Bedside assessment of dependence as an independent correlate of mortality in elderly patients admitted for Acute Coronary Syndromes

Abstract

Abstract Background Elderly patients are at high risk of dependence and mortality after acute coronary syndrome (ACS) Purpose To assess the impact of dependence detected by a simple bedside test in elderly patients admitted for ACS on 1-year mortality. Methods We compared mortality between patients with or without dependence based on an Activities of Daily Living (ADL) index <6 in a prospective, cohort of patients ≥75 years old admitted for an ACS to the cardiology department of our center using a Cox proportional survival model adjusted on pre-defined confounding variables (age, gender, revascularization, heart failure, left ventricular ejection fraction and admission GRACE and CRUSADE scores). Results In a cohort of 1011 consecutive patients, 946 underwent ADL assessment and completed one-year follow-up. Dependence was identified in 190 (20%). At 1 year follow-up 112 patients died, 52 (27.4%) in the dependent and 60 (7.9%) in the independent groups. Dependence was associated with higher rates of 1 year mortality both on undajusted (HR 3.79; 95% CI 2.62; 5.50], p<0.0001) and adjusted models (adj-HR 2.85; 95% CI 1.89; 4.33], p<0.0001). Other independent correlates of mortality were female gender (p<0.0001), CRUSADE score (p<0.0001) and coronary revascularization (p<0.001). Conclusions Dependence detected by a simple bedside test in patients ≥75 admitted for ACS is associated with a 2 to 3-fold increase of the risk of mortality independent of other predictors of poor outcome. Assessment of dependence should be performed in all elderly patients as a risk stratification tool and considered for the management of such patients. Funding Acknowledgement Type of funding sources: None.