Non-elderly Patients Research Articles

Nitroglycerin use and adverse clinical outcomes in elderly patients with acute coronary syndrome

ObjectiveThe primary care for acute coronary syndrome (ACS) includes the administration of nitroglycerin (GTN). This study aimed to investigate the association between the use of GTN before percutaneous coronary intervention...

Characteristics of proton pump inhibitor-resistant severe reflux esophagitis and efficacy of vonoprazan in elderly (older than 75 years) and non-elderly groups.

Previous studies on age differences in proton pump inhibitor (PPI)-resistant reflux esophagitis (RE) have found that stenosis and bleeding complications were significantly more common in the elderly than in the non-elderly. We sought to examine differences between two groups of elderly (75 years or older) and non-elderly (<75 years) patients with (PPI)-resistant severe RE and also the efficacy of vonoprazan (VPZ) in these patients. There were 14 patients in the elderly group and 15 in the non-elderly group. Information was obtained on patient background (sex, body mass index [BMI], gastric mucosal atrophy, and the presence of hernia and collagen disease), and all patients underwent the saliva secretion test and esophagogastroduodenoscopy (EGD). The saliva secretion test (amount of saliva secreted, salivary pH, and the acid-buffering capacity) was performed by chewing sugar-free gum for 3 min before EGD. The efficacy of VPZ in both groups was also assessed. Saliva secretion, sex, BMI, and the presence of gastric mucosal atrophy did not significantly differ between the two groups. The number of hernias larger than 4 cm was significantly higher in the elderly PPI-resistant group, and significantly more patients had collagen disease in the non-elderly group. The efficacy of VPZ was not significantly different between the two groups; however, 10 patients in the non-elderly group had collagen disease, and 4 did not achieve esophageal mucosal healing even with VPZ 20 mg. The number of large hernias (>4 cm) was significantly higher in the elderly group, while significantly more non-elderly patients had collagen disease. In the non-elderly group with scleroderma, the efficacy of VPZ 20 mg may not be sufficient.

Outcomes of Extended Middle Fossa Approach for Petroclival Tumors in the Elderly.

Objective The aims of the study are (1) to evaluate the extended middle fossa approach (eMCF) for resection of tumors in the petroclivus and anterior cerebellopontine angle (CPA) and (2) to compare surgical outcomes between elderly (≥65 years) and nonelderly patients. Design Retrospective cohort. Setting Tertiary referral center. Participants Adults with petroclival, anterior CPA, or posterior fossa lesions who underwent an eMCF approach from 2012 to 2021 were included in the study. Main Outcome Measure Demographics, symptoms, cranial nerve (CN) function, and postoperative outcomes. Results Twenty-nine patients (mean age of 55 years, 59% females) were identified. Eleven (38%) were ≥65 years (65-79 years). The most common pathology was meningioma ( n = 13, 45%), followed by vestibular schwannoma ( n = 4, 14%) and squamous cell carcinoma ( n = 3, 10%). Nineteen tumors (65.5%) were located in the petroclivus, 7 (24%) involved the cavernous sinus, and 10 (34%) were located in the posterior fossa. The mean tumor maximal diameter was 3.4 cm (range: 1.3-7.9 cm). Gross total tumor resection was accomplished in 15 (52%) patients. Most patients ( n = 23, 79%) did not develop new CN deficits postoperatively. Of the 13 patients who had complete pre- and postoperative audiometric data, 69% ( n = 9) maintained their hearing. Comparing the elderly versus nonelderly patients, there were no significant differences in the development of new CN palsies ( p = 0.14), length of stay ( p = 0.91), or incidence of postoperative complications ( p = 0.30). Conclusions The eMCF approach provides exposure to the petroclival region, anterior CPA cistern, and posterior fossa for a variety of pathologies. It has a favorable safety profile in the elderly (≥65 years) population with low morbidity.

The efficacy of immune checkpoint inhibitors is limited in elderly NSCLC: a retrospective efficacy study and meta-analysis.

