TY - JOUR
T1 - Nonagenarians admission and prognosis in a tertiary center intensive coronary care unit – a prospective study
AU - Bruoha, Sharon
AU - Maller, Tomer
AU - Loutati, Ranel
AU - Perel, Nimrod
AU - Tabi, Meir
AU - Taha, Louay
AU - Yosefy, Chaim
AU - Jafari, Jamal
AU - Braver, Omri
AU - Amsalem, Itshak
AU - Hitter, Rafael
AU - Manassra, Mohamed
AU - Levy, Nir
AU - Abu-Alkean, Ismael
AU - Hamyil, Kamal
AU - Steinmetz, Yoed
AU - Karameh, Hani
AU - Karmi, Mohamed
AU - Marmor, David
AU - Wolak, Arik
AU - Glikson, Michael
AU - Asher, Elad
N1 - Publisher Copyright:
© 2023, The Author(s).
PY - 2023/12/1
Y1 - 2023/12/1
N2 - 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.
AB - 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.
KW - Acute coronary syndrome
KW - Cardiac intensive care
KW - Nonagenarians
UR - http://www.scopus.com/inward/record.url?scp=85150751951&partnerID=8YFLogxK
U2 - 10.1186/s12877-023-03851-z
DO - 10.1186/s12877-023-03851-z
M3 - Article
C2 - 36941571
AN - SCOPUS:85150751951
SN - 1471-2318
VL - 23
JO - BMC Geriatrics
JF - BMC Geriatrics
IS - 1
M1 - 152
ER -
