The prognostic value of symptomatic peripheral arterial disease (PAD) in patients with coronary heart disease (CHD) is well documented, but few reports differentiating between symptomatic and ...asymptomatic forms of PAD are available. We investigated the respective prognostic effect of clinical and subclinical PAD on long-term all-cause mortality in patients with stable CHD. We analyzed 710 patients with stable CHD referred for hospitalization for CHD evaluation and management. As a part of the study, they completed questionnaires on medical history, underwent a standardized clinical examination, including ankle-brachial index (ABI) measurement, and provided a fasting blood sample. Three groups of patients were individualized: no PAD (no history of PAD and ABI >0.9 but ≤1.4); subclinical PAD (no history of PAD but abnormal ABI i.e., ≤0.9 or >1.4); and clinical PAD (history of claudication, peripheral arterial surgery, or amputation due to PAD). Clinical and subclinical PAD was present in 83 (11.7%) and 181 (25.5%) patients, respectively. After a median follow-up of 7.2 years, 130 patients died. On multivariate analysis adjusted for age, hypertension, diabetes, dyslipidemia, smoking, left ventricular ejection fraction, CHD duration, heart rate, history of stroke or transient ischemic attack, and coronary revascularization, previous clinical PAD (hazard ratio 2.11, 95% confidence interval 1.28 to 3.47) and subclinical PAD (hazard ratio 1.65, 95% confidence interval 1.11 to 2.44) were significantly associated with increased all-cause mortality. In conclusion, our study has demonstrated that the detection of subclinical PAD by ABI in patients with stable CHD provides additional information for long-term mortality risk evaluation.
Whether frailty, defined as a biological syndrome that reflects a state of decreased physiological reserve and vulnerability to stressors, may impact the outcomes of elderly patients admitted to a ...cardiac intensive care unit (CICU) remains unclear. We aimed to determine the prevalence of frailty and its impact on mortality in patients aged ≥ 80 years admitted to a CICU.
This prospective single-centre observational study was conducted among patients aged ≥ 80 years admitted to a CICU in a tertiary centre. Frailty was assessed using the Edmonton Frail Scale (EFS), which provides a score ranging from 0 (not frail) to 17 (very frail). The population was divided into 3 classes: EFS-score of 0-3, EFS-score of 4-6, and EFS-score > 7.
A total of 199 patients were included, and median follow-up duration was 365 days. The mean age was 84.8 years, and 50 patients (25.1%) died during the follow-up period. In all, 45 (22.6%), 60 (30.2%), and 94 patients (47.2%) had an EFS-score of 0-3, 4-6, and ≥ 7, respectively. The all-cause mortality rate was 4.4%, 27.1%, and 37.2% in the 0-3, 4-6, and ≥ 7 EFS-score groups, respectively (P < 0.001). After multivariate analysis, frailty status remained associated with all-cause mortality: hazard ratio was 2.60 (95% confidence interval 0.54-12.45) within the 4-6 EFS-score group, and 5.46 (95% confidence interval 1.23-24.08) within the ≥ 7 EFS-score group.
Frailty is highly prevalent in older adults admitted to the population hospitalized in a CICU and represents a strong prognostic factor for 1-year all-cause mortality.
On ignore si la fragilité, définie comme un syndrome biologique reflétant une diminution des réserves physiologique et une vulnérabilité au stress, impacte le pronostic des sujets âgés admis en unité de soins intensifs cardiologiques (USIC). Notre objectif était de déterminer la prévalence de la fragilité et son impact sur la mortalité chez les sujets âgés de 80 ans ou plus admis en USIC.
Il s'agit d'une étude prospective monocentrique observationnelle conduite sur les patients de 80 ans ou plus admis en USIC dans un centre tertiaire. La fragilité a été évaluée par l’échelle de fragilité d'Edmonton (EFS) qui donne un score allant de 0 (pas fragile) à 17 (très fragile). La population a été divisé en 3 classes : score EFS de 0 à 3, score EFS de 4 à 6, et score EFS de > 7.
Cent quatre-vingt-dix-neuf patients ont été inclus avec un suivi médian de 365 jours. L’âge moyen était de 84,8 ans. Cinquante patients (25,1 %) sont décédés au cours de la période de suivi. Quarante-cinq patients (22,6 %) avaient un score EFS de 0 à 3, 60 patients (30,2 %) avaient un score EFS de 4 à 6 et 94 patients (47,2 %) avaient un score EFS de ≥ 7. Les taux de mortalité toutes causes étaient de 4,4 % dans la classe de score EFS de 0 à 3, 27,1 % dans la classe de score EFS de 4 à 6 et 37,2 % dans la classe de score EFS de ≥ 7, (p < 0.001). En analyse multivariée, la fragilité demeurait associée avec la mortalité toutes causes : le rapport de risques instantanés (RRI) était à 2,60 (intervalle de confiance IC à 95 % 0,54 - 12,45) dans la classe de score EFS de 4 à 6, et le RRI était à 5,46 (IC à 95 % 1,23 - 24,08) dans la classe de score EFS de ≥ 7.
La fragilité est fortement prévalente dans la population des sujets âgés admis en USIC et constitue un facteur pronostique fort de mortalité toutes causes à un an.
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