Immune checkpoint inhibitors (ICIs) have improved the long-term survival of NSCLC patients. However, the efficacy of ICIs in elderly NSCLC patients remains controversial. We conducted a retrospective study and meta-analysis exploring the efficacy of ICIs in those patients using public databases and RCTs. NSCLC patients were identified into elderly and non-elderly groups by age 75 years. The retrospective study showed significant differences in OS and PFS between non-elderly and elderly patients treated with ICIs (P= 0.029 and 0.027), with reduced efficacy in elderly NSCLC patients. ECOG PS also negatively affected OS in elderly NSCLC patients (P= 0.007). In meta-analysis, the HR for OS in the non-elderly and elderly groups were 0.74 and 0.90, respectively, and the difference between the two age groups was statistically significant (P= 0.025). ICIs resulted in a lower incidence of all-grade (OR= 0.47) and high-grade TRAEs (OR= 0.38) than chemotherapy. Our findings revealed that the survival benefit of ICIs in elderly patients (≥ 75 years) may be lower than in non-elderly patients. In addition, the incidence of TRAEs induced by ICIs was lower than chemotherapy.

The Comparison of Clinical Outcomes in Elderly (≥75 Years) and Non-Elderly (

Background and Objectives: Acute cholangitis may be fatal, particularly in elderly patients. According to the Tokyo Guidelines 2018, those aged ≥75 years are classified as moderate (Grade II) severity. However, it has not been established whether age itself is the deciding factor of poor outcomes. We studied the impact of old age (≥75 years) on the mortality and morbidity of acute cholangitis due to choledocholithiasis. Materials and Methods: We retrospectively examined 260 patients with calculous acute cholangitis who had undergone biliary drainage. Patients were divided into two groups: elderly (≥75 years) and non-elderly (<75 years). We aimed to compare organ dysfunction, in-hospital mortality, intensive care unit (ICU) hospitalization, and the severity of acute cholangitis. Results: Of 260 patients, 134 (51.5%) were in the elderly group and 126 (48.5%) were in the non-elderly group. The mean age was 72.3 ± 14.4 years, and 152 (58.5%) were men. The elderly patients showed a higher incidence of shock (12.7% vs. 4.8%, p = 0.029), respiratory dysfunction (7.5% vs. 0%, p = 0.002), and renal dysfunction (8.2% vs. 0.8%, p = 0.006) than the non-elderly patients. The overall in-hospital mortality rate was 2.7%, with no significant differences between the elderly and the non-elderly (4.5% vs. 0.8%, p = 0.121). The incidence of severe acute cholangitis was significantly higher in the elderly group (26.9% vs. 9.5%, p < 0.001). However, there was no significant difference in the rates of ICU hospitalization (9.7% vs. 4%, p = 0.088) and lengths of hospital stay (LOS) (8.3 d vs. 7.1 d, p = 0.086). Conclusions: No difference was observed in the in-hospital mortality, ICU hospitalization, or LOS between the elderly (≥75 years) and the non-elderly (<75 years) with calculous acute cholangitis. However, severe acute cholangitis was significantly more frequent in elderly patients.

Safety and Feasibility of Gastrectomy in Super Elderly Patients (Aged ≥ 80): A Propensity Score-Matched Analysis.

The benefits of gastrectomy in elderly patients with gastric cancer (GC) remain unknown. This study was conducted to evaluate the short- and long-term outcomes of elderly patients with GC (≥ 80 years) who underwent gastrectomy. We enrolled 479 patients (Stages I-IV) who underwent gastrectomy with R0-1 resection. The patients were divided into an elderly group (E group; age ≥ 80 years) (n = 115) and a non-elderly group (NE group; age < 80 years) (n = 364). After propensity score matching (PSM) was performed, the short- and long-term outcomes were compared between the groups. The rate of postoperative complications (Clavien-Dindo classification ≥ IIIa) in the two groups did not differ significantly (p = 0.657). Before PSM, the five-year overall survival (OS, 35.3% vs. 71.7%, p < 0.001) and disease-specific survival (DSS, 56.8% vs. 81.8%, p < 0.001) in the E group were significantly shorter than that in the NE group, respectively. On the other hand, significant differences between the E and NE groups were not shown in either the five-year OS (35.5% vs. 50.8%, p = 0.0985) or the five-year DSS (56.5% vs. 66.9%, p = 0.274) after PSM. Gastrectomy for elderly patients with GC can be considered safe based on short-term outcomes. In terms of long-term results, elderly patients are not inferior to non-elderly patients if the patients' backgrounds are the same. On the other hand, the long-term outcomes of elderly GC patients who have various comorbidities are not satisfactory, so we should carefully consider the indications for gastrectomy.

