Impact of Different Geriatric Conditions on Choice of Therapy and In-Hospital Outcomes in Elderly Patients with Acute Coronary Syndrome

Harald Rittger,1,* Christoph Stadelmaier,1,* Thomas Kieschnick,1 Duygu Büber,1 Kristina Rank,1 Laura Vitali-Serdoz,1 Dirk Bastian,1 Matthias Waliszewski2,3 1Medizinische Klinik 1, Klinikum Fürth, Fürth, Germany; 2Medical Scientific Affairs, B. Braun Melsungen AG, Berlin, G...

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Autores principales:	Rittger H, Stadelmaier C, Kieschnick T, Büber D, Rank K, Vitali-Serdoz L, Bastian D, Waliszewski M
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	acute coronary syndromes elderly patients frailty interventional treatment Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/e28350dec4f644308a10527e68339848
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spelling	oai:doaj.org-article:e28350dec4f644308a10527e683398482021-12-02T12:07:59ZImpact of Different Geriatric Conditions on Choice of Therapy and In-Hospital Outcomes in Elderly Patients with Acute Coronary Syndrome1178-1998https://doaj.org/article/e28350dec4f644308a10527e683398482020-05-01T00:00:00Zhttps://www.dovepress.com/impact-of-different-geriatric-conditions-on-choice-of-therapy-and-in-h-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Harald Rittger,1,* Christoph Stadelmaier,1,* Thomas Kieschnick,1 Duygu Büber,1 Kristina Rank,1 Laura Vitali-Serdoz,1 Dirk Bastian,1 Matthias Waliszewski2,3 1Medizinische Klinik 1, Klinikum Fürth, Fürth, Germany; 2Medical Scientific Affairs, B. Braun Melsungen AG, Berlin, Germany; 3Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany*These authors contributed equally to this workCorrespondence: Harald RittgerKlinikum Fuerth, Medizinische Klinik 1, Jakob-Henle-Strasse 1, Fuerth 90766, GermanyTel +49-911-7580-1101Fax +49-911-7580-1104Email h.rittger@yahoo.comIntroduction: The clinical benefit of invasive therapy in elderly patients with acute coronary syndrome (ACS) remains unclear. Furthermore, the decision-making process to treat this growing patient group is also debatable. The purpose of this study was to assess the association between elderly ACS patients, the treatment choice and their in-hospital outcomes after non-ST-elevation (NSTE)-ACS in a consecutive series of patients > 75 years of age.Methods and Results: Consecutive patients > 75 years presenting with NSTE-ACS in our hospital between July 2017 and July 2018 were included during the first 2 days of hospital admission. Demographic data, prior medical history and present medical condition were documented. During day 0 and day 2, geriatric assessments (Clinical Frailty Scale [CFS], Barthel index, Charlson comorbidity index, “timed up and go” test [TUG], Mini-Mental Status Test [MMS], Geriatric Depression Scale [GDS], SF-36 for quality of life, instrumental activities of daily living [IADL], Killip-score, Grace-score and Euro-score) were conducted. After 6 months, patients were re-evaluated. In 106 patients (mean age 81.9± 5.3 years, 57% male gender), 68 patients (64%) were treated interventionally, and 38 patients had conservative treatment (36%). Patients treated with intervention were significantly younger (80.9± 4.7 years vs 83.5± 6.0 years, p=0.015), had a lower rate of prior cerebral events (17.6% vs 26.3%; p=ns) and suffered more often from chronic obstructive pulmonary disease (17.6% vs 34.2%; p=0.050). All other demographic variables were comparable between both groups. The composite clinical endpoint (death, re-infarction, bleeding) was reached in 7 patients (10.3%) of the invasive and in 2 patients (5.3%) of the conservative group. They were not significantly different between both groups. A frailty index, consisting of commonly used parameters of functional impairment in elderly patients, namely, MMS ≤ 2 at baseline, IADL ≤ 7, CFS ≥ 7 and age ≥ 85 years, significantly predicted conservative treatment.Conclusion: Effective revascularization techniques are still underused in patients of older age in the case of ACS. For decision-making, geriatric tests alone may not predict treatment in those patients, but the combination of different tests may better predict treatment and perhaps the clinical outcomes in those patients. Furthermore, frail patients are at higher risk for not receiving guideline recommended therapy.Keywords: acute coronary syndromes, elderly patients, frailty, interventional treatmentRittger HStadelmaier CKieschnick TBüber DRank KVitali-Serdoz LBastian DWaliszewski MDove Medical Pressarticleacute coronary syndromeselderly patientsfrailtyinterventional treatmentGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 15, Pp 723-731 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	acute coronary syndromes elderly patients frailty interventional treatment Geriatrics RC952-954.6
