Department of Cardiology, Barzilai Medical Center, The Ben-Gurion University of the Negev, Hahistadrout 2, Ashkelon, 7830604, Israel.
Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.
BMC Geriatr. 2023 Mar 20;23(1):152. doi: 10.1186/s12877-023-03851-z.
With increasing life expectancy, the prevalence of nonagenarians with cardiovascular disease is steadily growing. However, this population is underrepresented in randomized trials and thus poorly defined, with little quality evidence to support and guide optimal management. The aim of the present study was to evaluate the clinical management, therapeutic approach, and outcomes of nonagenarians admitted to a tertiary care center intensive coronary care unit (ICCU).
We prospectively collected all patients admitted to a tertiary care center ICCU between July 2019 - July 2022 and compared nonagenarians to all other patients. The primary outcome was in-hospital mortality.
A total of 3807 patients were included in the study. Of them 178 (4.7%) were nonagenarians and 93 (52%) females. Each year the prevalence of nonagenarians has increased from 4.0% to 2019, to 4.2% in 2020, 4.6% in 2021 and 5.3% in 2022. Admission causes differed between groups, including a lower rate of acute coronary syndromes (27% vs. 48.6%, p < 0.001) and a higher rate of septic shock (4.5% vs. 1.2%, p < 0.001) in nonagenarians. Nonagenarians had more comorbidities, such as hypertension, renal failure, and atrial fibrillation (82% vs. 59.6%, 23% vs. 12.9%, 30.3% vs. 14.4% p < 0.001, respectively). Coronary intervention was the main treatment approach, although an invasive strategy was less frequent in nonagenarians in comparison to younger subjects. In-hospital mortality rate was 2-fold higher in the nonagenarians (5.6% vs. 2.5%, p = 0.025).
With increasing life expectancy, the prevalence of nonagenarians in ICCU's is expected to increase. Although nonagenarian patients had more comorbidities and higher in-hospital mortality, they generally have good outcomes after admission to the ICCU. Hence, further studies to create evidence-based practices and to support and guide optimal management in these patients are warranted.
随着预期寿命的延长，患有心血管疾病的 90 岁以上老年人的患病率稳步上升。然而，由于这一人群在随机试验中的代表性不足，因此定义不明确，几乎没有高质量的证据来支持和指导最佳治疗。本研究旨在评估入住三级护理中心重症监护冠状动脉病房（ICCU）的 90 岁以上老年人的临床管理、治疗方法和结局。
我们前瞻性地收集了 2019 年 7 月至 2022 年 7 月入住三级护理中心 ICCU 的所有患者，并将 90 岁以上的患者与所有其他患者进行了比较。主要结局为院内死亡率。
共有 3807 名患者纳入研究。其中，90 岁以上的患者有 178 名（4.7%），女性 93 名（52%）。每年，90 岁以上老年人的患病率从 2019 年的 4.0%增加到 4.2%，2020 年增加到 4.6%，2021 年增加到 5.3%，2022 年增加到 5.3%。不同组别的入院原因不同，包括急性冠状动脉综合征的发生率较低（27% vs. 48.6%，p<0.001）和脓毒性休克的发生率较高（4.5% vs. 1.2%，p<0.001）。90 岁以上的老年人有更多的合并症，如高血压、肾衰竭和心房颤动（82% vs. 59.6%，23% vs. 12.9%，30.3% vs. 14.4%，p<0.001）。冠状动脉介入治疗是主要的治疗方法，尽管与年轻患者相比，90 岁以上老年人的侵入性治疗策略较少。90 岁以上的老年人院内死亡率是两倍（5.6% vs. 2.5%，p=0.025）。
随着预期寿命的延长，ICCU 中 90 岁以上老年人的比例预计会增加。尽管 90 岁以上的老年人有更多的合并症和更高的院内死亡率，但他们在入住 ICCU 后通常有较好的结局。因此，需要进一步的研究来制定基于证据的治疗方案，并支持和指导这些患者的最佳治疗。