Platelet-to-lymphocyte ratio and serum hsCRP levels in third trimester and adverse pregnancy outcomes in women with gestational diabetes mellitus

Gestational diabetes mellitus (GDM) is a major complication of pregnancy. GDM is associated with a higher risk of adverse pregnancy outcomes (APO). The purpose of this study was to assess the association between third-trimester platelet to lymphocyte ratio (PLR) and high-sensitivity C-reactive protein (hsCRP) concentration and the risk of APO in GDM pregnant women. This study selected 406 non-elderly gestational diabetes patients diagnosed in the Renmin Hospital of Wuhan University from May 2021 to February 2023 as the research objects. According to the presence or absence of APO, they were divided into an APO group (n = 171) and a non-APO group (n = 235). Logistic regression model to evaluate the correlation between PLR and hsCRP and APO in women with GDM; Restricted cubic spline analyses was used to explore nonlinear correlations between PLR or hsCRP and the risk of APO; ROC curve analysis of the diagnostic performance of PLR and hsCRP for APO in women with GDM. APO occurred in 171 of the 406 included participants. Compared with the non-APO group, patients in the APO group had higher PLR and hsCRP levels. The incidence of APO was positively associated with PLR and the hsCRP level in each logistic regression model (P < 0.05). After adjusting for all the risk factors included in this study, restricted cubic spline analyses found that the PLR and the hsCRP level were positively associated with the risk of APO. The levels of PLR and hsCRP in the third trimester are related to the occurrence of APO in women with GDM, and high levels of PLR and hsCRP may indicate the occurrence of APO.

Analysis of Uveal Melanoma 5-Year Survival Rates by Medicaid Status: A Nationwide Analysis

ABSTRACT Purpose The survival outcomes of patients with primary uveal melanomas based on Medicaid status have not been previously discussed in the literature. Methods The Surveillance, Epidemiology, and End Results Medicaid database were utilized to identify patients with primary uveal melanomas diagnosed between 2006 and 2013. The Kaplan–Meier method was utilized to construct 5-year survival curves in adult, non-elderly patients. Log-rank testing was used to determine differences in survival rates, and multivariate Cox proportional hazards modeling was utilized to perform adjusted survival analysis. Results A total of 1,765 patients were included (Medicaid: 81, non-Medicaid: 1684). A total of 1683 (95.4%) were White. The average age was 51.75 years (SD = 9.5 years). Medicaid patients were more likely to be unmarried, live in a high poverty neighborhood, and live in a rural area (all p < .001). We observed no significant difference in 5-year survival rates between those enrolled in Medicaid (86.6%, 95% CI: 79.1%1–94.7%) and those not enrolled in Medicaid (85.5, 95% CI: 83.8%–87.2%) (p = .80). After controlling for socioeconomic and clinical factors, Medicaid enrollment was not associated with an increased risk of mortality compared to non-Medicaid enrollment. Age (aHR: 1.04, 95% CI: 1.02–1.06, p < .001) and tumor size >10 mm (aHR: 3.04, 95% CI: 1.49–6.21, p = .002) were associated with an increased risk of mortality. Conclusion Medicaid enrollment was not associated with worse cancer-specific 5-year survival. Further research needs to be elicited to better understand the role of Medicaid enrollment in patients with primary uveal melanoma.

Safety of Tailored Transfemoral Carotid Artery Stenting for Symptomatic Elderly Patients: A Single Center Observational Study

Transfemoral carotid artery stenting (TFCAS) in symptomatic elderly patients (≥70 years old) may have a high periprocedural stroke rate. This study was performed to examine whether tailored TFCAS for symptomatic elderly patients is as safe as that for symptomatic nonelderly patients. The subjects were 185 patients with symptomatic internal carotid artery stenosis. Tailored TFCAS including postoperative management was performed based on preoperative examinations of vascular anatomy, plaque imaging, platelet aggregation activity, and cerebral hemodynamic impairment. The major 30-day perioperative stroke rates were examined. The patients included 51 (27.6%) <70 (group Y) and 134 (72.4%) ≥70 (group E) years old. Group E included significantly more cases with an elongated aortic arch, tortuous target lesion, and longer plaques (all P < 0.05). Among all cases, 181 (97.8%) procedures were performed as per preoperative planning. Group E had more frequent use of a proximal embolic protection device and a closed-cell or dual-layer micromesh stent (all P < 0.05). Seven patients (3.8%) had major stroke. Rates of major ischemic stroke (2.0% vs. 3.0%, P= 1.00) and intracranial hemorrhage (2.0% vs. 0.8%, P= 0.48) were low and did not differ significantly between groups Y and E. Symptomatic elderly patients have several unfavorable factors. However, tailored TFCAS for each patient based on preoperative examinations in symptomatic elderly patients may be as safe as that in symptomatic nonelderly patients.

