Impacto Pronóstico de los Síndromes Geriátricos en Pacientes Ancianos con Síndrome Coronario Agudo

Los síndromes geriátricos pueden predecir eventos adversos en el contexto del síndrome coronario agudo más allá de la propia edad y de los clásicos factores de riesgo cardiovascular. El objetivo de la presente tesis doctoral fue cuantificar y evaluar un amplio espectro de síndromes geriátricos en pacientes supervivientes a la fase aguda de un síndrome coronario. Se incluyeron un total de 342 pacientes mayores de 65 años que ingresaron de forma consecutiva en el servicio de Cardiología de un único hospital terciario. Al alta hospitalaria, se evaluaron 5 síndromes geriátricos: la fragilidad (Fried y Green), la dependencia física (Escala de Barthel), la dependencia instrumental (Escala de Lawton y Brody), el deterioro cognitivo (Cuestionario de Pfeiffer) y la comorbilidad (Índices de Charlsos y los índices de comorbilidad simples). Se analizó el impacto pronóstico de dichos síndromes geriátricos sobre la mortalidad por todas las causas durante el seguimiento ambulatorio, así como sobre la aparición del evento combinado (muerte/ infarto) y el evento cardiovascular mayor (muerte/infarto/insuficiencia cardiaca).Geriatric conditions can predict adverse events in the context of acute coronary syndrome beyond age and classic cardiovascular risk factors. The objetive of the present thesis was to quantify and evaluate a big spectrum of geriatric conditions in older patients survivors to an acute coronary syndrome. A total of 342 patients older than 65 years admitted consecutevely in the Cardiology department of a unique tertiary hospital were included. At discharge, 5 geriatric conditions were evaluated: frailty (Fried and Green scores), physical disability (Barthel index), instrumental disability (Lawton-Brody scale), cognitive impairment (Pfeiffer questionnaire) and comorbidity (Charlson and simple comorbidity index). The prognostic impact of geriatric conditions on total mortality during follow-up was analysed, as well as the the appearance of the combined event (death/myocardial infarction) and major cardiovascular events (death/myocardial infarction /heart failure)

Oxigenoterapia y cuidados paliativos en pacientes con insuficiencia cardiaca. Respuesta

Letter to the Edito

Main challenges of electrolyte imbalance in older patients with coronavirus disease and risk of QT prolongation. Response

Sin financiación4.753 JCR (2020) Q2, 45/142 Cardiac & Cardiovascular Systems0.455 SJR (2020) Q3, 202/349 Cardiology and Cardiovascular MedicineNo data IDR 2020UE

Telematic cardiology consultation in the elderly. The 5 M framework can help

Sin financiación4.753 JCR (2020) Q2, 45/142 Cardiac & Cardiovascular Systems0.455 SJR (2020) Q3, 202/349 Cardiology and Cardiovascular MedicineNo data IDR 2020UE

Selection of the best of 2021 in geriatric cardiology

En este texto repasamos algunos de los principales trabajos relacionados con el diagnóstico y tratamiento de las enfermedades cardiovasculares más prevalentes en el paciente mayor publicados durante el último año, a la vez que se resalta también la importancia de una adecuada prevención, tanto primaria como secundaria. De igual modo, merecen especial atención entidades tan prevalentes como la cardiopatía isquémica, la fibrilación auricular o la insuficiencia cardiaca, entre otras, y se destaca el papel de la rehabilitación cardiaca en los pacientes mayores, dado su impacto pronóstico al permitir abordar en gran medida algunos de los síndromes geriátricos presentes en esta población. Por último, repasamos algunos aspectos importantes en la situación de pandemia actual de COVID-19 y algunos de los trabajos liderados por la Sección de Cardiología Geriátrica de la Sociedad Española de Cardiología.In this text we review some of the main studies related to the diagnosis and treatment of the most prevalent cardiovascular diseases in older patients published during the last year, also highlighting the importance of adequate prevention, both primary and secondary. Similarly, prevalent entities such as ischemic heart disease, atrial fibrillation or heart failure, among others, deserve special attention, as well as the role of cardiac rehabilitation in older patients, given its benefits and prognostic impact regarding it addresses to a large extent some of the common geriatric syndromes in this population. Finally, we review some important aspects in the current COVID-19 pandemic and some of the works led by the Geriatric Cardiology Section of the Spanish Society of Cardiology.Sin financiaciónNo data JCR 20210.130 SJR (2021) Q4, 309/356 Cardiology and Cardiovascular MedicineNo data IDR 2020UE

