Events In Elderly Patients Research Articles

Applicability of tools to identify potentially inappropriate prescribing in elderly during medication review: Comparison of STOPP/START version 2, Beers 2019, EU(7)-PIM list, PRISCUS list, and Amsterdam tool-A pilot study.

Potentially inappropriate prescribing (PIP) is one of the major risk factors of adverse drug events in elderly patients. Pharmacotherapy assessment criteria may help reduce the instances of PIP among geriatric patients. This study aimed to verify the applicability of selected tools designed to assess prescribing appropriateness in elderly and to identify PIP in the study population. Based on pharmacist-led medication reviews that were performed among patients attending senior day-care centers based in Poland, aged 65 years and over, the following tools were applied for assessing the appropriateness of pharmacotherapy: PILA (patient-in-focus listing approach): STOPP/START v.2 and Amsterdam tool, DOLA (drug-oriented listing approach): PRISCUS list, and DOLA+: Beers criteria v.2019 and the EU(7)-PIM list–the criteria oriented on medications requiring indications. Fifty patients participated in the study. The prevalence of prescribing issues in the study population was very high and ranged from 28% to 100%, depending on the criteria applied. The highest number of PIP cases was identified based on the PILA criteria: STOPP/START v.2 (171, a mean of 3.4 PIP cases per patient), and the Amsterdam criteria (124, a mean of 2.5 PIP cases per patient). The lack of protective vaccinations against pneumococci identified using the START criterion was found to be the most common PIP (identified in 96% of the patients). Proton-pump inhibitors (PPIs) were identified as the most problematic group of medications. The STOPP, EU(7)-PIM and Beers criteria revealed cases of inappropriate prolonged PPI use, whereas the Amsterdam tool identified cases where PPIs should have been prescribed but were not. The highest number of PIP cases in the study population were identified with the PILA tools, and on this basis the most comprehensive assessment of pharmacotherapy appropriateness in geriatric patients was conducted. Further studies should be designed, covering a larger group of patients across different healthcare settings (inpatient and outpatient), with access to comprehensive patient data.

Dual Antiplatelet Therapy in Patients Aged 75 Years and Older with Coronary Artery Disease: A Meta-Analysis and Systematic Review.

Objectives This systematic review and meta-analysis evaluates the safety and efficacy of dual antiplatelet therapy (DAPT) in elderly patients with acute coronary syndrome (ACS). Background The safety and efficacy of DAPT in elderly patients with ACS is not well characterized. Methods We performed a systematic literature review to identify clinical studies that reported safety and efficacy outcomes after DAPT for ACS in elderly patients. The primary outcomes of primary efficacy endpoint rates and bleeding event rates were reported as random effects risk ratio (RR) with 95% confidence interval. No prior ethical approval was required since all data are public. Results Our search yielded 660 potential studies. We included 8 studies reporting on 29,217 patients. There was a higher risk of bleeding event rates in elderly patients treated with prasugrel or ticagrelor when compared to clopidogrel with a risk ratio of 1.17 (95% CI 1.08 to 1.27, p < 0.05). There was no difference in primary efficacy endpoint rates between elderly patients treated with prasugrel or ticagrelor when compared to clopidogrel with a risk ratio of 0.85 (95% CI 0.68 to 1.07, p=0.17). Conclusions This systematic review and meta-analysis suggests that DAPT with prasugrel or ticagrelor compared to clopidogrel is associated with a higher risk of bleeding events in elderly patients with ACS. There was no difference in the primary efficacy endpoints between the two treatment groups.

Critical values of monitoring indexes for perioperative major adverse cardiac events in elderly patients with biliary diseases.

BACKGROUNDMajor adverse cardiac events (MACE) in elderly patients with biliary diseases are the main cause of perioperative accidental death, but no widely recognized quantitative monitoring index of perioperative cardiac function so far.AIMTo investigate the critical values of monitoring indexes for perioperative MACE in elderly patients with biliary diseases. METHODSThe clinical data of 208 elderly patients with biliary diseases in our hospital from May 2016 to April 2021 were retrospectively analysed. According to whether MACE occurred during the perioperative period, they were divided into the MACE group and the non-MACE group. RESULTSIn the MACE compared with the non-MACE group, postoperative complications, mortality, hospital stay, high sensitivity troponin-I (Hs-TnI), creatine kinase isoenzyme (CK-MB), myoglobin (MYO), B-type natriuretic peptide (BNP), and D-dimer (D-D) levels were significantly increased (P < 0.05). Multivariate logistic regression showed that postoperative BNP and D-D were independent risk factors for perioperative MACE, and their cut-off values in the receiver operating characteristic (ROC) curve were 382.65 pg/mL and 0.965 mg/L, respectively. CONCLUSIONThe postoperative BNP and D-D were independent risk factors for perioperative MACE, with the critical values of 382.65 pg/mL and 0.965 mg/L respectively. Consequently, timely monitoring and effective maintenance of perioperative cardiac function stability are of great clinical significance to further improve the perioperative safety of elderly patients with biliary diseases.