Comparative study of diabetic ketoacidosis in the elderly and non-elderly patients: A nine-year experience from an academic hospital in North India

Background and aimsDespite an increasing prevalence of the aged population with diabetes in low-middle-income countries, there is limited literature on geriatric hyperglycemic emergencies. The present study aimed to compare the spectrum and outcomes of diabetic ketoacidosis (DKA) between elderly and non-elderly adult patients in India. MethodsSeventy-seven elderly patients (≥60 years) were compared to 477 non-elderly patients (13–59 years) with DKA admitted to the medical emergency, Postgraduate Institute of Medical Education and Research, Chandigarh, India, between January 2014 and December 2022. Clinical features, laboratory parameters, precipitating factors, and in-hospital outcomes were reviewed. ResultsElderly patients less commonly had vomiting and abdominal pain than non-elderly patients (31.3 % vs. 66.2 %, 27.3 % vs. 60.1 %, respectively) and typically presented with dyspnea (48.5 %), altered mental status (47.8 %), and fever (46.3 %). Ketonemia and metabolic acidosis were significantly more marked in non-elderly patients, whereas elderly patients frequently had anemia, hypoalbuminemia, and renal dysfunction. The most common precipitations of geriatric DKA were infections (70.1 %), followed by treatment non-adherence (66.2 %) and non-infectious disorders (35.1 %). Infections and non-infectious disorders were significantly more frequent in elderly patients than in non-elderly patients. Respiratory and urinary tract infections were prevalent in both age groups.In-hospital survival was 74.9 % (n = 415) and remained lower in older patients (48.1 % vs. 79.2 %, P-value <0.001). The independent prognostic factors were age (OR 1.030, 95 % CI 1.006–1.054, P = 0.014), Glasgow coma scale (OR 0.789, 95 % CI 0.717–0.869, P <0.001), and infection trigger (OR 6.635, 95 % CI 2.852–15.441, P <0.001). ConclusionOlder patients with DKA present atypically, frequently have precipitation with infections and noninfectious disorders, and have poor outcomes.

Comparison in efficacy of catheter ablation for elderly versus non-elderly patients with persistent atrial fibrillation

Abstract Background/Introduction Atrial fibrillation (AF) is common arrythmia among elderly patients. Advancing age is reportedly associated with left atrium (LA) fibrosis and remodeling. We hypothesized that an extensive ablation strategy in addition to pulmonary vein isolation (PVI-plus) might be effective for elderly patients, whereas the PVI alone strategy (PVI-alone) might be sufficient for young patients to maintain sinus rhythm. Purpose We investigated the efficacy of ablation strategy (PVI-alone or PVI-plus) for AF patients stratified by age. Methods This study is a post-hoc analysis of the EARNEST-PVI trial. The EARNEST-PVI trial was a prospective, multicenter, randomized, and open-label non-inferiority trial comparing PVI-alone vs PVI-plus in patients with persistent AF. The primary endpoint was recurrence of AF. Results A total of 497 patients were eligible and divided into two groups (elderly group (age≥65, n=291) or young group (age&amp;lt;65, n=206)). In elderly group, the event rate was significantly lower in the PVI-plus group than in the PVI-alone group (Hazard ratio (HR): 0.587, 95% confidence interval (CI): 0.406 – 0.849, P = 0.0047), while the event rate was similar between both groups in young group (HR: 1.101, 95%CI: 0.687 - 1.77, P = 0.692) (P for interaction: 0.0411). Conclusion In elderly patients, PVI-plus strategy was more effective than PVI-alone, whereas the PVI alone strategy was sufficient for young patients.