spellingShingle	acute coronary syndromes elderly patients frailty interventional treatment Geriatrics RC952-954.6 Rittger H Stadelmaier C Kieschnick T Büber D Rank K Vitali-Serdoz L Bastian D Waliszewski M Impact of Different Geriatric Conditions on Choice of Therapy and In-Hospital Outcomes in Elderly Patients with Acute Coronary Syndrome
description	Harald Rittger,1,* Christoph Stadelmaier,1,* Thomas Kieschnick,1 Duygu Büber,1 Kristina Rank,1 Laura Vitali-Serdoz,1 Dirk Bastian,1 Matthias Waliszewski2,3 1Medizinische Klinik 1, Klinikum Fürth, Fürth, Germany; 2Medical Scientific Affairs, B. Braun Melsungen AG, Berlin, Germany; 3Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany*These authors contributed equally to this workCorrespondence: Harald RittgerKlinikum Fuerth, Medizinische Klinik 1, Jakob-Henle-Strasse 1, Fuerth 90766, GermanyTel +49-911-7580-1101Fax +49-911-7580-1104Email h.rittger@yahoo.comIntroduction: The clinical benefit of invasive therapy in elderly patients with acute coronary syndrome (ACS) remains unclear. Furthermore, the decision-making process to treat this growing patient group is also debatable. The purpose of this study was to assess the association between elderly ACS patients, the treatment choice and their in-hospital outcomes after non-ST-elevation (NSTE)-ACS in a consecutive series of patients > 75 years of age.Methods and Results: Consecutive patients > 75 years presenting with NSTE-ACS in our hospital between July 2017 and July 2018 were included during the first 2 days of hospital admission. Demographic data, prior medical history and present medical condition were documented. During day 0 and day 2, geriatric assessments (Clinical Frailty Scale [CFS], Barthel index, Charlson comorbidity index, “timed up and go” test [TUG], Mini-Mental Status Test [MMS], Geriatric Depression Scale [GDS], SF-36 for quality of life, instrumental activities of daily living [IADL], Killip-score, Grace-score and Euro-score) were conducted. After 6 months, patients were re-evaluated. In 106 patients (mean age 81.9± 5.3 years, 57% male gender), 68 patients (64%) were treated interventionally, and 38 patients had conservative treatment (36%). Patients treated with intervention were significantly younger (80.9± 4.7 years vs 83.5± 6.0 years, p=0.015), had a lower rate of prior cerebral events (17.6% vs 26.3%; p=ns) and suffered more often from chronic obstructive pulmonary disease (17.6% vs 34.2%; p=0.050). All other demographic variables were comparable between both groups. The composite clinical endpoint (death, re-infarction, bleeding) was reached in 7 patients (10.3%) of the invasive and in 2 patients (5.3%) of the conservative group. They were not significantly different between both groups. A frailty index, consisting of commonly used parameters of functional impairment in elderly patients, namely, MMS ≤ 2 at baseline, IADL ≤ 7, CFS ≥ 7 and age ≥ 85 years, significantly predicted conservative treatment.Conclusion: Effective revascularization techniques are still underused in patients of older age in the case of ACS. For decision-making, geriatric tests alone may not predict treatment in those patients, but the combination of different tests may better predict treatment and perhaps the clinical outcomes in those patients. Furthermore, frail patients are at higher risk for not receiving guideline recommended therapy.Keywords: acute coronary syndromes, elderly patients, frailty, interventional treatment
format	article
author	Rittger H Stadelmaier C Kieschnick T Büber D Rank K Vitali-Serdoz L Bastian D Waliszewski M
author_facet	Rittger H Stadelmaier C Kieschnick T Büber D Rank K Vitali-Serdoz L Bastian D Waliszewski M
author_sort	Rittger H
title	Impact of Different Geriatric Conditions on Choice of Therapy and In-Hospital Outcomes in Elderly Patients with Acute Coronary Syndrome
title_short	Impact of Different Geriatric Conditions on Choice of Therapy and In-Hospital Outcomes in Elderly Patients with Acute Coronary Syndrome
title_full	Impact of Different Geriatric Conditions on Choice of Therapy and In-Hospital Outcomes in Elderly Patients with Acute Coronary Syndrome
title_fullStr	Impact of Different Geriatric Conditions on Choice of Therapy and In-Hospital Outcomes in Elderly Patients with Acute Coronary Syndrome
title_full_unstemmed	Impact of Different Geriatric Conditions on Choice of Therapy and In-Hospital Outcomes in Elderly Patients with Acute Coronary Syndrome
title_sort	impact of different geriatric conditions on choice of therapy and in-hospital outcomes in elderly patients with acute coronary syndrome
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/e28350dec4f644308a10527e68339848
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Impact of Different Geriatric Conditions on Choice of Therapy and In-Hospital Outcomes in Elderly Patients with Acute Coronary Syndrome

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