Adverse Hemodynamic Effects of Dexmedetomidine in Critically Ill Elderly Adults

Background: Dexmedetomidine is a currently recommended first-line sedative agent for critically ill patients requiring mechanical ventilation. Recent trials demonstrated no difference in clinical outcomes between patients treated with dexmedetomidine vs usual care, but significantly more hemodynamic adverse effects in the dexmedetomidine group. One subgroup analysis suggested a 90-day mortality benefit in elderly patients, but no distinction was made between groups regarding age when reporting adverse effects. Given potential decreased baroreceptor function in the elderly, adverse hemodynamic effects of dexmedetomidine may impact them more. Objective: To assess the incidence of adverse hemodynamic effects of dexmedetomidine in elderly ICU patients compared to other sedative agents to clarify the role of dexmedetomidine in this patient population. Methods: This was a single-center, retrospective study including mechanically ventilated elderly patients requiring sedative agents for ≥12 hours. The primary outcome evaluated was composite end point of incidence of bradycardia and hypotension. Secondary outcomes included incidence of each adverse event individually, hospital and ICU length of stay, and duration of mechanical ventilation. Results: There was no difference in adverse events between the two groups (58.7% vs 74.1% in the dexmedetomidine vs usual care groups, P =.074). There was no difference in hospital or ICU length of stay. Patients in the dexmedetomidine group were on the ventilator longer than patients in the usual care group with a median of 6 vs 3 days, respectively (P = 0.004). Conclusion: In this single-center, retrospective study dexmedetomidine had a similar incidence of adverse events in elderly patients compare to the usual care group.

Comparison of the prognostic value of frailty assessment tools in patients aged ≥ 65 years hospitalized in a cardiac care unit with acute coronary syndrome.

BACKGROUNDFrailty is associated with adverse events in elderly patients with acute coronary syndrome (ACS). Our aim was to compare the prognostic value of four frailty scales in patients aged ≥ 65 years hospitalized with ACS in a cardiac care unit (CCU).METHODSPatients aged ≥ 65 years with ACS were included. Frailty was assessed using the Fried frailty scale (reference standard), the Edmonton Frail Scale (EFS), the FRAIL scale, and the Clinical frailty scale (CFS). The primary end point was all-cause mortality and the secondary end point was unscheduled rehospitalization.RESULTSOne hundred and seventy four patients aged ≥ 65 years with ACS were recruited. The median follow-up was 637.5 days. Frailty was identified in 41.4%, 40.2%, 39.1% and 36.3% patients by the Fried frailty scale, EFS, FRAIL scale and CFS, respectively. The agreement coefficients were 0.88, 0.86, and 0.79 for the FRAIL scale, EFS and CFS, respectively. In the Cox regression model, frailty was associated with all-cause mortality regardless of the scale used (univariate: hazard ratio [HR] 95% CI = 10.5, 2.4–46.8 Fried frailty scale; 12.0, 2.7–53.4 FRAIL scale; 7.1, 2.0–25.2 EFS; 8.3, 2.4–29.6 CFS. Multivariate: HR = 5.1, 1.1–23.8 Fried frailty scale; 5.7, 1.2–26.8 FRAIL scale; 3.7, 1.0–14.0 EFS; 4.2, 1.1–15.9 CFS). The FRAIL scale had the highest HR. In the univariate analysis, frailty was associated with unscheduled rehospitalization (HR = 3.2, 1.7–6.0 Fried frailty scale; 3.4, 1.8–6.3 FRAIL scale; 3.5, 1.8–6.6 EFS; 3.1, 1.7–5.8 CFS). In the multivariate analysis, only the EFS independently predicted unscheduled rehospitalization (HR = 2.2, 1.1–4.63).CONCLUSIONSFrailty assessed by the Fried frailty scale, FRAIL scale, EFS and CFS is associated with all-cause mortality and unscheduled rehospitalization in elderly patients hospitalized in a CCU with ACS. The adjusted HR of the FRAIL scale for all-cause mortality was the highest among the scales compared, whereas the EFS was an independent predictor of unscheduled rehospitalization. These data should be taken into consideration when choosing a frailty assessment tool.