Abstract 146: Advanced Age and Neurological Recovery in Elderly Patients With Out-of-Hospital Cardiac Arrest Treated With Targeted Temperature Management: A Nationwide Population-Based Registry Study

Objectives: The chance of neurological recovery after out-of-hospital cardiac arrest (OHCA) can be influenced by advanced age, however further recent evidence will be need in elderly population. The purpose of this study is to evaluate the impact of advanced age on the neurological recovery in elderly OHCA survivors treated with targeted temperature management (TTM). Methods: This retrospective observational study, using a nationwide population-based OHCA registry, was conducted from January 2016 to December 2020. Non-traumatic elderly (≥ 65 years) comatose OHCA survivors treated with TTM were enrolled. The elderly patients were divided into four groups (65-69 years, 70-74 years, 75-79 years, and ≥ 80 years). The primary outcome was good neurological outcome, defined as Cerebral Performance Categories (CPC) of 1 or 2 at hospital discharge. Results: Among 23,336 OHCA patients who admitted to the hospital, 3,398 patients treated with TTM. Excluding 2,033 non-elderly patients, 1,365 patients were analyzed. In four elderly group, the rate of good neurological outcomes were decreased by advanced age (24.2%, 16.1%, 11.4%, and 5.9%). This was also observed after subgroup analysis based on the initial shockable (40.6%, 31.5%, 28.6%, and 14.9%) and non-shockable rhythm (10.6%, 7.2%, 4.1%, and 3.4%). Multivariate analysis showed the adjusted odds ratio (aOR) for good neurological outcome decreased as advanced age (65-69 years: reference, 70-74 years: aOR 0.70, 75-79 years: aOR 0.49, and ≥ 80: aOR 0.25). The optimal age cutoffs for good outcome in elderly OHCA survivors with shockable and non-shockable rhythm were 77 years and 72 years respectively. Conclusions: The neurologic recovery rate in OHCA survivors treated with TTM was gradually decreased with advanced age. However even with ≥ 80 years with shockable rhythm, had a good neurologic outcome of 14.9%, which is higher than 65-69 years of 10.6% in non-shockable rhythm.

Abstract 12037: Impact of Age on Hospital Outcomes After Catheter Ablation for Ventricular Tachycardia

Background: Catheter ablation for ventricular tachycardia (VT) has been increasingly performed over the past decades. However, the real-world data on the safety profile of this procedure among elderly patients is limited. Objective: This study aimed to evaluate the procedural outcomes and 30-day readmission among those aged 18-64 years versus those aged ≥65 years who underwent catheter ablation of VT. Method: Using the all-payer, nationally representative Nationwide Readmissions Database, our study included patients aged 18 years or older who underwent VT catheter ablation between 2017 and 2020. We divided the patients into non-elderly (18-64 years old) and elderly age groups (≥65 years old). We then analyzed the in-hospital procedural outcome and 30-day readmission between these groups. Results: Our study included 2075 (49.1%) non-elderly patients and 2153 (50.9%) elderly patients who underwent VT ablation. Following the procedure, elderly patients had significantly higher rates of prolonged index hospitalization (≥7 days) (35.5% vs 29.3%, p&lt;0.01), non-home discharge (13.4% vs 6.0%, p&lt;0.01), 30-day readmission (17.0% vs 11.4%, p&lt;0.01), and early mortality (5.5% v 2.4%, p&lt;0.01). The median cumulative cost of hospitalization was significantly higher in the elder groups ($40,230 vs. $37,612, p ≤0.01). There was no significant difference in the procedural complications between the two groups. Through multivariable analysis, the elderly group was associated with significantly higher odds of early mortality (OR: 7.50; CI 1.86 - 30.31, p=0.01), non-home discharge (OR: 2.41; CI: 1.93 - 3.00, p&lt;0.01) and 30-day readmissions (OR: 1.58; CI 1.32 - 1.89, p&lt;0.01). Conclusion: Our study suggests that elderly patients have poorer in-hospital outcome in early mortality, non-home discharge and 30-day readmissions following catheter ablation for VT. There was no significant difference between elderly and non-elderly groups in the procedural complications.

