RESUMO
In recent decades, life expectancy has been increasing significantly. In this scenario, health interventions are necessary to improve prognosis and quality of life of elderly with cardiovascular risk factors and cardiovascular disease. However, the number of elderly patients included in clinical trials is low, thus current clinical practice guidelines do not include specific recommendations. This document aims to review prevention recommendations focused in patients ≥ 75 years with high or very high cardiovascular risk, regarding objectives, medical treatment options and also including physical exercise and their inclusion in cardiac rehabilitation programs. Also, we will show why geriatric syndromes such as frailty, dependence, cognitive impairment, and nutritional status, as well as comorbidities, ought to be considered in this population regarding their important prognostic impact.
RESUMO
ANTECEDENTES Y OBJETIVOS: La prevalencia de fibrilación auricular (FA) y cardiopatía isquémica (CI) aumenta con la edad. Coexisten en hasta un 20% de los pacientes octogenarios, situación que supone un desafío terapéutico. Los ensayos que han abordado este escenario, que incluyeron un porcentaje bajo de octogenarios, demostraron que la doble terapia (antiagregación simple + anticoagulación) en comparación con la triple terapia (doble antiagregación + anticoagulación) se asocia menos eventos hemorrágicos, especialmente con anticoagulantes orales de acción directa. Estos estudios no tenían potencia suficiente para detectar diferencias en eventos isquémicos. Por otro lado, aspectos prevalentes en la población mayor, como los síndromes geriátricos, no se valoraron en estos estudios, y tampoco en la práctica clínica habitual, desconociéndose su impacto pronóstico en este contexto clínico. MATERIAL Y MÉTODOS: Estudio observacional, prospectivo y multicéntrico, que incluirá pacientes ≥ 80 años con FA y CI en España. Se valorarán las características basales y los síndromes geriátricos, así como la elección del tratamiento antitrombótico. El objetivo primario es conocer la mortalidad cardiovascular y por todas las causas a uno y tres años. RESULTADOS: Este estudio permitirá conocer las características y el pronóstico de pacientes octogenarios con FA y CI en nuestro medio, los factores implicados en la elección del tratamiento antitrombótico y la incidencia de eventos isquémicos y hemorrágicos durante el seguimiento a corto y largo plazo. CONCLUSIONES: Nuestro trabajo contribuirá a mejorar el conocimiento en términos de seguridad y eficacia de las distintas opciones terapéuticas en pacientes mayores con FA y CI y su impacto pronóstico
BACKGROUND AND OBJECTIVES: The prevalence of atrial fibrillation (AF) and ischaemic heart disease (IHC) increases with age. They coexist in up to 20% of octogenarian patients, a situation that poses a therapeutic challenge. Trials that have addressed this scenario, which included a low percentage of octogenarians, showed that double therapy (single antiplatelet + anticoagulation) compared to triple therapy (double antiplatelet + anticoagulation) was associated with less bleeding events, especially with direct oral anticoagulants. These studies did not have sufficient power to detect differences in ischaemic events. On the other hand, prevalent characteristics in the elderly, such as geriatric syndromes, were not assessed in these studies, and are not usually evaluated in clinical practice. Accordingly, their prognostic impact remains unknown in this clinical context. METHODS: Observational, prospective, and multicentre study that will include patients ≥ 80 years with AF and IHC in Spain. Baseline characteristics and geriatric syndromes will be assessed, as well as the choice of antithrombotic treatment. The primary endpoint is cardiovascular and overall mortality at one and three years follow-up. RESULTS: This study will assess both characteristics and prognosis of octogenarian patients with AF and IHC in Spain, the factors involved in the choice of antithrombotic treatment, and the incidence of ischaemic and haemorrhagic events during the short- and long-term follow-up. CONCLUSION: This study will contribute to improve the knowledge in terms of safety and efficacy of the different therapeutic options in older patients with AF and IHC, as well as their prognostic impact
Assuntos
Humanos , Fibrilação Atrial/tratamento farmacológico , Isquemia Miocárdica/tratamento farmacológico , Fibrinolíticos/uso terapêutico , Resultado do Tratamento , Estudos Prospectivos , Comorbidade , Prognóstico , IncidênciaRESUMO
