New Research Highlights Opportunities to Improve Care in Elderly CV Patients
With life expectancy increasing and the general population aging, more and more elderly patients are being admitted to hospitals with cardiovascular issues. As such, several new studies presented as part of ESC Congress 2014 offer insights into ways the cardiovascular profession can adapt to this change and improve medical care.
In one study of 342 patients over the age of 65 admitted for angina or myocardial infarction (MI), frailty increased mortality risk three-fold and was the strongest independent predictor of death or recurrent myocardial infarction. Other geriatric conditions including physical disability, instrumental disability, cognitive impairment and comorbidity also had a statistically significant association with worse outcome, but frailty captured most of the prognostic information.
In presenting these findings, Clara Bonanad, MD, of the University Clinic Hospital in Valencia, Spain, suggested that elderly patients admitted for MI be routinely assessed for frailty. She also urged specific strategies for patients with geriatric conditions including frailty that will help improve rehabilitation after MI. "Such strategies should include help with nutrition and mobility with the aim of achieving a better prognosis and quality of life in these patients," she said.
A second study suggests a closer look at resuscitation policies for those over the age of 80. The nine-year study of 4,000 patients with out-of-hospital cardiac arrest in Copenhagen found that 19 percent of those 80 years or older were alive 30 days later, compared to 45 percent of younger patients. While resuscitation attempts were more often successful in younger cardiac arrest patients (40 percent), compared to octogenarians (25 percent), Helle Søholm, MD, from Denmark said the study's findings "show that most octogenarians who do survive are able to live an active life after the incident." Seventy-five percent of surviving octogenarians were discharged with a high functional status, compared to 85 percent of younger patients.
While octogenarian numbers are on the rise, so too are the numbers for centenarians. In 2011 there were 317,000 centenarians globally. This population is projected to grow to 3.2 million by 2050, reaching nearly 18 million by the end of the century, according to Manuel Martínez-Sellés, MD, from Madrid, who presented data from the Cardiac and Clinical Characterisation of Centenarians (4C) study.
The 4C study used standardized echocardiography to define the rate of normal electrocardiograms (ECGs) in the centenarian population. Findings showed most centenarians had ECG alterations and abnormalities in echocardiography were almost universal. For example, one-fifth of participants had atrial fibrillation and most had echocardiographic evidence of different heart dysfunctions. Aortic regurgitation was found in half of the centenarians and the more severe it was, the higher the mortality. A normal ECG was more frequent in women (31 percent) than men (9 percent).
According to Sellés, the 4C study indicated that aging is associated with extensive changes in cardiovascular structure and function that may result in detectable electrocardiographic and echocardiographic findings. "Our results add to our knowledge of cardiac anatomy and function in centenarians and help us to better understand the process of aging and exceptional longevity," he said. "They also point to areas that can be targeted for prevention and treatment to improve the health of older people."
Keywords: Myocardial Infarction, Cognition, Life Expectancy, Geriatric Assessment, Comorbidity, Longevity, Electrocardiography, Prognosis, Out-of-Hospital Cardiac Arrest, Quality of Life, Resuscitation Orders, Atrial Fibrillation, Echocardiography
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