Frailty assessment by two screening instruments in non-elderly patients with head and neck cancer

PurposeFrailty assessment is often overlooked in non-elderly patients with cancer, possibly due to the lack of an effective frailty screening tool. This study aimed to evaluate the performance of two modern frailty screening tools, the Flemish version of the Triage Risk Screening Tool (fTRST) and the modified 5-Item Frailty Index (mFI-5), compared to the gold standard comprehensive geriatric assessment (GA) among non-elderly patients with head and neck cancer (HNC). MethodsWe prospectively included 354 consecutive patients aged < 65 years with newly diagnosed HNC scheduled for definitive concurrent chemoradiotherapy (CCRT) at three academic hospitals in Taiwan between January 2020 and December 2022. Frailty assessment using the GA, fTRST, and mFI-5 was performed in all patients to evaluate the relationship between frailty and treatment outcomes. ResultsThe prevalence of frailty was 27.1%, 37.0%, and 42.4% based on GA, mFI-5, and fTRST, respectively. mFI-5 and fTRST demonstrated good predictive value in identifying frail patients compared to the GA. Patients with frailty, as defined by GA, mFI-5, and fTRST, exhibited higher risks of treatment-related complications, incomplete treatment, and poorer baseline quality of life (QoL). However, only GA showed significant prognostic value for overall survival. ConclusionsFrailty assessment using fTRST and mFI-5 is valuable for predicting treatment-related adverse events, treatment tolerance, and QoL in non-elderly patients with HNC. Incorporating frailty assessment into the management of non-elderly cancer patients can aid in the identification of high-risk individuals. However, the performance of these tools varies, highlighting the need for further validation and refinement.

P31-9 A retrospective study of elderly and non-elderly patients with metastatic pancreatic cancer treated with GEM+nab-PTX therapy

P31-9 A retrospective study of elderly and non-elderly patients with metastatic pancreatic cancer treated with GEM+nab-PTX therapy

The real-life treatments and surgeons' opinions on aortic valve diseases in non-elderly patients.

The real-life treatments and surgeons' opinions on aortic valve diseases in non-elderly patients.

BRCA testing in patients with breast cancer with Medicaid vs. commercial insurance.

148 Background: Systemic therapies targeting breast cancers associated with germline BRCA1/2 mutations (gBRCAm) have been available since 2018, approved first for locally advanced or metastatic HER-2 negative disease and more recently for use in the adjuvant setting. Prior studies have found substantial underuse of BRCA testing in breast cancer patients and disparities by socioeconomic factors. We compared rates of BRCA testing in non-elderly breast cancer patients with Medicaid vs. commercial insurance. Methods: We used the Clarivate Real-World Data Product (Clarivate RWD), a database of open claims from clearinghouses. The database links medical and pharmacy claims from ≥98% of commercial and government health insurance plans and covers 300 million lives. We identified adults ages 18-64 with commercial insurance or Medicaid with claims for breast cancer diagnosis and treatment in 2016-2021. The primary outcome was receipt of a BRCA test within 6 months after the first breast cancer (index) claim. We compared the proportion who received a BRCA test in Medicaid vs. commercial insurance. In multivariable logistic regression we estimated the impact of insurance type on receipt of a BRCA test, controlling for demographic and health characteristics. We also examined trends over time. Results: We identified 147,050 patients with commercial insurance and 41,259 with Medicaid who met inclusion criteria. The cohort was 99% female, 65% were age 50-64, 35% lived in the South, 11% had diagnosis codes for metastatic disease, and 61% had an Elixhauser comorbidity score of 0. Compared to those with commercial insurance, patients with Medicaid were younger, less likely to live in the South, more likely to have metastatic disease and have comorbid conditions. Medicaid beneficiaries were more likely to receive a BRCA test within 6 months of index claim than commercially insured patients (16.8% vs. 11.7%), with an adjusted odds ratio of 1.41 (95% CI 1.36-1.46). Receipt of a BRCA test was also more likely in patients who were male; younger; lived in the Northeast, Midwest or West; had metastatic disease or greater comorbidity. In analysis stratified by presumed stage, the advantage of Medicaid coverage was statistically significant only in patients with metastatic disease. While the proportion of all patients who received a BRCA test increased substantially in both groups beginning in 2019, it grew at a much greater rate among those with Medicaid, exceeding 20% in those patients by late 2021. Conclusions: In this analysis of health insurance claims, breast cancer patients with Medicaid were more likely to receive a BRCA test than their peers with commercial insurance, and this difference was driven by testing rates in those with presumed metastatic disease. Expanding testing in both groups could facilitate access to effective therapies for both metastatic and non-metastatic breast cancers associated with gBRCAm, thereby improving health outcomes.

