Health status and clinical outcomes in older adults with chronic coronary disease: the ISCHEMIA trial
J. Am. Coll. Cardiol
; 81(17): 1697-1709, May 2023. ilus
Artigo
em Inglês
| CONASS, Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP
| ID: biblio-1437676
Biblioteca responsável:
BR79.1
ABSTRACT
BACKGROUND:
Whether initial invasive management in older vs younger adults with chronic coronary disease and moderate or severe ischemia improves health status or clinical outcomes is unknown.OBJECTIVES:
The goal of this study was to examine the impact of age on health status and clinical outcomes with invasive vs conservative management in the ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial.METHODS:
One-year angina-specific health status was assessed with the 7-item Seattle Angina Questionnaire (SAQ) (score range 0-100; higher scores indicate better health status). Cox proportional hazards models estimated the treatment effect of invasive vs conservative management as a function of age on the composite clinical outcome of cardiovascular death, myocardial infarction, or hospitalization for resuscitated cardiac arrest, unstable angina, or heart failure.RESULTS:
Among 4,617 participants, 2,239 (48.5%) were aged <65 years, 1,713 (37.1%) were aged 65 to 74 years, and 665 (14.4%) were aged ≥75 years. Baseline SAQ summary scores were lower in participants aged <65 years. Fully adjusted differences in 1-year SAQ summary scores (invasive minus conservative) were 4.90 (95% CI 3.56-6.24) at age 55 years, 3.48 (95% CI 2.40-4.57) at age 65 years, and 2.13 (95% CI 0.75-3.51) at age 75 years (Pinteraction = 0.008). Improvement in SAQ Angina Frequency was less dependent on age (Pinteraction = 0.08). There were no age differences between invasive vs conservative management on the composite clinical outcome (Pinteraction = 0.29).CONCLUSIONS:
Older patients with chronic coronary disease and moderate or severe ischemia had consistent improvement in angina frequency but less improvement in angina-related health status with invasive management compared with younger patients. Invasive management was not associated with improved clinical outcomes in older or younger patients. (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches [ISCHEMIA]; NCT01471522).
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Coleções:
Bases de dados nacionais
/
Brasil
Base de dados:
CONASS
/
Sec. Est. Saúde SP
/
SESSP-IDPCPROD
Assunto principal:
Qualidade de Vida
/
Doença da Artéria Coronariana
Tipo de estudo:
Estudo prognóstico
Aspecto:
Preferência do paciente
Limite:
Idoso
Idioma:
Inglês
Revista:
J. Am. Coll. Cardiol
Ano de publicação:
2023
Tipo de documento:
Artigo
Instituição/País de afiliação:
Department of Cardiology, Ospedali Riuniti Ancona/IT
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Department of Cardiology, Swiss Cardiovascular Centre, University Hospital Inselspital/CH
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Department of Medical Sciences, Cardiology, Uppsala University, Uppsala Clinical Research Center/SE
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Department of Medicine, Northwick Park Hospital-Royal Brompton Hospital/GB
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Department of Medicine, Stanford University/US
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Duke Clnical Research Institute/US
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Dél-pesti Centrumkóház Hospital, National Institute of Hematology and Infectious Disease, Cardiovascular Department/HU
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Green Lane Cardiovascular Services, Auckland City Hospital, University of Auckland/NZ
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Instituto Dante Pazzanese de Cardiologia/BR
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London Health Sciences Centre/CA