The association between older age and receipt of care and outcomes in patients with acute coronary syndromes: a cohort study of the Myocardial Ischaemia National Audit Project (MINAP)

Zaman, M Justin S; Stirling, Susan; Shepstone, Lee; Ryding, Alisdair; Flather, Marcus; Bachmann, Max; Myint, Phyo Kyaw

doi:10.1093/eurheartj/ehu039

Cited by 125 publications

(84 citation statements)

References 26 publications

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“…One other limitation was that we did not have information on reperfusion therapy for patients. However, previously analyses within MINAP have reported that receipt of evidence-based cardiac medications post-ACS is less in older age groups,26 and we expect that our cohort will be similar to other cohorts in literature where it has been reported that younger patients are more likely to receive reperfusion therapy 27. Another limitation was that we do not have information on time to therapy as we expect that delay in presentation may be associated with delayed treatment and worse outcomes.…”

Section: Study Limitationssupporting

confidence: 62%

Prognostic value of troponins in acute coronary syndrome depends upon patient age

Myint

Kwok

Bachmann

et al. 2014

Heart

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Section: Study Limitationssupporting

confidence: 62%

Prognostic value of troponins in acute coronary syndrome depends upon patient age

Myint

Kwok

Bachmann

et al. 2014

Heart

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“…Increased mortality risk in the presence of comorbidities likely relates to a myriad of pathological processes (such as dyslipidemia, chronic inflammation, endothelial dysfunction, hypertension, volume overload, impaired left ventricular function, microvascular disease, and immune compromise). [19][20][21][22] Whereas age-adjusted stroke incidence rates in high-income countries have decreased by 42% since the 1970s, the stroke incidence rates in low-to middle-income countries have more than doubled during this period (52 per 100 000 and 117 per 100 000 person-years, respectively; P<0.0001) with little sign of slowing. 23 As a result, the incidence of stroke in low-to middle-income countries has now exceeded that of highincome countries.…”

Section: Discussionmentioning

confidence: 99%

Rheumatic Mitral Valve Disease Is Associated With Worse Outcomes in Stroke

Wood

Mannu

Clark

et al. 2016

Stroke

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Background and Purpose— Rheumatic valvular heart disease is associated with the increased risk of cerebrovascular events, although there are limited data on the prognosis of patients with rheumatic mitral valve disease (RMVD) after stroke. Methods— We examined the association between RMVD and both serious and common cardiovascular and noncardiovascular (respiratory and infective) complications in a cohort of hospitalized stroke patients based in Thailand. Factors associated with in-hospital mortality were also explored. Data were obtained from a National Insurance Database. All hospitalized strokes between October 1, 2004, and January 31, 2013, were included in the current study. Characteristics and outcomes were compared for RMVD and non-RMVD patients. Logistic regression, propensity score matching, and multivariate models were used to assess study outcomes. Results— In total, 594 681 patients (mean [SD] age=64 [14.5] years) with a diagnosis of stroke (ischemic=306 154; hemorrhagic=195 392; undetermined=93 135) were included in this study, of whom 5461 had RMVD. Results from primary analyses showed that after ischemic stroke, and controlling for potential confounding covariates, RMVD was associated ( P <0.001) with increased odds for cardiac arrest (odds ratio [95% confidence interval]=2.13 [1.68–2.70]), shock (2.13 [1.64–2.77]), arrhythmias (1.70 [1.21–2.39]), respiratory failure (2.09 [1.87–2.33]), pneumonia (2.00 [1.81–2.20]), and sepsis (1.39 [1.19–1.63]). In hemorrhagic stroke patients, RMVD was associated with increased odds (fully adjusted model) for respiratory failure (1.26 [1.01–1.57]), and in patients with undetermined stroke, RMVD was associated with increased odds (fully adjusted analyses) for shock (3.00 [1.46–6.14]), respiratory failure (2.70 [1.91–3.79]), and pneumonia (2.42 [1.88–3.11]). Conclusions— RMVD is associated with the development of cardiac arrest, shock, arrhythmias, respiratory failure, pneumonia, and sepsis after acute stroke.

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“…Elderly patients presenting with acute coronary syndromes are at high risk even after successful coronary intervention 43. For patients over 75 years, the presence of comorbidities such as chronic kidney disease, significant LV dysfunction, CHF, chronic lung disease, anaemia and peripheral vascular disease increase the 1 year mortality risk substantially.…”

Section: Which Patients With Heart Disease Benefit From Fcp?mentioning

confidence: 99%

Future care planning: a first step to palliative care for all patients with advanced heart disease

Denvir

Murray

Boyd

2015

Heart

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Palliative care is recommended for patients with end-stage heart failure with several recent, randomised trials showing improvements in symptoms and quality of life and more studies underway. Future care planning provides a framework for discussing a range of palliative care problems with patients and their families. This approach can be introduced at any time during the patient's journey of care and ideally well in advance of end-of-life care. Future care planning is applicable to a wide range of patients with advanced heart disease and could be delivered systematically by cardiology teams at the time of an unplanned hospital admission, akin to cardiac rehabilitation for myocardial infarction. Integrating cardiology care and palliative care can benefit many patients with advanced heart disease at increased risk of death or hospitalisation. Larger, randomised trials are needed to assess the impact on patient outcomes and experiences.

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The association between older age and receipt of care and outcomes in patients with acute coronary syndromes: a cohort study of the Myocardial Ischaemia National Audit Project (MINAP)

Cited by 125 publications

References 26 publications

Prognostic value of troponins in acute coronary syndrome depends upon patient age

Prognostic value of troponins in acute coronary syndrome depends upon patient age

Rheumatic Mitral Valve Disease Is Associated With Worse Outcomes in Stroke

Future care planning: a first step to palliative care for all patients with advanced heart disease

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