Affiliation:
1. Barzilai Medical Center, The Ben-Gurion University of the Negev
2. Shaare Zedek Medical Center, Hebrew University of Jerusalem
Abstract
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% in 2019, to 4.2% in 2020, 4.6% in 2021 and 5.3% in 2022. Admission causes were similar in both groups except for a lower rate of ST segment myocardial infarction (STEMI) (12.9% vs. 27.3%, 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). In-hospital mortality rate was 2-fold higher in the nonagenarians (5.6% vs. 2.5%, p = 0.025).
Conclusions
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.
Publisher
Research Square Platform LLC