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The relationship between Elder Risk Assessment (ERA) scores and cardiac revascularization: a cohort study in Olmsted
Saurabh Sharma1, Shruti Datta, Shahyar Gharacholou
1Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Insights
A higher Elder Risk Assessment (ERA) score in older adults is linked to increased use of coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI). High ERA scores also predict higher mortality risk following these cardiovascular procedures.
Area of Science:
- Cardiology
- Geriatrics
- Health Services Research
Background:
- The aging population faces increased cardiovascular disease risk.
- The Elder Risk Assessment (ERA) Index is a tool to predict healthcare utilization in older adults.
Purpose of the Study:
- To investigate the association between higher Elder Risk Assessment (ERA) scores and the utilization of coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) in adults over 60.
- To evaluate the predictive value of ERA scores for cardiovascular intervention outcomes and mortality.
Main Methods:
- Retrospective cohort study of community-dwelling individuals aged 60+.
- Primary outcome: CABG or PCI within 2 years. Secondary outcome: 5-year mortality.
- Logistic regression and time-to-event analysis were used to assess the relationship between ERA scores and outcomes.
Main Results:
- A total of 12,650 patients were analyzed; 7.1% underwent CABG or PCI.
- Patients in the highest ERA score group (top 10%) had a significantly higher likelihood (OR 15.4) of undergoing CABG/PCI compared to the lowest score group.
- Higher ERA scores were associated with increased mortality, with 5-year survival rates of 50% in the highest-score group versus 97% in the lowest-score group (P < 0.001).
Conclusions:
- Higher ERA scores correlate with greater utilization of CABG/PCI in older adults.
- Elevated ERA scores identify patients undergoing coronary revascularization who are at the highest risk of mortality.
- Healthcare providers should consider ERA scores as a valuable tool for predicting outcomes in high-risk elderly patients requiring cardiovascular interventions.
Purpose:
The aging population is predisposed to cardiovascular disease. Our goal was to determine the relationship between a higher Elder Risk Assessment (ERA) score and coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI), in adults over 60 years.
Methods:
This was a retrospective cohort study in a primary care internal medicine practice. Patients included community-dwelling individuals aged 60 years or older on January 1, 2005. The primary outcome was a combined outcome of CABG and PCI in 2 years. The secondary outcome was mortality 5 years after CABG or PCI. The primary predictor variable was the score on the ERA Index, an instrument that predicts emergency room visits and hospitalization. The outcomes were obtained using administrative data from electronic medical records. The analysis included logistic regression, with odds ratios for the primary outcome and time-to-event analysis for mortality.
Results:
The records of 12,650 patients were studied. A total of 902 patients (7.1%) had either CABG or PCI, with an average age of 74.5 years (±8.3 years). There were 205 patients (23%) who experienced CABG or PCI in the highest-score group (top 10%) compared with 29 patients (3%) in the lowest score group, for an odds ratio of 15.4; 95% confidence interval, 10.1-23.5. There was a greater association of revascularization events by increasing score group. We noted increased mortality by increasing ERA score, in patients undergoing CABG or PCI. The patients in the highest-scoring group had a 50% 5-year survival rate compared with a 97% 5-year survival rate in the lowest-scoring group (P < 0.001).
Conclusion:
Older adults in the highest-ERA-scoring group had the highest utilization of CABG or PCI. Patients with high ERA scores undergoing coronary revascularization were also at the highest risk of mortality. Providers should be aware that higher ERA scores can potentially predict outcomes in high-risk patients.
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