BACKGROUND AND OBJECTIVES: The prevalence of atrial fibrillation (AF) and ischaemic heart disease (IHC) increases with age. They coexist in up to 20% of octogenarian patients, a situation that poses a therapeutic challenge. Trials that have addressed this scenario, which included a low percentage of octogenarians, showed that double therapy (single antiplatelet + anticoagulation) compared to triple therapy (double antiplatelet + anticoagulation) was associated with less bleeding events, especially with direct oral anticoagulants. These studies did not have sufficient power to detect differences in ischaemic events. On the other hand, prevalent characteristics in the elderly, such as geriatric syndromes, were not assessed in these studies, and are not usually evaluated in clinical practice. Accordingly, their prognostic impact remains unknown in this clinical context. METHODS: Observational, prospective, and multicentre study that will include patients ≥ 80 years with AF and IHC in Spain. Baseline characteristics and geriatric syndromes will be assessed, as well as the choice of antithrombotic treatment. The primary endpoint is cardiovascular and overall mortality at one and three years follow-up. RESULTS: This study will assess both characteristics and prognosis of octogenarian patients with AF and IHC in Spain, the factors involved in the choice of antithrombotic treatment, and the incidence of ischaemic and haemorrhagic events during the short- and long-term follow-up. CONCLUSION: This study will contribute to improve the knowledge in terms of safety and efficacy of the different therapeutic options in older patients with AF and IHC, as well as their prognostic impact.
Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial , Fibrinolíticos/uso terapêutico , Isquemia Miocárdica , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Fibrinolíticos/efeitos adversos , Humanos , Estudos Multicêntricos como Assunto , Isquemia Miocárdica/complicações , Isquemia Miocárdica/tratamento farmacológico , Isquemia Miocárdica/mortalidade , Estudos Observacionais como Assunto , Estudos Prospectivos , Fatores de RiscoRESUMO
La mejora en la supervivencia de los pacientes con cáncer ha puesto de manifiesto el impacto clínico que la cardiotoxicidad tiene en el pronóstico tanto cardiovascular como onco-hematológico, sobre todo cuando motiva la interrupción de terapias antitumorales altamente eficaces. La fibrilación auricular es una complicación frecuente en pacientes con cáncer activo y su tratamiento supone un gran reto. Estos pacientes tienen mayores riesgos tromboembólico y hemorrágico y, sin embargo, no se dispone de escalas específicas para guiar la atención clínica. El objetivo de este documento promovido por los grupos de Cardio-Onco-Hematología y Trombosis de la Sociedad Española de Cardiología y elaborado de manera conjunta con las diferentes áreas de conocimiento de la Sociedad Española de Cardiología y con expertos de la Sociedad Española de Oncología Médica, la Sociedad Española de Oncología Radioterápica y la Sociedad Española de Hematología y Hemoterapia, es proporcionar un enfoque multidisciplinario y práctico para la prevención y el tratamiento de la fibrilación auricular de pacientes con cáncer activo y basado en el consenso de expertos
Improvements in survival among cancer patients have revealed the clinical impact of cardiotoxicity on both cardiovascular and hematological and oncological outcomes, especially when it leads to the interruption of highly effective antitumor therapies. Atrial fibrillation is a common complication in patients with active cancer and its treatment poses a major challenge. These patients have an increased thromboembolic and hemorrhagic risk but standard stroke prediction scores have not been validated in this population. The aim of this expert consensus-based document is to provide a multidisciplinary and practical approach to the prevention and treatment of atrial fibrillation in patients with active cancer. This is a position paper of the Spanish Cardio-Oncology working group and the Spanish Thrombosis working group, drafted in collaboration with experts from the Spanish Society of Cardiology, the Spanish Society of Medical Oncology, the Spanish Society of Radiation Oncology, and the Spanish Society of Hematology
Assuntos
Humanos , Fibrilação Atrial/tratamento farmacológico , Anticoagulantes/uso terapêutico , Neoplasias/complicações , Tromboembolia/prevenção & controle , Fibrilação Atrial/complicações , Antineoplásicos/uso terapêutico , Consenso , Padrões de Prática MédicaRESUMO
Improvements in survival among cancer patients have revealed the clinical impact of cardiotoxicity on both cardiovascular and hematological and oncological outcomes, especially when it leads to the interruption of highly effective antitumor therapies. Atrial fibrillation is a common complication in patients with active cancer and its treatment poses a major challenge. These patients have an increased thromboembolic and hemorrhagic risk but standard stroke prediction scores have not been validated in this population. The aim of this expert consensus-based document is to provide a multidisciplinary and practical approach to the prevention and treatment of atrial fibrillation in patients with active cancer. This is a position paper of the Spanish Cardio-Oncology working group and the Spanish Thrombosis working group, drafted in collaboration with experts from the Spanish Society of Cardiology, the Spanish Society of Medical Oncology, the Spanish Society of Radiation Oncology, and the Spanish Society of Hematology.
