Comparison of Usefulness of Secondary Prevention of Coronary Disease in Patients &lt;80 Versus ≥80 Years of Age

Mehta, Hardik; Sacrinty, Matthew; Johnson, Dominic; Clair, Mitchell St.; Paladenech, Connie; Robinson, Killian

doi:10.1016/j.amjcard.2013.05.058

Cited by 12 publications

(8 citation statements)

References 22 publications

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“…In addition, the same exercise device was not used for each patient for each MET level. However, our previously reported investigations without stress tests 25,46 concur qualitatively with other studies using formal treadmill exercise testing. 47,48 Finally, we did not evaluate muscle function, which may be adversely affected in patients with CKD.…”

Section: Discussionsupporting

confidence: 90%

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Effect of Chronic Kidney Disease and Supplemental Polyunsaturated Fatty Acid Use on Exercise Levels During Cardiac Rehabilitation in Patients With Coronary Artery Disease

Pflum

Gomadam²,

Mehta³

et al. 2017

Journal of Cardiopulmonary Rehabilitation and Prevention

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PURPOSE The correlation between chronic kidney disease (CKD) and increased cardiovascular disease-related mortality is well established. Cardiac rehabilitation (CR) improves exercise capacity, quality of life, and risk factors in patients with coronary artery disease (CAD). Data on the benefits of CR in patients with CKD are sparse. To compare outcomes after CR in patients with CAD but normal renal function, versus those with CAD and CKD. METHODS We studied 804 patients with CAD entering an exercise-based CR program. Demographics, risk factors, exercise capacity in metabolic equivalent levels (METs), and estimated glomerular filtration rate (GFR) were recorded before and after the 3-month CR program. Use of polyunsaturated fatty acid (PUFA) was determined by medical records review. Stage III-V CKD (GFR <60 mL/min/1.73 m2) was present in 167 patients at baseline. RESULTS After CR, METs improved in all patients, although increases in patients with a GFR 30 to 59 mL/min/1.73 m2 (Δ1.6) and a GFR <30 (Δ1.3) were smaller than those in patients with a GFR ≥60 (Δ2.6, P < .05 vs GFR 30–59 and GFR <30). In patients with a GFR ≥60 mL/min/1.73 m2, PUFA use was associated with a 20% greater increase in MET levels compared with nonusers (Δ3.0 vs Δ2.5, P = .02); and in patients with a GFR 30 to 59, PUFA use was associated with 30% increase in MET level compared with nonusers (Δ2.0 vs Δ1.4, P = .03). These observations persisted after multivariable adjustment for baseline MET level, demographics, and risk factors. CONCLUSIONS Potential mitigation by PUFA of the smaller improvement in exercise capacity with decreasing GFR requires confirmation in prospective randomized trials.

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Section: Discussionsupporting

confidence: 90%

“…25 It lasted 12 weeks (three 30- to 40-minute sessions per week of upper and lower body exercises with exercise machines). Clinical status was used by an exercise physiologist to develop an individualized exercise plan.…”

Section: Methodsmentioning

confidence: 99%

Effect of Chronic Kidney Disease and Supplemental Polyunsaturated Fatty Acid Use on Exercise Levels During Cardiac Rehabilitation in Patients With Coronary Artery Disease

Pflum

Gomadam²,

Mehta³

et al. 2017

Journal of Cardiopulmonary Rehabilitation and Prevention

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“…In the present study in older people in the general population, rates of secondary cardiovascular preventive drug prescriptions were relatively low; this may increase the risks of recurrent CVD. Since an intensive outpatient cardiac rehabilitation programme recently showed benefits even in patients aged ≥ 80 years [ 34 ], optimising secondary preventive measures can be worthwhile, even in old age. The observed low prescription rates, especially of statins, in women and in participants with minor CVD, may be the result of a careful decision process weighing all the pros and cons of preventive treatment; however, it may also reflect forgetfulness or loss of attention for these patients.…”

Section: Discussionmentioning

confidence: 99%

Drug prescription rates in secondary cardiovascular prevention in old age: Do vulnerability and severity of the history of cardiovascular disease matter?

