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Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit
Published on: September 30, 2020
[Acute coronary syndrome in elderly patients: experience of Aix-en-Provence General Hospital]
H Khachab1, Y Rahal, L Boulain
1Service de cardiologie, centre hospitalier d'Aix-en-Provence, avenue des Tamaris, 13616 Aix-en-Provence cedex 1, France.
Insights
Elderly patients with acute coronary syndromes (ACS) present unique challenges due to atypical symptoms and comorbidities. Treatment should align with evidence-based guidelines for all age groups, with improved radial access noted.
Area of Science:
- Geriatric Cardiology
- Acute Coronary Syndromes (ACS)
- Clinical Practice Evaluation
Background:
- Cardiovascular diseases are the leading cause of mortality in the elderly population.
- Elderly patients are underrepresented in clinical trials for acute coronary syndromes (ACS).
- Specific considerations are necessary for managing ACS in older individuals.
Purpose of the Study:
- To investigate the specific clinical characteristics and management of acute coronary syndromes (ACS) in patients over 75 years old.
- To compare treatment strategies and outcomes between two time periods (2010 and 2012) in elderly ACS patients.
- To evaluate and identify areas for improvement in the clinical practice for elderly ACS patients.
Main Methods:
- Retrospective study comparing two groups of patients aged over 75 admitted for ACS.
- Group A: First six months of 2010; Group B: First six months of 2012.
- Analysis of clinical presentation, comorbidities, and treatment strategies including revascularization, stent use, and access site.
Main Results:
- No significant difference in initial presentation (chest pain) or comorbidities (renal insufficiency, anemia) between groups.
- Invasive strategy and Drug-Eluting Stent use remained similar; however, radial access significantly increased in Group B (P=0.02).
- Unfractionated heparin use decreased slightly in Group B.
Conclusions:
- Elderly ACS patients often present atypically and have comorbidities, increasing risks. Treatment should follow evidence-based guidelines.
- A positive trend was observed in radial access utilization, indicating improved practice.
- Further improvements needed in systematic invasive strategies and the use of low molecular weight heparin and Fondaparinux.
Introduction:
Cardiovascular causes are the first causes of death in elderly patients. Nevertheless, elderly patients are underrepresented in randomized studies of acute coronary syndromes although treatment of ACS for elderly patients has specificities that need special attention.
Methods And Results:
To discuss these specificities, we realized a retrospective study involving patients aged more than 75years old and admitted for ACS in the cardiology department of Aix-en-Provence General Hospital in the first six months of 2010 (Group A) and 2012 (Group B) which we compared. Initial presentation was chest pain in only 78.6% of Group A versus 81.6% in Group B (NS), renal insufficiency was found in 41.4% of the patients of Group A versus 50.5% of the patients in Group B (NS), anaemia was found in 34.3% of Group A patients versus 40.2% of Group B (NS), invasive strategy is less systematic with 74.2% of Group A patients having a revascularization versus 73.6% of Group B (NS), Drug Eluting Stents were less frequently used with 14.3% of Group A patients versus 14.7% of Group B (NS), radial access was used for angioplasty in 61.2% of Group A patients versus 80.2% of Group B (P=0.02), unfractioned heparin was used in 74.3% of the cases in Group A versus 68% in Group B (NS).
Discussion And Conclusion:
Acute coronary syndrome of the elderly patients has numerous specificities, first there are frequent unusual presentation making diagnosis more difficult, second they have frequent co morbidities making them frail patients with higher risk of hemorrhagic complications and lesser tendency to invasive evidence based treatment. In the absence of specific recommendations, their treatment should not differ from younger patients. This work allowed us also to evaluate our professional practices in order to improve them; we note a positive evolution with the significant raise in the use of radial access, invasive strategy though should be more systematic and use of low molecular weight heparin and Fondaparinux should be more frequent.
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