Association between Rapid Dementia Screening Test score and clinical events in elderly patients with cardiovascular disease: a retrospective cohort study.

Cognitive decline is prevalent among patients with cardiovascular disease (CVD). Cognitive measurement has been considered as a standard assessment for secondary prevention; however, standard cognitive tests are sometimes infeasible due to time constraints. This study aimed to examine the association between the Rapid Dementia Screening Test (RDST), a brief screening tool for cognitive function, and clinical events in elderly patients with CVD. This retrospective cohort study included 140 hospitalized patients with CVD who participated in inpatient cardiac rehabilitation (median age, 75 years; male, 67%). Cognitive function for each patient was assessed using the RDST and Montreal Cognitive Assessment (MoCA), a standard test of mild cognitive impairment. The clinical events assessed as outcomes included all-cause mortality and unplanned rehospitalization. Receiver-operating characteristic (ROC) curve analysis showed similar predictive accuracy for the study outcome (P = 0.337) between the RDST [area under the curve, 0.651; 95% confidence interval (CI), 0.559-0.743] and MoCA (0.625; 0.530-0.720). The ROC analysis identified a cut-off value of 9 points for the RDST (sensitivity, 77.8%; specificity, 50.5%). Patients with RDST ≤9 showed a poor survival rate compared with those with ≥10 points (log-rank test, P = 0.002; hazard ratio, 2.94, 95% CI, 1.46-5.94). This result was consistent even after adjusting for potential confounders. The RDST was associated with clinical events in elderly patients with CVD and its predictive capability was comparable with that of MoCA, a standard cognitive test. The RDST may be useful in CVD as an alternative screening tool for cognitive decline.

Prognostic Value of Aortic Stiffness using Cardiovascular Magnetic Resonance in The Elderly with Known or Suspected Coronary Artery Disease.

ResumoFundamento A rigidez aórtica é considerada um marcador de doença cardiovascular. A ressonância magnética cardiovascular (RMC) permite realizar uma avaliação abrangente da rigidez aórtica e da isquemia miocárdica em um único exame. Entretanto, dados prognósticos relacionados à rigidez aórtica em pacientes idosos permanecem limitados.Objetivo Determinar o valor prognóstico da rigidez aórtica usando a velocidade da onda de pulso (VOP) baseada em RMC em pacientes idosos com doença arterial coronariana (DAC).Métodos Foram cadastrados pacientes consecutivos com idade >70 com indicação para RMC com perfusão de estresse com adenosina incluindo VOP, entre 2010 e 2014. Os pacientes foram acompanhados para verificar a ocorrência de eventos cardíacos adversos maiores (MACE), incluindo mortalidade cardíaca, infarto do miocárdio não fatal, hospitalização por insuficiência cardíaca, revascularização tardia (>180 dias após a RMC), e acidente vascular isquêmico. Foram realizadas análises univariadas e multivariadas para determinar os preditores de MACE. Um p-valor <0,05 foi considerado estatisticamente significativo.Resultados A VOP média foi 13,98±9,00 m/s. Depois de um período mediano de acompanhamento de 59,6 meses em 263 pacientes (55% do sexo feminino, 77±5 anos), ocorreram 61 MACE. Pacientes com VOP elevada (>13,98 m/s) tiveram índices de MACE significativamente mais altos (FC 1,75; IC 95% 1,05-2,94; p=0,03) que os dos pacientes com VOP não elevada (<13,98 m/s). A análise multivariada demonstrou que pressão arterial diastólica, fração de ejeção ventricular esquerda (FEVE), isquemia miocárdica, e VOP elevada são preditores independentes de MACE (p<0,05 para todos). A VOP apresentou um valor prognóstico incremental em relação a dados clínicos, FEVE e isquemia (qui-quadrado global aumentado = 7,25, p=0,01).Conclusão A rigidez aórtica, usando-se a RMC, é um preditor independente forte de eventos cardiovasculares em pacientes idosos com suspeita de DAC ou DAC confirmada.