Assuntos
Fibrilação Atrial/complicações , Cardiologia , Consenso , Oncologia , Neoplasias/complicações , Sociedades Médicas , Tromboembolia/prevenção & controle , Anticoagulantes/uso terapêutico , Humanos , Fatores de Risco , Espanha , Tromboembolia/etiologiaRESUMO
BACKGROUND/OBJETCTIVES: Mitral regurgitation (MR)after an acute coronary syndrome is associated with a poor prognosis. However,the prognostic impact of MR in elderly patients with non-ST-segment elevation myocardialinfarction (NSTEMI) has not been well addressed. DESIGN: Prospective registry. SETTING AND PARTICIPANTS: The multicenter LONGEVO-SCA prospective registry included 532 unselected NSTEMI patients aged ≥80 years. MEASUREMENTS: MR was quantified using echocardiography during admission in 497 patients. They were classified in two groups: significant (moderate or severe) or not significant MR (absent or mild). We evaluated the impact of MR status on mortality or readmission at 6 months. RESULTS: Mean age was 84.3±4.1 years, and 308 (61.9%) were males. A total of 108 patients (21.7%) had significant MR. Compared with those without significant MR, they were older and showed worse baseline clinical status, with higher frailty, disability, and risk of malnutrition. They also had lower systolic blood pressure, higher heart rate, worse Killip class, lower left ventricular ejection fraction, and higher pulmonary pressure on admission, as well as more often new onset atrial fibrillation (all p values = 0.001). Patients with significant MR also had higher in-hospital mortality (4.6% vs. 1.3%, p = 0.04), longer hospital stay (median 8 [5-12] vs. 6 [4-10] days, p = 0.002), and higher mortality/readmission at 6 months (hazard ratio 1.54, 95% confidence interval 1.09-2.18, p = 0.015). However, after adjusting for potential confounders, this last association was not significant. CONCLUSIONS: Significant MR is seen in one fifth of octogenarians with NSTEMI. Patients with significant MR have a poor prognosis, mainly determined by their baseline clinical characteristics. J Am Geriatr Soc 67:1641-1648, 2019.
Assuntos
Insuficiência da Valva Mitral/mortalidade , Infarto do Miocárdio sem Supradesnível do Segmento ST/mortalidade , Idoso de 80 Anos ou mais , Ecocardiografia , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação , Masculino , Insuficiência da Valva Mitral/etiologia , Infarto do Miocárdio sem Supradesnível do Segmento ST/complicações , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Sistema de Registros , Fatores de RiscoRESUMO
No disponible
Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/diagnóstico , Idoso Fragilizado , Prognóstico , Estudos de Coortes , Estudos Prospectivos , Serviço Hospitalar de Emergência/normas , Peptídeos Natriuréticos/análiseRESUMO
No disponible
Assuntos
Humanos , Troponina T/isolamento & purificação , Doenças Cardiovasculares/fisiopatologia , Fatores de Risco , Biomarcadores/análise , Doenças AssintomáticasAssuntos
Doenças Cardiovasculares , Troponina T , Biomarcadores , Humanos , Infarto do Miocárdio , Fatores de RiscoRESUMO
No disponible
Assuntos
Humanos , Idoso , Insuficiência Cardíaca/epidemiologia , Estenose da Valva Aórtica/epidemiologia , Avaliação Geriátrica , Peptídeos Natriuréticos/análise , Biomarcadores/análise , Registros de Doenças/estatística & dados numéricos , Idoso Fragilizado/estatística & dados numéricosAssuntos
Diuréticos/administração & dosagem , Furosemida/administração & dosagem , Insuficiência Cardíaca/tratamento farmacológico , Infusões Subcutâneas , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Humanos , Bombas de Infusão , Masculino , Prognóstico , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Análise de Sobrevida , Resultado do TratamentoRESUMO
No disponible
