Nonagenarians admission and prognosis in a tertiary center intensive coronary care unit – a prospective study

Sharon Bruoha, Tomer Maller, Ranel Loutati, Nimrod Perel, Meir Tabi, Louay Taha, Chaim Yosefy, Jamal Jafari, Omri Braver, Itshak Amsalem, Rafael Hitter, Mohamed Manassra, Nir Levy, Ismael Abu-Alkean, Kamal Hamyil, Yoed Steinmetz, Hani Karameh, Mohamed Karmi, David Marmor, Arik WolakMichael Glikson, Elad Asher

    Research output: Contribution to journalArticlepeer-review

    Abstract

    Background: With increasing life expectancy, the prevalence of nonagenarians with cardiovascular disease is steadily growing. However, this population is underrepresented in randomized trials and thus poorly defined, with little quality evidence to support and guide optimal management. The aim of the present study was to evaluate the clinical management, therapeutic approach, and outcomes of nonagenarians admitted to a tertiary care center intensive coronary care unit (ICCU). Methods: We prospectively collected all patients admitted to a tertiary care center ICCU between July 2019 – July 2022 and compared nonagenarians to all other patients. The primary outcome was in-hospital mortality. Results: A total of 3807 patients were included in the study. Of them 178 (4.7%) were nonagenarians and 93 (52%) females. Each year the prevalence of nonagenarians has increased from 4.0% to 2019, to 4.2% in 2020, 4.6% in 2021 and 5.3% in 2022. Admission causes differed between groups, including a lower rate of acute coronary syndromes (27% vs. 48.6%, p < 0.001) and a higher rate of septic shock (4.5% vs. 1.2%, p < 0.001) in nonagenarians. Nonagenarians had more comorbidities, such as hypertension, renal failure, and atrial fibrillation (82% vs. 59.6%, 23% vs. 12.9%, 30.3% vs. 14.4% p < 0.001, respectively). Coronary intervention was the main treatment approach, although an invasive strategy was less frequent in nonagenarians in comparison to younger subjects. In-hospital mortality rate was 2-fold higher in the nonagenarians (5.6% vs. 2.5%, p = 0.025). Conclusion: With increasing life expectancy, the prevalence of nonagenarians in ICCU’s is expected to increase. Although nonagenarian patients had more comorbidities and higher in-hospital mortality, they generally have good outcomes after admission to the ICCU. Hence, further studies to create evidence-based practices and to support and guide optimal management in these patients are warranted.

    Original languageEnglish
    Article number152
    JournalBMC Geriatrics
    Volume23
    Issue number1
    DOIs
    StatePublished - 1 Dec 2023

    Keywords

    • Acute coronary syndrome
    • Cardiac intensive care
    • Nonagenarians

    ASJC Scopus subject areas

    • Geriatrics and Gerontology

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