MO057: Serum Irisin and Prediction of Cardiovascular Events in Elderly Patients with CKD Stage 3–5

Abstract BACKGROUND AND AIMS Irisin is a circulating myokine released by skeletal muscle after exercise. Its production decreases in chronic kidney disease (CKD) as a potential consequence of sarcopenia and physical inactivity. Irisin produces beneficial effects in glucose and lipid homeostasis: it promotes glucose tolerance and lipid metabolism and improves insulin resistance, stimulates browning of white adipose tissue and upregulates thermogenesis. Irisin may also produce a protective effect on the cardiovascular system as it promoted the proliferation of cardiomyocytes and suppressed myocardial fibrosis and hypertrophy. Low serum irisin was proposed as a predictor of cardiovascular mortality. We studied the relationship of serum irisin with cardiovascular risk in a sample of patients at different stages of CKD not undergoing dialysis and characterized for their artery calcification and mineral metabolism variables. METHOD Seventy-nine consecutive patients with stage 3–5 CKD were recruited from the patients of the nephrology outpatient clinic of our institute in Milan from 2010 to 2014. Serum irisin levels were measured at baseline in all recruited patients and in 20 healthy controls. Incident cardiovascular events were recorded during a 3-year follow-up. They included myocardial infarction, angina pectoris, coronary revascularization, congestive heart failure, stroke, TIA and cardiovascular death. RESULTS Serum irisin was significantly higher in controls than that in patients with CKD and in patients with CKD stage 3 than that in patients at stage 4 and 5 taken together. Taking controls and patients with CKD together eGFR was positively correlated with serum irisin. Patients with CKD were grouped according to tertiles of serum irisin. Patients in the lowest tertile had lower serum 1,25(OH)2D levels than patients in the middle and the highest tertile. Patients in the highest tertile had lower Kauppila aortic calcification score than patients in the middle and the lowest tertiles. Twenty patients suffered from cardiovascular events during a 3-year follow-up. Cox regression analysis confirmed the association of serum irisin with incident cardiovascular events during the follow-up, as patients in the highest tertile of serum irisin showed a lower cardiovascular risk than patients in the middle or the lowest tertile. Kaplan–Meier survival analysis showed that patients in the highest serum irisin tertile developed less cardiovascular events during the follow-up than patients in the other tertiles taken together (P = 0.049). CONCLUSION The present study suggests that irisin is a marker of cardiovascular risk in patients with CKD. It might contribute to the cardiovascular protection that physical exercise and active lifestyle produce in patients with CKD.

Association among mild cognitive impairment, social frailty, and clinical events in elderly patients with cardiovascular disease

BackgroundSocial support is considered a key factor for secondary prevention in patients with cardiovascular disease (CVD) and mild cognitive impairment (MCI). Recent studies have suggested the clinical importance of social frailty in CVD. ObjectiveThis study aimed to examine the association among coexistent MCI, social frailty, and clinical events in patients with CVD. MethodsThis study included 184 hospitalized elderly patients with CVD who participated in inpatient cardiac rehabilitation (median age, 75 years; male, 66.3%). MCI was defined as a Montreal Cognitive Assessment score of ≤25 points at discharge. Social frailty was defined using the Makizako criteria. Lack of caregiver support was also assessed as an indicator of poor social support. The Kaplan-Meier survival curve analysis and Cox regression analysis were conducted to evaluate the combined impact of MCI and social frailty or the lack of caregiver support on the composite endpoint of all-cause mortality or unplanned rehospitalization. ResultsThe prevalence of MCI, social frailty, and lack of caregiver support were 65.2%, 70.7%, and 19.0%, respectively. There was a significant difference among subgroups by MCI and a lack of caregiver support (log-rank test, p = 0.018), and the MCI/non-caregiver group showed the worst prognosis (adjusted hazard ratio 3.96; 95% confidence interval 1.57–9.98). Likewise, MCI/social frailty group showed a significantly high event risk (3.94; 1.20–12.9) among the subgroups by MCI and social frailty. ConclusionOur results highlight the clinical importance of assessing the presence of caregiver support along with conventional social frailty for patients with CVD and MCI.

Analysis of drug adverse events in elderly patients based on the Japanese Adverse Drug Event Report Database.