352TiP Randomized phase III study of daratumumab (D) versus bortezomib plus D as a maintenance therapy after D-MPB for elderly or non-elderly patients refusing transplant with untreated multiple myeloma (JCOG1911, B-DASH study)

352TiP Randomized phase III study of daratumumab (D) versus bortezomib plus D as a maintenance therapy after D-MPB for elderly or non-elderly patients refusing transplant with untreated multiple myeloma (JCOG1911, B-DASH study)

Retrospective cohort study: Effect of age as a barrier to diagnosis of eosinophilic oesophagitis.

Prior work suggests eosinophilic oesophagitis (EoE) is rare in those aged over 65 years. However, elderly patients with EoE experience a substantial diagnostic delay from symptom onset to diagnosis. To assess if age predicted whether oesophageal biopsies were obtained in patients with EoE symptoms, what clinical features predict EoE in the elderly, and if EoE phenotype differs between elderly and non-elderly patients. We conducted a retrospective cohort study utilising the University of North Carolina (UNC)electronic medical record, EoE clinicopathologic database and UNC endoscopy software from July 2008 to April 2021. A sample of 193 elderly and non-elderly patients with dysphagia, chest pain and/or heartburn were assembled. Patients with EoE were newly diagnosed per contemporaneous guidelines. Patient demographics, clinical characteristics and procedural data were extracted. Summary statistics, bivariate and multivariate analyses were performed. Of 193 patients, we included 91 elderly (47%) and 102 non-elderly (53%). Age independently predicted the odds of biopsies (adjusted odds ratio (aOR): 0.44 elderly vs. non-elderly; 95% CI: 0.21-0.92). Endoscopic features of EoE, but not symptoms, were more common in elderly than non-EoE elderly patients. Elderly patients with EoE differed from non-elderly only by time to diagnosis (aOR per year of symptoms preceding diagnosis: 1.08, 95% CI: 1.04-1.11). Elderly patients with EoE have <50% the odds of oesophageal biopsies. There were no significant differences between elderly and non-elderly EoE patients, although endoscopic features helped discriminate the two groups. Our findings suggest that older age represents a barrier to EoE diagnosis.

Catheter ablation of atrial fibrillation in elderly and very elderly patients: safety, outcomes, and quality of life.

Atrial fibrillation (AF) risk increases with age. We aim to assess the efficacy and safety of catheter ablation in the older population. All patients undergoing AF ablation (2013-2021) at our institution were enrolled in a prospectively maintained registry. The primary endpoint was AF recurrence. Patients were divided into 3 groups: non-elderly (< 65 years), elderly (65-75 years), and very elderly (> 75 years). Patient surveys at baseline and during follow-up were used to calculatequality of life (QoL)metrics: the AF severity score as well as the AF burden. A total of 7020 patients were included (42% non-elderly, 42% elderly, and 16% very elderly). Periprocedural major complications were low (< 1.5%) and similar in all groups besides pericardial effusion which was more frequent with older age and similar between the elderly and very elderly. At 3 years, AF recurrence for persistent AF (PersAF) was highest in the very elderly group (48%), followed by the elderly group (42%), and was the lowest in the non-elderly group (36%). In paroxysmal AF (PAF), there was no difference in AF recurrence between the elderly and non-elderly, while the very elderly remained associated with a significantly increased risk. Multivariable Cox analysis confirmed these findings (PersAF; elderly: HR = 1.23, P = 0.003; very elderly: HR = 1.44, P < 0.001) (PAF; elderly: HR = 1.04, P = 0.62; very elderly: HR = 1.30, P = 0.01). Catheter ablation resulted in a significant improvement in quality of life, irrespective of age group. Catheter ablation in elderly and very elderly patients is safe, efficacious, and associated with QoL benefits. Overall, major complications were minimal and did not differ significantly between age groups, with the exception of pericardial effusions which were higher in the elderly and very elderly compared to non-elderly adults. Very elderly patients had a higher rate of AF recurrence when compared with elderly or non-elderly patients. Nevertheless, ablation resulted in a remarkable improvement in QoL and a reduction of AF burden and AF symptoms with a similar magnitude, irrespective of age.