Barthel Index as a Predictor of 1‐Year Mortality in Very Elderly Patients Who Underwent Percutaneous Coronary Intervention for Acute Coronary Syndrome: Better Activities of Daily Living, Longer Life

Abstract

Background: Percutaneous coronary intervention (PCI) is safe and effective in very elderly patients, defined as those who are age ≥85 years, with acute coronary syndrome (ACS). However, the prognostic factors remain unknown. The association between activities of daily living (ADL) and the prognosis after PCI has not yet been investigated. Hypothesis: Better ADL is associated with better 1-year prognosis. Methods: This retrospective study included 91 consecutive very elderly patients with ACS. We calculated the Barthel Index (BI) as an indicator for ADL. Patients were classified into 2 groups according to BI: high BI (≥85) and low BI (<85). The BI was assessed both on admission (pre-BI) and at discharge (post-BI). Results: In the 91 patients (mean age, 88.2 ± 3.0 years, 52% male), 1-year mortality was 33%. The Cox regression model demonstrated that low pre-BI was not a risk factor for 1-year mortality (hazard ratio: 0.73, 95% confidence interval [CI]: 0.30-1.78, P = 0.490). However, post-BI was significantly associated with 1-year mortality (hazard ratio: 0.25, 95% CI: 0.11-0.57, P = 0.001). The 1-year mortality of the high and the low post-BI group was estimated as 21% (95% CI: 12%-35%) and 62% (95% CI: 42%-82%), respectively. A 5-unit decrease in post-BI was related to a 1.10-fold increased risk for 1-year mortality (95% CI: 1.05-1.15, P < 0.001). Conclusions: Activities of daily living at discharge, although not before admission, may be a useful predictor for 1-year mortality in very elderly patients undergoing PCI for ACS. IntroductionIn elderly patients who are affected by comorbidities, primary percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) seems to be a promising strategy. 1 As PCI has become a safer and less invasive procedure, the very elderly population-defined as those age ≥85 years-is increasingly being referred for PCI, particularly in the setting of ACS. Although evidence on ACS in very elderly patients is scarce, a few studies have reported clinical outcomes related to this topic. A retrospective cohort study reported that long-term survival of patients age ≥90 years who underwent PCI was not inferior to those who were included in a Minnesota cohort matched by age and sex.2 Other studies have also reportedThe authors have no funding, financial relationships, or conflicts of interest to disclose.that PCI for patients with ACS who were ≥85 years was safe, feasible, and effective. 3,4 However, most patients with advanced age have disabilities such as dementia, cerebral infarction sequelae, and muscle weakness, all of which can influence their prognosis. This study aimed to confirm the hypothesis that better activities of daily living (ADL) is associated with better prognosis in very elderly patients with ACS who underwent PCI. Methods Study DesignThis study retrospectively included 91 consecutive patients, age ≥85 years, who were admitted to our hospital for ACS and underwent primary PCI between January 2007 and January 2014. We reviewed the medical records of all patients ...

<p>Barthel Index as a Predictor of Mortality in Patients with Acute Coronary Syndrome: Better Activities of Daily Living, Better Prognosis</p>

“…Patients with disability in ADL are more likely to develop to be bedridden and have disuse syndrome, which may easily cause decubitus ulcer and infections, such as pneumonia and urinary tract infection. 20 These morbidities may lead to a worse outcome of disease development. Undertaking vigorous timely rehabilitation can help patients recover from disability in ADL and improve the prognosis of patients.…”

“…To the best of our knowledge, this study is the largest one till now to verify the association between BI scores at admission and mortality both in-hospital and during follow-up for ACS patients. One study 20 did research on BI scores and prognosis for very elderly ACS patients. They enrolled 91 very elderly (≥85 years) ACS patients who underwent PCI, showing that there was correlation between BI scores assessed at discharge and one-year mortality of these patients.…”

“…19 A recent study showed that the BI at discharge may be related to one-year mortality of ACS patients >85 years old undergoing PCI. 20 We hypothesized that BI scores at admission would provide additional prognostic information for ACS patients. Thus, we conducted this retrospective multi-center study to determine whether BI scores at admission could predict all-cause death and cardiac death in patients with ACS and identify high-risk ACS patients, with the aim of providing appropriate therapeutic and management strategies.…”

Thromboembolic Risk, Bleeding Outcomes and Effect of Different Antithrombotic Strategies in Very Elderly Patients With Atrial Fibrillation: A Sub‐Analysis From the PREFER in AF ( PRE vention o F Thromboembolic Events– E uropean R egistry in A trial F ibrillation)

“…There is a broad interest in the best treatment of very elderly patients with cardiovascular diseases, usually defined as ≥85 years . Unfortunately, there has, so far, been no controlled trial with sufficient power in this age group to inform treatment of very elderly patients with AF.…”

Percutaneous coronary intervention in the elderly: current updates and trends

“…Also, the activity of daily living (ADL) of old age patients after PCI can be used to predict mortality. ADL assessment by Barthel index (BI) at the time of admission and discharge has been investigated by Higuchi et al [44] to predict 1-year mortality in very old patients undergoing PCI for ACS. They have shown that lower BI at the discharge of the patient can be a predictor of higher mortality in patients aged 85 years and older with each 5 unites decrease in BI being associated with 1.1 fold increase in 1-year mortality risk.…”