Compared with the general adult population, pharmacokinetics and changes in drug responsiveness occur to a greater extent in the elderly. Interactions may occur between drugs used in combination to treat various diseases and may cause adverse events (AEs). We conducted a cross-sectional risk assessment of AEs in elderly patients based on information gathered from Japanese medical practices with the goal of obtaining information that will contribute to optimizing pharmacotherapy. The Japanese Adverse Drug Event Report database was used to determine the incidence of AEs in elderly patients (aged 80 years or older) compared with patients aged less than 80 years old by evaluating the reporting odds ratio using the data obtained from reports. Hypnotics and anxiolytics, as well as anticoagulants and theophylline, were identified as groups of drugs that warrant special attention in the elderly. Hypnotics and anxiolytics, especially those that are short-acting, tend to cause delirium and geriatric syndromes including falls and fractures. With respect to anticoagulants, no increase in the risk of bleeding was evident and the dose was believed to be properly adjusted; however, there was an increased risk of anemia. Theophylline toxicity tended to occur more frequently in the elderly, suggesting the need for drug monitoring. Based on these cross-sectional studies, the evaluation of the risk of AEs for drugs commonly used in the elderly based on near real-world information was achieved.

Prognostic Factors for Cardiovascular Events in Elderly Patients with Community Acquired Pneumonia: Results from the CAP-China Network.

BackgroundLimited data were available about the burden of cardiovascular events (CVEs) during hospitalization in elderly patients with community-acquired pneumonia (CAP). The aim was to assess the incidence, characteristics, predictive factors and outcomes of CVEs in elderly patients with CAP during hospitalization.MethodsThis study was a multicenter, retrospective research on hospitalized elderly patients with CAP from the CAP-China network. Predictive factors for the occurrence of CVEs and 30-day mortality were identified by multivariable logistic regression analysis.ResultsOf 2941 hospitalized elderly patients, 402 (13.7%) developed CVEs during hospitalization with the median age of 81 years old. Compared with non-CVEs patients, patients with CVEs were older, more comorbidities, and higher disease severity; use of glucocorticoids, leukocytosis, azotemia, hyponatremia, multilobe infiltration and pleural effusion were more common; the rate of clinical failure (CF), in-hospital mortality and 30-day mortality were higher, which significantly increased with age and the number of CVEs (p < 0.001). Multivariable logistic regression showed previous history of congestive heart failure (odds ratio [OR], 6.16; 95% CI, 4.14–9.18), CF (OR, 4.69; 95% CI, 3.392–6.48), previous history of ischemic heart disease (OR, 2.22; 95% CI, 1.61–3.07), use of glucocorticoids (OR, 2.0; 95% CI, 1.39–2.89), aspiration (OR, 1.88; 95% CI, 1.26–2.81), pleural effusion (OR, 1.66; 95% CI, 1.25–2.20), multilobe infiltration (OR, 1.50; 95% CI, 1.15–1.96), age (OR, 1.05; 95% CI, 1.04–1.07), and blood urea nitrogen (OR, 1.03; 95% CI, 1.01–1.06) were independent predictors for the occurrence of CVEs, while level of blood sodium (OR, 0.98; 95% CI, 0.97–0.99) was protective factor. Renal failure (OR, 9.46; 95% CI, 4.17–21.48), respiratory failure (OR, 9.32; 95% CI, 5.91–14.71), sepsis/septic shock (OR, 7.87; 95% CI, 3.58–17.31), new cerebrovascular diseases (OR, 5.94; 95% CI, 1.78–19.87), new heart failure (OR, 4.04; 95% CI, 1.15–14.14), new arrhythmia (OR, 2.38; 95% CI, 1.11–5.14), aspiration (OR, 1.95; 95% CI, 1.09–3.50), CURB-65 (OR, 1.57; 95% CI, 1.21–2.02), and white blood cell count (OR, 1.05; 95% CI, 1.02–1.09) were independent predictors for 30-day mortality in elderly patients with CAP, while lymphocyte count (OR, 0.63; 95% CI, 0.46–0.87) was protective factor.ConclusionPatients with CVEs had heavier disease burden and worse prognosis. Early recognition of risk factors is meaningful to strengthen the management in elderly patients with CAP.

Incidence of atrial fibrillation in elderly patients with type 2 diabetes mellitus

IntroductionThe incidence of atrial fibrillation (AF), a significant risk factor for cardiovascular disease (CVD), is increasing worldwide. Type 2 diabetes mellitus (T2D) and advanced age are recognized as major risk...

Optimal anticoagulation in elderly patients with atrial fibrillation: Which drug at which dose?

