Prognostic Factors and Outcomes in Elderly Patients with Acute Cardiovascular Events - A Retrospective Analysis
DOI:
https://doi.org/10.53350/pjmhs02025191.5Keywords:
Keywords: Acute myocardial infarction, elderly, heart failure, NT-proBNP, mortality predictors, beta-blockers, PakistanAbstract
Background: Elderly patients presenting with acute cardiovascular events (ACVEs) often have higher mortality from atypical symptoms, comorbidities, and delayed treatment. Prognostic markers need to be accurately identified in order to improve outcomes.
Aim: To assess the prognostic factors and clinical outcomes of elderly patients (≥ 65 years) admitted with ACVEs at a tertiary care hospital in Pakistan.
Methods: This retrospective observational study of 100 patients over age 65 years with acute myocardial infarction, acute heart failure, or unstable angina. Demographics, comorbidities, biomarkers, echocardiographic parameters, treatment timelines, and outcomes were analyzed. Independent predictors of in-hospital mortality were determined by performing multivariate logistic regression.
Results: Mean age was 74.1 ± 6.3 years, and male patients were 56%. In hospital mortality was 17 per cent, and 29 per cent were readmitted within six months. The LVEF <40% (OR 3.4; p<0.001), NT-proBNP >1800 pg/mL (OR 2.9; p=0.003), age >75 years (OR 2.6; p=0.008), serum creatinine >1.5mg/dL (OR 2.1; p=0.021) and PCI delay > 90 minutes (OR 1.7; p=0.042) were found to be independent predictors of mortality. Reduction of mortality risk by beta blockers was significant (OR 0.59, p=0.021).
Conclusion: Elderly patients with ACVEs have high mortality, especially in the presence of reduced LVEF and renal impairment, as well as delayed PCI. Beta-blocker therapy is protective. Identification of these prognostic factors in early stages can improve outcomes, especially in resource-constrained settings.
References
Van Riet EE, Hoes AW, Wagenaar KP, Limburg A, Landman MA, et al. Epidemiology of heart failure: the prevalence of heart failure and ventricular dysfunction in older adults over time. A systematic review. Eur J Heart Fail. 2016;18(3):242–52.
Ceia F, Fonseca C, Mota T, Morais H, Matias F, et al. Prevalence of chronic heart failure in Southwestern Europe: the EPICA study. Eur J Heart Fail. 2002;4(4):531–9.
Berthelot E, Nouhaud C, Lafuente-Lafuente C, Assayag P, Hittinger L. Insuffisance cardiaque chez les sujets âgés de plus de 80 ans. Presse Méd. 2019;48:143–53.
Hanon DO, Friocourt P. Le guide papa en cardio-gériatrie. Prescriptions médicamenteuses adaptées aux personnes âgées. 2020.
Imazio M, Cotroneo A, Gaschino G, Chinaglia A, Gareri P, et al. Management of heart failure in elderly people. Int J Clin Pract. 2008;62(2):270–80.
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56.
Solomon DH. Geriatric assessment: methods for clinical decision making. JAMA. 1988;259(16):2450–2.
Zheng PP, Yao SM, He W, Wan YH, Wang H, et al. Frailty related all-cause mortality or hospital readmission among adults aged 65 and older with stage-B heart failure inpatients. BMC Geriatr. 2021;21(1):125.
Denfeld QE, Winters-Stone K, Mudd JO, Gelow JM, Kurdi S, et al. The prevalence of frailty in heart failure: a systematic review and meta-analysis. Int J Cardiol. 2017;236:283–9.
Khan H, Kalogeropoulos AP, Georgiopoulou VV, Newman AB, Harris TB, et al. Frailty and risk for heart failure in older adults: the Health, Aging, and Body Composition Study. Am Heart J. 2013;166(5):887–94.
Kane RL, Shamliyan T, Talley K, Pacala J. The association between geriatric syndromes and survival. J Am Geriatr Soc. 2012;60(5):896–904.
Haute autorité de Santé (HAS). Stratégie de prise en charge en cas de dénutrition protéino-énergétique chez la personne âgée: recommandations professionnelles. Méd Mal Métab. 2007;1:92–6.
Derouesne C, Poitreneau J, Hugonot L, Kalafat M, Dubois B, et al. Mini-mental state examination: a useful method for the evaluation of the cognitive status of patients by the clinician. Consensual French version. Presse Med. 1999;28(21):1141–8.
Katz S, Akpom CA. A measure of primary sociobiological functions. Int J Health Serv. 1976;6(3):493–508.
Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9(3):179–86.
Fuller GF. Falls in the elderly. Am Fam Physician. 2000;61(7):2159–64, 2173–4.
Fried L, Bernardini J, Piraino B. Charlson comorbidity index as a predictor of outcomes in incident peritoneal dialysis patients. Am J Kidney Dis. 2001;37(2):337–42.
Monégat M, Sermet C, Perronnin M, Rococo E. La polymédication: définitions, mesures et enjeux. Revue de la littérature et tests de mesure. Rev Méd Assur Mal. 2014.
National Pressure Ulcer Advisory Panel (NPUAP). Description of NPUAP. Adv Wound Care. 1995;8:93–5.
Muñoz MA, Calero E, Duran J, Navas E, Alonso S, et al. Short term mortality in patients with heart failure at the end-of-life stages: HADES study. J Clin Med. 2022;11(9):2280.
Zhang Y, Zhang J, Ni W, Yuan X, Zhang H, et al. Sarcopenia in heart failure: a systematic review and meta-analysis. ESC Heart Fail. 2021;8(2):1007–17.
Celano CM, Villegas AC, Albanese AM, Gaggin HK, Huffman JC. Depression and anxiety in heart failure: a review. Harv Rev Psychiatry. 2018;26(4):175–84.
Downloads
How to Cite
Issue
Section
License
Copyright (c) 2025 MARYAM ASHRAF, MUHAMMAD ZAHID ALI RAZA, FAIZA ALTAF, MAIDA ANWAR, ARSALAN ASLAM CHAUDHARY, AAMIR SIDDIQUE
This work is licensed under a Creative Commons Attribution 4.0 International License.
