Mortality associated with stopping statins in the oldest-old - with and without ischemic heart disease.

ABSTRACT: The association between stopping statins and 1-year mortality in the general population of the oldest-old - with or without ischemic heart disease (IHD) - has been studied herein for the first time.This was a retrospective study. Included were all consecutive patients (n = 369) aged 80 years or more (mean age 87.8 years) hospitalized in a single Geriatrics department during 1 year. The study group included 140 patients in whom statins were stopped upon admission (statin stoppers). The control group included 229 patients who did not use statins in the first place (statin non-users). All-cause 1-year mortality rates were studied in both groups following propensity score matching and in IHD patients separately.Overall, 110 (29.8%) patients died during the year following admission: 38 (27.1%) statin stoppers and 72 (31.4%) statin non-users (P = .498). Cox regression analysis showed no association between stopping statins and 1-year mortality in the crude analysis (hazard ratio [HR] 0.976, 95% confidence interval [CI] 0.651-1.463, P = .907) and following propensity score matching (HR 1.067, 95%CI 0.674-1.689, P = .782). Among 108 IHD patients, 38 (35.2%) patients died during the year following admission: 18 (27.7%) statin stoppers and 20 (46.5%) statin non-users (P = .059). Cox regression analysis showed a nearly significant association between stopping statins (rather than not using statins) in IHD patients and lower 1-year mortality (HR 0.524, 95%CI 0.259-1.060, P = .072).Hence, stopping statins in the general population of the oldest-old - with or without IHD - is possibly safe. Future studies including the oldest-old statin continuers are warranted to confirm this observation.

Unprovoked pulmonary embolism in older adults: incidence and prognosis.

INTRODUCTION: Unprovoked pulmonary embolism (UPE) is not rare and it is associated with an unfavorable prognosis in adults. However, the incidence and the prognosis of UPE in older adults have never been studied. MATERIAL AND METHODS: This was a historical prospective study. We reviewed all the medical charts of all older adults (aged 70 years or more) with UPE, provoked pulmonary embolism (PPE), and malignancy-associated PE (MAPE), admitted to a tertiary medical center between 2010 and 2012. The all-cause 3-year mortality rates and cumulative survival following admission were compared between the groups. RESULTS: The final cohort included 249 patients with PE: 161 (64.7%) were women; the mean age was 79.8 ±5.7 years. Overall, 36 (14.5%) patients had UPE, 81 (32.5%) patients had MAPE, and 132 (53.0%) patients had PPE. Overall, 39 (15.7%) patients died within 30 days, 76 (30.5%) patients died within 6 months, 101 (40.6%) patients died within 1 year, and 136 (54.6%) patients died within 3 years of admission. Relative to PPE and MAPE patients, the cumulative survival was significantly higher in UPE patients at each time point within 1 year of admission (p < 0.05 and p < 0.001, respectively). However, 3 years after admission, the cumulative survival was comparable between PPE patients and UPE patients, and was significantly lower in MAPE patients (p < 0.001). CONCLUSIONS: UPE is not rare in older adults with PE, and it is associated with a favorable prognosis within 1 year of admission in this population.

Which laboratory malnutrition markers best predict 1-year mortality in hospitalized older adults?