Comorbidity assessment for mortality risk stratification in elderly patients with acute coronary syndrome

Background The Charlson's is the most used comorbidity index. It comprises 19 comorbidities, some of which are infrequent in elderly patients with acute coronary syndrome (ACS), while some others are manifestations of cardiac disease rather than comorbidities. Our goal was to simplify comorbidity assessment in elderly non-ST-segment elevation ACS patients. Methods The study group consisted of 1 training (n = 920, 76 ± 7 years) and 1 testing (n = 532; 84 ± 4 years) cohorts. The end-point was all-cause mortality at 1-year follow-up. Comorbidities were assessed selecting those medical disorders other than cardiac disease that were independently associated with mortality by multivariable analysis. Results A total of 130 (14%) patients died in the training cohort. Six comorbidities were predictive: renal failure, anemia, diabetes, peripheral artery disease, cerebrovascular disease and chronic lung disease. The increase in the number of comorbidities yielded a gradient of risk on top of well-known clinical predictors: ≥3 comorbidities (27% mortality, HR = 1.90, 95% CI 1.20–3.03, p = .006); 2 comorbidities (16% mortality, HR = 1.29, 95% CI 0.81–2.04, p = .30); and 0–1 comorbidities (7.6% mortality, reference category). The discrimination accuracy (C-statistic = 0.80) and calibration (Hosmer-Lemeshow test, p = .20) of the predictive model using the 6 comorbidities was comparable to the predictive model using the Charlson index (C-statistic = 0.80; Hosmer-Lemeshow test, p = .70). Similar results were reproduced in the testing cohort (≥3 comorbidities: 24% mortality, HR = 2.37, 95% CI 1.25–4.49, p = .008; 2 comorbidities: 14% mortality, HR = 1.59, 95% CI 0.82–3.07, p = .20; 0–1 comorbidities: 7.5% reference category). Conclusion A simplified comorbidity assessment comprising 6 comorbidities provides useful risk stratification in elderly patients with ACS.Sin financiación4.329 JCR (2019) Q1, 26/165 Medicine, General & Internal1.017 SJR (2019) Q2, 35/139 Internal MedicineNo data IDR 2019UE

Prognostic value of geriatric conditions beyond age after acute coronary syndrome

The aim of the present study was to investigate the prognostic value of geriatric conditions beyond age after acute coronary syndrome. This was a prospective cohort design including 342 patients (from October 1, 2010, to February 1, 2012) hospitalized for acute coronary syndrome, older than 65 years, in whom 5 geriatric conditions were evaluated at discharge: frailty (Fried and Green scales), comorbidity (Charlson and simple comorbidity indexes), cognitive impairment (Pfeiffer test), physical disability (Barthel index), and instrumental disability (Lawton-Brody scale). The primary end point was all-cause mortality. The median follow-up for the entire population was 4.7 years (range, 3-2178 days). A total of 156 patients (46%) died. Among the geriatric conditions, frailty (Green score, per point; hazard ratio, 1.11; 95% CI, 1.02-1.20; P=.01) and comorbidity (Charlson index, per point; hazard ratio, 1.18; 95% CI, 1.0-1.40; P=.05) were the independent predictors. The introduction of age in a basic model using well-established prognostic clinical variables resulted in an increase in discrimination accuracy (C-statistic=.716-.744; P=.05), though the addition of frailty and comorbidity provided a nonsignificant further increase (C-statistic=.759; P=.36). Likewise, the addition of age to the clinical model led to a significant risk reclassification (continuous net reclassification improvement, 0.46; 95% CI, 0.21-0.67; and integrated discrimination improvement, 0.04; 95% CI, 0.01-0.09). However, the addition of frailty and comorbidity provided a further significant risk reclassification in comparison to the clinical model with age (continuous net reclassification improvement, 0.40; 95% CI, 0.16-0.65; and integrated discrimination improvement, 0.04; 95% CI, 0.01-0.10). In conclusion, frailty and comorbidity are mortality predictors that significantly reclassify risk beyond age after acute coronary syndrome