Aging is an important risk factor for adverse events in elderly patients with atrial fibrillation (AF) and complicates the management of anticoagulation. Underuse of oral anticoagulants (OACs) is common in elderly patients because of comorbidities, the altered physiological function of multiple organs, frailty, risk of falls, and the lack of randomized controlled trials (RCTs) specifically for elderly patients. Nevertheless, current data still support OACs use for reducing ischemic stroke with positive net clinical benefits. Sub-analyses of RCTs and real-world cohort studies showed that non-vitamin K antagonist OACs (NOACs) would be more favorable choices compared to warfarin for stroke prevention in the elderly. This review will discuss important data on stroke prevention and the use of NOACs in elderly AF patients.

Prevalence of COVID-19 related factors among medical and emergency and critical care nursing students during COVID-19 pandemic outbreak

In recent years, there has been increasing interest in the frailty as a prognostic factor of acute myocardial infarction in elderly patients. Frailty is an important prognostic marker of frequent complications, readmission to hospital, high hospital mortality and major cardiovascular events in elderly patients with acute myocardial infarction. This category of persons is often not allowed to undergo invasive interventions and are often excluded from the recommended treatment, and they tolerate cardiac surgery worse, recovery from illness is slower, functionality decreases, then disability and death develop. The present review aims to investigate the impact of frailty on management of elderly patients with acute myocardial infarction (AMI). To analyze the literature, we searched for information on this issue in PubMed / MEDLINE, PMC, Web of Science, Scopus, The Сochrane[AA1] [П2] Library. The search depth was 15 years: from 2006 to 2021. One of the important factors in improving clinical outcomes, improving the quality of life in elderly patients with acute myocardial infarction is the early detection of frailty. Frailty assessment is a valuable tool for risk stratification that can be helpful to clinicians in deciding the optimal pathway for management and treatment strategies. Risk prediction is also important for deciding secondary prevention and cardiac rehabilitation measures in the elderly with acute myocardial infarction. Key words: acute myocardial infarction, advanced age, frailty, prognosis, risk assessment

Frailty in elderly patients with acute myocardial infarction

In recent years, there has been increasing interest in the frailty as a prognostic factor of acute myocardial infarction in elderly patients. Frailty is an important prognostic marker of frequent complications, readmission to hospital, high hospital mortality and major cardiovascular events in elderly patients with acute myocardial infarction. This category of persons is often not allowed to undergo invasive interventions and are often excluded from the recommended treatment, and they tolerate cardiac surgery worse, recovery from illness is slower, functionality decreases, then disability and death develop. The present review aims to investigate the impact of frailty on management of elderly patients with acute myocardial infarction (AMI). To analyze the literature, we searched for information on this issue in PubMed / MEDLINE, PMC, Web of Science, Scopus, The Сocrane Library. The search depth was 15 years: from 2006 to 2021. One of the important factors in improving clinical outcomes, improving the quality of life in elderly patients with acute myocardial infarction is the early detection of frailty. Frailty assessment is a valuable tool for risk stratification that can be helpful to clinicians in deciding the optimal pathway for management and treatment strategies. Risk prediction is also important for deciding secondary prevention and cardiac rehabilitation measures in the elderly with acute myocardial infarction.

Comprehensive geriatric assessment as a useful tool in predicting adverse events in elderly patients with diffuse large B-cell lymphoma

We conducted a multicenter prospective study on whether a comprehensive geriatric assessment (CGA) can predict the adverse events (AEs) of chemotherapy in elderly patients with diffuse large B-cell lymphoma (DLBCL). Patients aged ≥ 65 years with newly diagnosed DLBCL underwent a pretreatment baseline CGA consisting of six assessment tools: activities of daily living (ADL), instrumental ADL (IADL), mood, nutritional status, comorbidities, and cognitive function. An attending physician chose each patient’s treatment but was blind to CGA results. Patients were grouped as “dependent” or “independent” according to the CGA. The primary endpoint was to evaluate the association between chemotherapy-induced grade 3–4 toxicity and CGA. Of 86 patients, 78 completed the designated CGA. The median age was 79 years (65–89). Seventy-two patients were treated with a cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP-like) regimen, and six were treated with low-toxicity regimens. Forty-one patients were classified as dependent and 37 as independent. In multivariate analysis, an impairment of IADL was independently associated with grade 3–4 leukopenia (odds ratio [OR] 0.63; 95% confidence interval [CI] 0.43–0.92, p = 0.017) and anemia (OR 0.67; 95% CI 0.50–0.90, p = 0.008). The presence of a comorbidity was also associated with grade 3–4 non-hematological toxicity (OR 2.17; 95% CI 1.37–3.43, p = 0.001). The 4-year survival rate tended to be longer in the independent (72.7%) compared to dependent (56.9%) group. Overall, a CGA may be a useful tool for predicting serious AEs associated with chemotherapy in elderly patients with DLBCL.

