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Published on: September 22, 2020
Impact of Age Differences in Chronic Limb-Threatening Ischemia Outcomes in Octogenarians
Sai Sashank Jagannath Wunnava1, Krishna Ravulapalli2, Tamer El-Sayed1
1Northern Vascular Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, Tyne and Wear, UK.
Insights
Outcomes for octogenarians with chronic limb-threatening ischemia (CLTI) are similar to younger patients, despite increased frailty. This highlights the need for comprehensive assessment and risk stratification in older adults undergoing CLTI intervention.
Area of Science:
- Vascular Surgery
- Geriatric Medicine
- Cardiovascular Research
Background:
- The aging global population presents significant challenges for healthcare systems.
- Multimorbidity and aging are key research areas, particularly concerning chronic limb-threatening ischemia (CLTI) in older adults.
- Evidence on CLTI outcomes in the elderly is limited, despite perceived high morbidity and mortality.
Purpose of the Study:
- To investigate the outcomes of octogenarians (patients aged 80 and above) with CLTI.
- To compare the morbidity, mortality, and adverse event rates between octogenarians and younger patients with CLTI.
- To evaluate the impact of frailty and comorbidities on CLTI treatment outcomes in the elderly.
Main Methods:
- Retrospective review of consecutive CLTI admissions at a UK tertiary vascular center in 2020.
- Analysis included descriptive statistics and age-based comparisons.
- Primary outcome: survival (Kaplan-Meier analysis). Secondary outcomes: major adverse limb events (MALE) and major adverse cardiovascular events (MACE).
Main Results:
- The study included 183 CLTI patients (median age 72), with 55 (30%) being octogenarians.
- Octogenarians had lower rates of diabetes but higher rates of comorbidities like stroke and atrial fibrillation.
- Octogenarians exhibited significantly higher rates of moderate to severe frailty (87.3% vs. 57.8%).
- Median survival was 30 months with no significant difference between age groups (P=0.406).
- MACE (10.9% vs. 7.81%) and MALE (34.5% vs. 24.2%) rates were comparable.
- Octogenarians were less likely to undergo open surgery (10.9% vs. 25.8%, P=0.024).
Conclusions:
- Octogenarians with CLTI demonstrate similar survival, cardiovascular, and limb outcomes post-intervention compared to younger patients.
- Despite increased frailty and comorbidities, older adults achieve comparable results.
- Holistic assessment, perioperative optimization, and risk stratification are crucial for managing CLTI in the octogenarian population.
Background:
The aging population is a growing challenge for healthcare services and as such multimorbidity and associated aging are the focus of research programs. Chronic limb-threatening ischemia (CLTI) in the older patient is perceived to be associated with high morbidity and mortality but a potentially contentious area with limited evidence.
Methods:
Retrospective review of all consecutive CLTI admissions to a UK tertiary vascular during 2020. Analysis included descriptive statistics and comparisons by age. The primary outcome was survival (by Kaplan-Meier) with secondary outcomes being major adverse limb and cardiovascular events.
Results:
One hundred eighty-three patients with a median age of 72 of which 55 (30%) were octogenarians. Fewer octogenarians were diabetic (38.2% vs. 58.6%, P = 0.015), but comorbidities such as previous stroke (25.5% vs. 10.9%, P = 0.015) and atrial fibrillation (36.4% vs. 16.4%, P = 0.004) were increasingly common. 87.3% of octogenarians had moderate or severe frailty compared to 57.8% in those <80 (P = 0.001) (by electronic frailty index). Median survival time was 30 months with no significant difference between groups (P = 0.406). Major adverse cardiovascular event (10.9% vs. 7.81%, P = 0.504) and major adverse limb event (34.5% vs. 24.2% P = 0.261) were comparable between groups. Octogenarians were less likely to have open surgery (10.9% vs. 25.8%, P = 0.024).
Conclusions:
Octogenarians have similar cardiovascular, limb, and survival outcomes following intervention despite being increasingly frail and comorbid. Holistic assessment, perioperative optimization, and risk stratification are important in this group.
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