Selection of the best of 2020 in geriatric cardiology

Durante el último año se han publicado numerosos trabajos centrados en el paciente mayor con enfermedad cardiovascular. En este texto repasamos algunos de los principales trabajos relacionados con el abordaje del paciente mayor con cardiopatía, incluyendo escenarios clínicos tan complejos como la situación de la pandemia de enfermedad por coronavirus de 2019 (COVID-19) que vivimos. Hemos querido resaltar y prestar especial atención a aspectos de gran relevancia clínica, dado su impacto pronóstico, como son los síndromes geriátricos y la comorbilidad, entidades prevalentes en el paciente mayor con cardiopatía, y que conviene conocer para mejorar la atención que proporcionamos a nuestros pacientes en distintos ámbitos (urgencias, hospitalización, ambulatorio). Analizamos también algunos de los principales estudios y trabajos impulsados desde la Sección de Cardiología Geriátrica de la Sociedad Española de Cardiología.During last year several papers focusing on elderly patients with cardiovascular disease have been published. In this article, we review some of the most important studies focused on the management of elderly patients with heart disease, also including complex clinical scenarios such as the COVID-19 pandemic. We highlight some aspects of great clinical relevance, given their prognostic impact, such as geriatric syndromes and comorbidity, all of them prevalent in the elderly. We also emphasize on how to improve the care we provide to our patients in different scenarios (emergency, hospitalization, outpatients). Finally, we analyze some of the main studies promoted by the Geriatric Cardiology Section of the Spanish Society of Cardiology.Sin financiaciónNo data JCR 20200.114 SJR (2020) Q4, 316/349 Cardiology and Cardiovascular MedicineNo data IDR 2020UE

Impact of Diabetes Mellitus and Frailty on Long-Term Outcomes in Elderly Patients with Acute Coronary Syndromes

Objectives Diabetes mellitus (DM) and frailty are common in older patients with acute coronary syndromes (ACS). No data exists about its prognostic impact on long-term outcomes and their possible interaction in this setting. Design Observational prospective study. Setting Multicenter registry conducted in 44 hospitals in Spain. Participants Consecutive patients with ACS aged 80≥years. Measurements A comprehensive geriatric evaluation was performed during hospitalization, including frailty assessment by the FRAIL score. The impact of DM and frailty on the incidence of mortality/readmission at 24 months was analysed by a Cox regression model. Results A total of 498 patients were included (mean age 84.3 years). Prevalence of previous DM was 199/498 (40.0%). The rate of frail patients was 135/498 (27.1%). The incidence of mortality/readmission was higher frail patients (HR 2.49) (both p<0.001). In contrast, DM was not significantly associated to a higher rate of outcomes (HR 1.23, p=0.060) in the whole cohort. Among non-frail patients, patients with DM had a similar incidence of mortality or readmission (p=0.959). In contrast, among frail patients, DM was significantly associated with a higher incidence of events (HR 1.51, p=0.034). Conclusions Unlike frailty status, DM was not associated to poorer long-term outcome in elderly patients with ACS. Among frail patients the presence of DM seems to provide additional prognostic information.Sin financiación4.075 JCR (2020) Q3, 22/53 Geriatrics & Gerontology0.987 SJR (2020) Q1, 566/2447 Medicine (miscellaneous)No data IDR 2020UE