PURPOSE: To study which laboratory malnutrition markers best predict 1-year mortality in the general population of hospitalized older adults as well as among patients at risk for malnutrition. METHODS: A historical prospective study. All older adults (age ≥ 65 years) hospitalized in one geriatric department during 9 months were included. Malnutrition Universal Screening Tool (MUST) was used to determine malnutrition risk. Laboratory malnutrition markers included albumin serum levels, transferrin serum levels, total cholesterol serum levels, vitamin D serum levels, and lymphocyte count. A receiver operating characteristic (ROC) curve analysis was used to study which markers best predict 1-year mortality. RESULTS: Overall, 437 patients (63.2% women; mean age 84.7 years) were included. Overall, 126 (28.8%) patients died in the year following admission. ROC curve analysis showed that low albumin serum levels best predict 1-year mortality (AUC 0.721, p < 0.001), followed by low transferrin serum levels (AUC 0.661, p < 0.001) and low lymphocyte count (AUC 0.575, p = 0.016). Among 178 (40.7%) patients at risk for malnutrition, 63 (35.4%) patients died in the year following admission. ROC curve analysis showed that albumin serum levels best predict 1-year mortality in patients at risk for malnutrition (AUC 0.720, p < 0.001), followed by transferrin serum levels (AUC 0.659, p = 0.001). Regression analysis showed that low albumin serum levels were also independently associated with 1-year mortality among the whole cohort and among patients at risk for malnutrition (OR 0.2, 95% CI 0.1-0.4, p < 0.001, for both). CONCLUSIONS: Low albumin serum levels best predict 1-year mortality in hospitalized older adults, followed by low transferrin serum levels.

Reckless administration of QT interval-prolonging agents in elderly patients with drug-induced torsade de pointes.

A systematic review was conducted for all published case reports on drug-induced torsade de pointes (TdP) in elderly (≥80 years) patients to study if the administration of the offending agent was reckless. Overall, 61 reports on drug-induced TdP in patients aged 80-97 years were included in the analysis. Non-modifiable risk factors for drug-induced TdP (e.g. acute coronary syndrome, female gender and congestive heart failure), modifiable risk factors (e.g. hypokalemia, severe hypomagnesemia and digitalis toxicity) and reckless administration of a QT interval-prolonging agent (e.g. despite a known QT interval prolongation or a history of TdP, together with other QT interval prolonging agents in higher than recommended doses) were recorded in each case. Overall, 54 (88.5%) patients had non-modifiable risk factors for drug-induced TdP and 21 (34.4%) patients had modifiable risk factors. The administration of the offending agent was reckless in one half (n = 31; 50.8%) of the patients. The most prevalent reckless administration of a QT interval-prolonging agent was together with other QT interval-prolonging agents (n = 16; 51.6%) or despite QT interval prolongation (n = 8; 25.8%). In conclusion, although risk factors for drug-induced TdP are prevalent in elderly patients with drug-induced TdP, in approximately 50% of patients it appeared following a reckless administration of a QT interval-prolonging agent. In this population physicians should particularly avoid administration of two or more QT interval-prolonging agents simultaneously or administration of a QT interval-prolonging agent despite QT interval prolongation.

Gender differences in mortality among statin users aged 80 years or more.

BACKGROUND: Little is known about the prognosis associated with statin therapy and its gender differences in older adults aged ≥80 years. OBJECTIVE: To study the mortality and survival associated with statin therapy and their gender differences in older adults aged ≥80 years. METHOD: This was a historical prospective study conducted at a tertiary medical center. The medical charts of all older adults aged ≥80 years who had been admitted to a single internal medicine department during 1 year were reviewed. All-cause 3­year mortality and survival rates following hospital admission in men and in women using statins were investigated. RESULTS: The final cohort included 216 patients: 122 (56.5%) women, mean age 85.3 ± 3.9 years. Overall, 66 (53.2%) women and 58 (46.8%) men used statins for 3 years or more following hospital admission. During this time 48 (39.3%) women and 48 (51.1%) men died. The all-cause 3­year mortality rates were significantly lower only in women who had used statins compared with women who had not used statins (24.2% vs. 57.1%; relative risk = 0.2; 95% confidence interval 0.1-0.5; p < 0.0001). The 3­year cumulative survival rates were significantly higher in women who had used statins as part of primary as well as secondary cardiovascular prevention (p < 0.0001 and p = 0.014, respectively). A Cox regression analysis showed that statin therapy was independently associated with low 3­year cumulative mortality rates in women (hazard ratio=0.3; 95% confidence interval=0.1-0.6; p = 0.001). CONCLUSION: In older adults aged ≥80 years, statin therapy is associated with high 3­year cumulative survival rates only in women.