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Ischemic cardio-cerebrovascular disease and all-cause mortality in Chinese elderly patients: a propensity-score
Qian Yang1,2, Shasha Sun3, Long-Biao Cui2
1Medical School of Chinese PLA, Beijing, 100039, China.
Insights
Elderly patients with combined ischemic cardio-cerebrovascular disease face higher mortality. Anemia and malnutrition upon admission are independent risk factors for death in this population.
Area of Science:
- Cardiovascular Medicine
- Geriatrics
- Neurology
Background:
- Ischemic cardio-cerebrovascular disease is a leading global cause of death.
- Limited research exists on elderly and very elderly populations.
- This study focuses on Chinese elderly patients.
Purpose of the Study:
- To characterize ischemic cardio-cerebrovascular diseases in elderly Chinese patients.
- To investigate the long-term prognostic implications of these conditions.
- To identify risk factors for mortality in this demographic.
Main Methods:
- Retrospective cohort study of 1026 patients aged ≥65 years.
- Categorization into mono ischemic cardio-cerebrovascular disease (MICCD) and comorbidity of ischemic cardio-cerebrovascular disease (CICCD).
- Cox proportional hazards model and propensity-score-based approaches for mortality risk evaluation.
Main Results:
- The CICCD group, predominantly very elderly, showed significantly higher long-term mortality (adjusted HR: 1.71).
- IPTW modeling confirmed worse mortality risk for CICCD (IPTW-adjusted HR: 2.07).
- Anemia (HR: 1.48) and malnutrition (HR: 1.43) were independent predictors of all-cause mortality.
Conclusions:
- Elderly patients with ischemic cardio-cerebrovascular disease, especially with anemia or malnutrition, face elevated mortality risk.
- These risk factors may be identifiable upon hospital admission.
- Further research is warranted to validate these findings.
Background:
Ischemic cardio-cerebrovascular disease is the leading cause of mortality worldwide. However, studies focusing on elderly and very elderly patients are scarce. Hence, our study aimed to characterize and investigate the long-term prognostic implications of ischemic cardio-cerebrovascular diseases in elderly Chinese patients.
Methods:
This retrospective cohort study included 1026 patients aged ≥ 65 years who were categorized into the mono ischemic cardio-cerebrovascular disease (MICCD) (either coronary artery disease or ischemic stroke/transient ischemic attack) (n = 912) and the comorbidity of ischemic cardio-cerebrovascular disease (CICCD) (diagnosed with both coronary artery disease and ischemic stroke/transient ischemic attack at admission) (n = 114). The primary outcome was all-cause death. The mortality risk was evaluated using the Cox proportional hazards risk model with multiple adjustments by conventional and propensity-score-based approaches.
Results:
Of the 2494 consecutive elderly patients admitted to the hospital, 1026 (median age 83 years [interquartile range]: 76.5-86.4; 94.4% men) met the inclusion criteria. Patients with CICCD consisted mostly of very elderly (79.2% vs. 66.1%, P < 0.001) individuals with a higher burden of comorbidities. Over a median follow-up of 10.4 years, 398 (38.8%) all-cause deaths were identified. Compared with the MICCD group, the CICCD group exhibited a higher adjusted hazard ratio (HR) (95% confidential interval, CI) of 1.71 (1.32-2.39) for long-term mortality after adjusting for potential confounders. The sensitivity analysis results remained robust. After inverse probability of treatment weighting (IPTW) modeling, the CICCD group displayed an even worse mortality risk (IPTW-adjusted HR: 2.07; 95% CI 1.47-2.90). In addition, anemia (adjusted HR: 1.48; 95% CI 1.16-1.89) and malnutrition (adjusted HR: 1.43; 95% CI 1.15-1.78) are also independent risk factors for all-cause mortality among elderly and very elderly patients.
Conclusions:
Our results thus suggest that elderly patients with ischemic cardio-cerebrovascular disease and anemia or malnutrition may have higher mortality, which may be predicted upon admission. These findings, however, warrant further investigation.
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