Peet

Gussekloo

Elzen

et al. 2015

Scandinavian Journal of Primary Health Care

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Objective: To assess the influence vulnerability and severity of cardiovascular disease (CVD), on prescription rates of secondary cardiovascular preventive drugs in old age.Design: Population-based observational study within the ISCOPE study. Setting: General practices in the Netherlands.Subjects: A total of 1350 patients with a history of CVD (median age 81 years, 50% female).Main outcome measures. One-year prescription rates of lipid-lowering drugs and antithrombotics were obtained from the electronic medical records of 46 general practitioners (GPs). Prescription of both drugs for ≥ 270 days per year was considered optimal. GPs made a judgement of vulnerability. Severity of CVD was expressed as major (myocardial infarction, stroke, or arterial surgery) versus minor (angina, transient ischaemic attack, or claudication).Results: GPs considered 411 (30%) participants to be vulnerable and 619 (55%) participants had major CVD. Optimal treatment was prescribed to 680 (50%) participants, whereas 370 (27%) received an antithrombotic drug only, 53 (4%) a lipid-lowering drug only, and 247 (18%) received neither. Optimal treatment was lower in participants aged ≥ 85 years (OR 0.37 [95% CI 0.29–0.48]), in females (OR 0.63 [0.50–0.78]), in vulnerable persons (OR 0.79 [0.62–0.99]) and in participants with minor CVD (OR 0.65 [0.53–0.81]). Multivariate ORs remained similar whereas vulnerability lost its significance (OR 0.88 [0.69–1.1]).Conclusion: In old age, GPs’ judgement of vulnerability is not independently associated with lower treatment rates of both lipid-lowering drugs and antithrombotics, whereas a history of minor CVD is. Individual proactive re-evaluation of preventive treatment in older (female) patients, especially those with a history of minor CVD, is recommended.Key pointsPrescriptions of lipid-lowering drugs and antithrombotics in secondary cardiovascular prevention tend to decline with age.In this study with median age 81 years, 50% of participants received optimal treatment with both lipid-lowering drugs and antithrombotics.GPs’ judgement of vulnerability was not independently associated with optimal treatment.A history of less severe cardiovascular disease was independently associated with lower prescription rates of lipid-lowering drugs and antithrombotics.Proactive individual re-evaluation of cardiovascular preventive treatment in older (female) patients, especially patients with less severe cardiovascular disease, is recommended.

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“…4 Engaging in lifestyle exercise is especially important for primary and secondary prevention of cardiovascular disease. 5,6 For overall cardiovascular health, the American Heart Association recommends at least 30 minutes of moderate-intensity aerobic activity within a target heart rate zone (50 percent to 85 percent of maximum heart rate by age) at least 5 days a week for a total of 2.5 hours a week. 7-9 Similarly, the U.S. Department of Health and Human Services recommends 150 minutes of moderate physical activity a week and this applies to older adults with chronic conditions.…”

Section: Introductionmentioning

confidence: 99%

Does Lifestyle Exercise After a Cardiac Event Improve Metabolic Syndrome Profile in Older Adults?

Wright

Moore‐Schiltz²,

Sattar

et al. 2018

J Cardiovasc Nurs

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Comparison of Usefulness of Secondary Prevention of Coronary Disease in Patients <80 Versus ≥80 Years of Age

Cited by 12 publications

References 22 publications

Effect of Chronic Kidney Disease and Supplemental Polyunsaturated Fatty Acid Use on Exercise Levels During Cardiac Rehabilitation in Patients With Coronary Artery Disease

Effect of Chronic Kidney Disease and Supplemental Polyunsaturated Fatty Acid Use on Exercise Levels During Cardiac Rehabilitation in Patients With Coronary Artery Disease

Drug prescription rates in secondary cardiovascular prevention in old age: Do vulnerability and severity of the history of cardiovascular disease matter?

Does Lifestyle Exercise After a Cardiac Event Improve Metabolic Syndrome Profile in Older Adults?

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