Retrospective analysis of outcomes and complications after Korus hemiarthroplasty in elderly patients with neck femur fractures.

Background:Femoral neck fractures (FNF) is one of the most common traumatic events in elderly patients: the choice of an appropriate treatment is necessary to decrease the related mortality and to achieve the best possible outcomes. Nowadays, it is still debated whether or not to cement the stem in hemiarthroplasty and above all, which stem to use to best respect the integrity of the elderly bone.Methods:From January 2017 to December 2019, a bi-centric study utilizing prospectively collected databases of elderly patients with FNF treated with uncemented Korus stem hemiarthroplasty was performed. Patients were preoperatively classified according to ASA score. Patients’ clinical and X-ray follow-up was at 1, 3, 6, 12 months. Harris Hip Score (HHS) was used for analyzed clinical improvement. On the X-rays, we analyzed iatrogenic fractures, osteolysis area and radiolucent lines in the stem region during follow up.Results:233 patients were identified. Median follow-up was 12 months. Over time, 51 patients died (21.88%). Mean age was 89,56 ± 6,25. 75 patients had ASA score of 2 (32.3%), 102 patients a score of 3 (43.7%), 56 an ASA score of 4 (24,0%). The main Harris hip score was 68,66 ± 8.53 at 1 month of follow-up, 71,74 ± 9.65 after 3 months, 72,50 ± 10.66 at 6 months and 75,61 ± 9.63 at 12 months control.Conclusions:Hydroxyapatite coated stem with an accurate design guarantee early fixation, good clinical and radiographic results, low rate of re-intervention and mortality rate and a satisfying return to pre-injury activities. (www.actabiomedica.it)

Chronic kidney disease and risk of postoperative cardiovascular events in elderly patients receiving hip fracture surgery

IntroductionThe long-term risk of cardiovascular events caused by chronic kidney disease (CKD) is well described in the general population. Less is known concerning the risk of postoperative cardiovascular events in geriatric hip fracture patients with CKD. MethodsThis study involved patients at least 65 years of age who received surgery for acute hip fracture between January 2000 and April 2016. We identified CKD patients with a baseline diagnosis of CKD or an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 at admission. Each CKD patient was matched, for age, gender, fracture type, and year of admission, with 4 control non-CKD patients. The primary endpoint was a compositepostoperative cardiovascular events, including pulmonary embolism, angina pectoris, myocardial infarction, heart failure, arrhythmia, stroke, and death. Conditional logistic regression was used to evaluate the association between CKD and the outcome after adjusting for potential confounders including age, gender, fracture type, body mass index, preexisting comorbidities, history of cardiovascular events, and the Charlson Comorbidity Index (CCI). ResultsThree hundred and seventy-five CKD patients were matched with 1,438 non-CKD patients. The mean age of the CKD patients was 81.9 ± 7.0 (mean ± SD), 69.9% were females, and 59.2% had an intertrochanteric fracture. Compared to non-CKD patients, CKD patients had a higher proportion of preexisting comorbidities, including hypertension, coronary heart disease, heart failure, and type 2 diabetes (all p < 0.05). The risk of postoperative cardiovascular events was 125.3 per 1000 persons (95%CI, 91.8–158.8) in CKD patients and 64.7 per 1000 persons (95%CI, 52.0–77.4) in non-CKD patients. A 1.96-fold risk of cardiovascular events after hip fracture surgery was found in CKD patients than those without CKD (adjusted OR, 1.96; 95%CI, 1.23–3.12). ConclusionPatients with CKD were more likely to have cardiovascular events after hip fracture surgery than those without CKD. Appropriate preoperative cardiovascular risk assessment and corresponding preventive and therapeutic measures should be given to this vulnerable population to mitigate such complications.

