagenarians in our study (7% of the total population). Compared with younger patients, octogenarians and nonagenarians were less likely to be men (73% vs. 83.2%, p \u3c 0.0001) and more likely to have atrial fibrillation (27% vs. 12%, p \u3c 0.0001) and prior coronary artery bypass graft surgery (43% vs. 29%, p \u3c 0.0001). They were more likely to have CTOs with moderate/severe calcification (71% vs. 46%, p \u3c 0.0001), but had similar mean J-CTO scores (2.5 ± 1.3 vs. 2.4 ± 1.3, p = 0.09). The most common crossing strategy used was antegrade wire escalation in both groups (84% in octogenarians/nonagenarians vs. 85% in younger patients, p = 0.64).Non-CTOs were treated at the same time in 32% of patients in the ≥80-year-old group compared with 25% in the \u3c80-year-old group (p = 0.018). Octogenarians and nonagenarians were more likely to have balloon uncrossable (17% vs. 10%, p = 0.0006) and balloon undilatable lesions (15% vs. 9%, p = 0.006). The octogenarians/nonagenarians had lower technical and procedural success (82.2% vs. 86.3%, p = 0.02, 80.3% vs. 84.8%, p = 0.016, respectively) and higher incidence of in-hospital major adverse cardiovascular events (MACE) (3.4% vs. 1.8%, p = 0.02) (Figure 1). Most in-hospital MACE events were cardiac tamponade requiring pericardiocentesis (Figure 2). [Formula presented] [Formula presented] Conclusion: CTO-PCI is feasible in octogenarians and nonagenarians, although success rates are lower, and the risk of complications is higher compared with younger patients

Chronic total occlusion percutaneous coronary intervention in octogenarians and nonagenarians

OBJECTIVE: The outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in octogenarians and nonagenarians have received limited study. METHODS: We compared in-hospital outcomes of CTO PCI between patients ≥80 vs. \u3c80-years-old in 6233 CTO PCIs performed between 2012 and 2020 at 33 U.S. and international centers. RESULTS: There were 415 octogenarians and nonagenarians in our study (7% of the total population). Compared with younger patients, octo- and nonagenarians were less likely to be men (73% vs. 83.2%, p \u3c 0.0001) and more likely to have atrial fibrillation (27% vs. 12%, p \u3c 0.0001) and prior coronary artery bypass graft surgery (CABG) (43% vs. 29%, p \u3c 0.0001). They were more likely to have CTOs with moderate/severe calcification (71% vs. 46%, p \u3c 0.0001), but had similar mean J-CTO scores (2.5 ± 1.3 vs. 2.4 ± 1.3, p = 0.08). They had lower technical and procedural success (82.2% vs. 86.3%, p = 0.0201; 80.3% vs. 84.8%, p = 0.016, respectively) and higher incidence of in-hospital major adverse cardiovascular events (3.4% vs. 1.8%, p = 0.021). On multivariable analysis PCI in octo- and nonagenarians was not independently associated with technical and procedural success or with in-hospital MACE. CONCLUSION: CTO PCI is feasible in octo- and nonagenarians, although success rates are lower, and the risk of complications is higher compared with younger patients, likely related to more comorbidities and higher coronary lesion complexity