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Association between discharge destination and mid-term mortality in octogenarian patients with ST-elevation
Naoki Yoshioka1, Kensuke Takagi1, Itsuro Morishima2
1Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan; Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Insights
Discharging elderly ST-elevation myocardial infarction (STEMI) survivors to non-home destinations, such as nursing homes, significantly increases their 2-year mortality risk. This finding highlights the importance of discharge planning for frail elderly patients after PCI.
Area of Science:
- Cardiology
- Geriatrics
- Public Health
Background:
- The aging population is increasing the number of elderly patients undergoing percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI).
- Elderly STEMI survivors may experience increased frailty, leading to non-home discharge despite surviving the initial event.
- The prognostic impact of discharge destination in this vulnerable population remains under-evaluated.
Purpose of the Study:
- To evaluate the association between discharge destination and prognosis in octogenarian STEMI survivors treated with PCI.
- To identify predictors of mid-term mortality in this patient group.
Main Methods:
- A multicenter registry evaluated 245 octogenarian STEMI survivors who underwent PCI between 2014 and 2016.
- Two-year mortality rates were compared between home discharge and non-home discharge groups.
- Cox regression analysis, including multivariate analysis, was used to assess mortality risk.
Main Results:
- Non-home discharge (transfer to another hospital or nursing home) occurred in 36 patients.
- Two-year all-cause mortality was significantly higher in the non-home discharge group (36.4%) compared to the home discharge group (14.8%) (HR, 2.95; p=0.003).
- Independent predictors of mortality included non-home discharge, low left ventricular ejection fraction, prior heart failure, target lesion in the LAD, and low serum albumin.
Conclusions:
- Non-home discharge is a significant independent predictor of increased mid-term mortality in octogenarian STEMI survivors.
- Factors such as reduced cardiac function, prior heart failure, and poor nutritional status also contribute to adverse outcomes.
Background:
Owing to an increasing aging population, the number of elderly patients undergoing percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) is escalating. The onset of STEMI in elderly patients may lead to increased frailty, resulting in failure of discharge to home despite survival. However, the association of discharge destination with prognosis has not been fully evaluated in this population.
Methods:
Between January 2014 and December 2016, a total of 245 octogenarian STEMI survivors who underwent PCI (mean age, 84.4 years; male, 46.5%) were evaluated from a multicenter registry. The 2-year mortalities of the home discharge and non-home discharge groups were compared and analyzed using a Cox regression model.
Results:
Non-home discharge, which was defined as transfer to another hospital or nursing home after STEMI, was seen in 36 patients. During the 2 years, 37 patients died (home discharge, 27 patients; non-home discharge, 10 patients). The most frequent cause of death was due to infection (21.6%), followed by sudden death (18.9%) and heart failure (16.2%). The cumulative all-cause mortality was significantly higher in the non-home discharge group than in the home discharge group [36.4% vs. 14.8%; hazard ratio (HR), 2.95; 95% confidence interval (CI), 1.43-6.10; p = 0.003]. After multivariate analysis, non-home discharge (adjusted HR, 2.62; 95% CI, 1.20-5.75; p = 0.016) together with left ventricular ejection fraction <40% (adjusted HR, 3.15; 95% CI, 1.57-6.31; p = 0.001), prior heart failure (adjusted HR, 4.88; 95% CI, 1.82-13.13; p = 0.002), target lesion in the left anterior descending artery (adjusted HR, 2.20; 95% CI, 1.12-4.32; p = 0.022), and serum albumin level <3.5 g/dL (adjusted HR, 2.13; 95% CI, 1.06-4.27; p = 0.034) remained significant predictors of all-cause mortality.
Conclusion:
Non-home discharge was associated with an increased risk of mid-term mortality in octogenarian STEMI survivors.
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