Nonagenarians admission and prognosis in a tertiary center intensive coronary care unit - a prospective study

Sharon Bruoha; Tomer Maller; Ranel Loutati; Nimrod Perel; Meir Tabi; Louay Taha; Chaim Yosefy; Jamal Jafari; Omri Braver; Itshak Amsalem; Rafael Hitter; Mohamed Manassra; Nir Levy; Ismael Abu-Alkean; Kamal Hamyil; Yoed Steinmetz; Hani Karameh; Mohamed Karmi; David Marmor; Arik Wolak; Michael Glikson; Elad Asher

doi:10.1186/s12877-023-03851-z

Nonagenarians admission and prognosis in a tertiary center intensive coronary care unit - a prospective study

BMC Geriatr. 2023 Mar 20;23(1):152. doi: 10.1186/s12877-023-03851-z.

Authors

Sharon Bruoha¹, Tomer Maller², Ranel Loutati², Nimrod Perel², Meir Tabi², Louay Taha², Chaim Yosefy³, Jamal Jafari³, Omri Braver³, Itshak Amsalem², Rafael Hitter², Mohamed Manassra², Nir Levy², Ismael Abu-Alkean³, Kamal Hamyil², Yoed Steinmetz², Hani Karameh², Mohamed Karmi², David Marmor², Arik Wolak², Michael Glikson², Elad Asher²

Affiliations

¹ Department of Cardiology, Barzilai Medical Center, The Ben-Gurion University of the Negev, Hahistadrout 2, Ashkelon, 7830604, Israel. sharonitob@gmail.com.
² Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.
³ Department of Cardiology, Barzilai Medical Center, The Ben-Gurion University of the Negev, Hahistadrout 2, Ashkelon, 7830604, Israel.

Abstract

Background: 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).

Methods: 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.

Results: 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).

Conclusion: 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.

Keywords: Acute coronary syndrome; Cardiac intensive care; Nonagenarians.

MeSH terms

Acute Coronary Syndrome* / diagnosis
Acute Coronary Syndrome* / epidemiology
Acute Coronary Syndrome* / therapy
Aged, 80 and over
Coronary Care Units
Female
Humans
Male
Nonagenarians*
Prognosis
Prospective Studies
Retrospective Studies
Risk Factors
Treatment Outcome