Exploration of risk factors for high‐risk adverse events in elderly patients after discharge and comparison of discharge planning screening tools

AbstractObjectivesDischarge planning is an effective strategy to prevent adverse health events and reduce medical expenditures. The high‐risk target populations of discharged elderly patients and important predictors for the occurrence of adverse events are still not clear. Therefore, the purposes of this study were to examine the validity of discharge planning screening tools in sufficiently identifying high‐risk adverse events to health after discharge and to compare two screening tools with our study model.DesignWe conducted a prospective study and recruited elderly patients who had had no hospitalization within 3 months before admission to 13 general wards of a medical center in northern Taiwan from November 2018 to May 2020.MethodsElderly patients were randomly selected during the study period. Within 24 h of admission, patients were asked to consent to join this study. After the patient was discharged, the patient's health and hospitalization for the next year were tracked by telephone interviews.ResultsIn total, 300 participants were recruited for this study. Incidences of high‐risk adverse events within 30 days, 60 days, and 12 months after discharge were 20.3%, 25.7%, and 48.7% respectively. A logistic regression showed that an increased age, physical or mental disabilities or a major illness, a low body‐mass index, and having been hospitalized in the past year were significantly related to the occurrence of high‐risk events among elderly discharge patients. The pooled sensitivity of the Pra was 52% and the specificity was 72%; the pooled sensitivity of the LACE index was 67% and the specificity was 36%. The predictive model of this study had a higher discriminatory power than the Pra and LACE index for high‐risk events after discharge.ConclusionsElderly patients are more vulnerable to high‐risk adverse events after discharge. Both the LACE index and Pra are useful discharge planning screening tools to screen for high‐risk adverse events after discharge. Elderly patients need more‐active and complete continuity of care plans and discharge planning services to ensure that the overall quality of patient care can be improved and readmissions and mortality reduced.Clinical relevanceThe findings of this study can provide information for discharge planning managers to identify high‐risk elderly patients during hospitalization and promptly offer care education or resources to improve care management.

Long-term impact of β-blocker in elderly patients without myocardial infarction after percutaneous coronary intervention.

AimsLittle is known about the long‐term outcomes of β‐blockers use in patients with coronary artery disease (CAD) without myocardial infarction (MI) and reduced ejection fraction (rEF). However, more attention should be paid to the oral administration of β‐blockers in elderly patients who are susceptible to heart failure (HF), sinus node dysfunction, or rate response insufficiency. We aimed to evaluate the long‐term impact of β‐blockers in elderly patients with CAD without MI or systolic HF who have undergone percutaneous coronary intervention.Methods and resultsA total of 1018 consecutive elderly patients with CAD (mean age, 72 ± 7 years; 77% men) who underwent their first intervention between 2010 and 2018 were included in this study. According to the presence or absence of the use of β‐blockers, 514 patients (50.5%) were allocated to the β‐blocker group, and 504 (49.5%) to the non‐β‐blocker group. We evaluated the incidence of 4‐point major adverse cardiovascular events (4P‐MACE), including cardiovascular death, non‐fatal MI, non‐fatal stroke, admission for HF, target vessel revascularization (TVR), and all‐cause death. We focused on the association between chronotropic incompetence of β‐blockers and incidence of a new HF and analysed the results using an exercise electrocardiogram regularly performed in the outpatient department after percutaneous coronary intervention. During a median follow‐up duration of 5.1 years, 83 patients (8.3%) developed 4P‐MACE, including cardiovascular death in 17, non‐fatal MI in 13, non‐fatal stroke in 25, and admission for HF in 39 patients. Additionally, 124 patients (12.2%) had a TVR and 104 (10.2%) died of other causes. Kaplan–Meier analysis showed that the cumulative incidence rate of 4P‐MACE in the β‐blocker group was significantly higher than that in the non‐β‐blocker group (15.4% vs. 10.0%, log‐rank test, P = 0.015). Above all, the cumulative incidence rate of admission for HF in the β‐blocker group was significantly higher (8.8% vs. 3.2%, log‐rank test, P < 0.001). The β‐blocker group had significantly lower resting heart rate, stress heart rate, and stress‐rest Δ heart rate on exercise electrocardiogram. Multivariate Cox hazard analysis revealed that EF, β‐blocker use, stress‐rest Δ heart rate, and CKD were strong independent predictors of admission for HF.ConclusionsLong‐term β‐blocker use was significantly associated with an increased risk of adverse cardiovascular events in elderly patients with CAD without MI or systolic HF. In particular, the chronotropic incompetence action of β‐blockers could increase the risk of admission for HF in elderly patients with CAD without MI and systolic HF, and the present findings warrant further investigation.