Prognosis Impact of Diabetes in Elderly Women and Men with Non-ST Elevation Acute Coronary Syndrome.

Few studies have addressed to date the interaction between sex and diabetes mellitus (DM) in the prognosis of elderly patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). Our aim was to address the role of DM in the prognosis of non-selected elderly patients with NSTEACS according to sex. A retrospective analysis from 11 Spanish NSTEACS registries was conducted, including patients aged ≥70 years. The primary end point was one-year all-cause mortality. A total of 7211 patients were included, 2,770 (38.4%) were women, and 39.9% had DM. Compared with the men, the women were older (79.95 ± 5.75 vs. 78.45 ± 5.43 years, p < 0.001) and more often had a history of hypertension (77% vs. 83.1%, p < 0.01). Anemia and chronic kidney disease were both more common in women. On the other hand, they less frequently had a prior history of arteriosclerotic cardiovascular disease or comorbidities such as peripheral artery disease and chronic pulmonary disease. Women showed a worse clinical profile on admission, though an invasive approach and in-hospital revascularization were both more often performed in men (p < 0.001). At a one-year follow-up, 1090 patients (15%) had died, without a difference between sexes. Male sex was an independent predictor of mortality (HR = 1.15, 95% CI 1.01 to 1.32, p = 0.035), and there was a significant interaction between sex and DM (p = 0.002). DM was strongly associated with mortality in women (HR: 1.45, 95% CI = 1.18-1.78; p < 0.001), but not in men (HR: 0.98, 95% CI = 0.84-1.14; p = 0.787). In conclusion, DM is associated with mortality in older women with NSTEACS, but not in men.

Comorbidity burden and revascularization benefit in elderly patients with acute coronary syndrome.

INTRODUCTION AND OBJECTIVES: To evaluate the interaction between comorbidity burden and the benefits of in-hospital revascularization in elderly patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). METHODS: This retrospective study included 7211 patients aged ≥ 70 years from 11 Spanish NSTEACS registries. Six comorbidities were evaluated: diabetes, peripheral artery disease, cerebrovascular disease, chronic pulmonary disease, renal failure, and anemia. A propensity score was estimated to enable an adjusted comparison of in-hospital revascularization and conservative management. The end point was 1-year all-cause mortality. RESULTS: In total, 1090 patients (15%) died. The in-hospital revascularization rate was 60%. Revascularization was associated with lower 1-year mortality; the strength of the association was unchanged by the addition of comorbidities to the model (HR, 0.61; 95%CI, 0.53-0.69; P=.0001). However, the effects of revascularization were attenuated in patients with renal failure, peripheral artery disease, and chronic pulmonary disease (P for interaction=.004, .007, and .03, respectively) but were not modified by diabetes, anemia, and previous stroke (P=.74, .51, and .28, respectively). Revascularization benefits gradually decreased as the number of comorbidities increased (from a HR of 0.48 [95%CI, 0.39-0.61] with 0 comorbidities to 0.83 [95%CI, 0.62-1.12] with ≥ 5 comorbidities; omnibus P=.016). The results were similar for the propensity score model. The same findings were obtained when invasive management was considered the exposure variable. CONCLUSIONS: In-hospital revascularization improves 1-year mortality regardless of comorbidities in elderly patients with NSTEACS. However, the revascularization benefit is progressively reduced with an increased comorbidity burden. Renal failure, peripheral artery disease, and chronic lung disease were the comorbidities with the most detrimental effects on revascularization benefits.

Paciente anciano y medicación crónica inapropiada en la comunidad ¿somos conscientes de ello? / Inappropriate prescription in the community elderly, are we aware of?

Objetivos. Analizar la prescripción según criterios de idoneidad de STOPP (Screening Tool of Older Person's Prescriptions) y de Beer's y los factores asociados en personas de 85 años. Pacientes y métodos. Estudio transversal de prescripción inadecuada a los 85 años. Se registraron: variables sociodemográficas, factores de riesgo cardiovascular, enfermedades crónicas, polifarmacia (4 o más) y valoración geriátrica. La prescripción inadecuada (PI) se valoró según prescripción total y cardiovascular. Resultados. La media de fármacos en el total de 78 sujetos fue 6,1 (3,3). El 34,6% de pacientes tenían un fármaco de PI; el 19,2% tenían dos; el 15,4% tenían tres o más, y en total, el 69,2% de pacientes presentaban algún fármaco de PI; el 37,2% tenía uno o más fármacos de PI cardiovascular. Los grupos terapéuticos responsables del total de PI fueron benzodiazepinas (BZP) 23,1%, diuréticos del asa 17,9%, inhibidores de recaptación de la serotonina (ISRR) 16,7% y los antiinflamatorios no esteroideos (AINE) representaron un 10,3% del total de criterios. El análisis bivariado halló asociación de número de fármacos y polifarmacia (p=0,030 en ambos) con PI total; no se halló significación en PI cardiovascular. El análisis multivariante mostró asociación de polifarmacia (OR: 1,22; IC 95% 1,02-1,47; p=0,031) para la PI total y de dislipemia (OR: 0,30; IC 95% 0,10-0,87; p=0,026) y de HTA (OR: 0,15; IC 95% 0,03-0,78; p=0,024) para la PI cardiovascular. Conclusiones. Más de la mitad de los pacientes de 85 años recibió una prescripción inapropiada. Dislipemia e HTA se asociaron a prescripción inapropiada cardiovascular y los grupos más frecuentes fueron BZP, diuréticos, ISRR y AINE(AU)

Objectives. To analyse the prescription according to the STOPP (Screening Tool of Older Person's Prescriptions) and Beer's suitability criteria, and associated factors in patients over 85 years-old. Patients and methods. Cross-sectional study of inappropriate prescribing to over 85 year-olds. The data recorded were: sociodemographic variables, cardiovascular risk factors, chronic illnesses, multiple medication (or polypharmacy) (4 or more) and geriatric assessment. The inappropriate prescription (IP) was evaluated according to total and cardiovascular prescription. Results. The mean number of drugs in the total of 78 subjects was 6.1 (3.3). Of the total number, 34.6% patients had 1 IP drug; 19.2% had 2; 15.4% had 3 or more, and in total 69.2% of patients had at least one IP drug, and 37.2% had 1 or more IP cardiovascular drugs. The therapeutic groups involved in the overall IP were benzodiazepines (BZP) 23.1%, loop diuretics 17.9%, selective serotonin reuptake inhibitors (SSRIs) 16.7%, and non-steroidal anti-inflammatory drugs (NSAIDs) made up 10.3% of the total criteria. The bivariate analyse found a relationship between the number of drugs and multiple medication (P=.030 in both) and total IP, with no significance found in cardiovascular IP. The multivariate analysis showed an association between multiple medication (OR: 1.22; 95% CI: 1.02-1.47; P=.031) and total IP, and dyslipaemia (OR: 0.30; 95% CI: 0.10-0.87; P=.026) and AHT (OR: 0.15; 95% CI: 0.03-0.78; P=.024) for cardiovascular IP. Conclusions. More than half the over 85 year-old patients received an inappropriate prescription. Dyslipaemia and AHT are associated with an inappropriate cardiovascular prescription, and the most frequent drug groups were, BZP, diuretics, SSRIs, and NSAIDs(AU)