Journal of Geriatric Cardiology最新文献

Severe aortic stenosis has increased exponentially as a result of the aging of the population. Transcatheter aortic valve replacement (TAVR) procedures increase by 20%-30% per year in Spain. Referred patients are increasingly older, have comorbidities, and frailty. TAVR cardiac rehabilitation (CR) programs significantly improve both functional capacity and quality of life of patients. However, there are no guidelines on how to carry out them and few elderly patients are referred to CR. Furthermore, mortality in women who undergo TAVR is higher than in men and even fewer are referred to CR programs. Multidisciplinary patient care, including comorbidities and frailty, is essential. It is necessary to ensure exquisite continuity of care during TAVR, CR, and the rest of the patient's life. Telerehabilitation could be an option in some lower-risk patients to include more patients in CR programs after TAVR, given the high demand. This article reviews the evidence on why CR should be performed in post-TAVR patients and proposes a practical and novel approach to the care process and the recommended aspects and components of the CR program.

Background: Based on the China-VHD database, this study sought to develop and validate a Valvular Heart Disease- specific Age-adjusted Comorbidity Index (VHD-ACI) for predicting mortality risk in patients with VHD.

Methods & results: The China-VHD study was a nationwide, multi-centre multi-centre cohort study enrolling 13,917 patients with moderate or severe VHD across 46 medical centres in China between April-June 2018. After excluding cases with missing key variables, 11,459 patients were retained for final analysis. The primary endpoint was 2-year all-cause mortality, with 941 deaths (10.0%) observed during follow-up. The VHD-ACI was derived after identifying 13 independent mortality predictors: cardiomyopathy, myocardial infarction, chronic obstructive pulmonary disease, pulmonary artery hypertension, low body weight, anaemia, hypoalbuminaemia, renal insufficiency, moderate/severe hepatic dysfunction, heart failure, cancer, NYHA functional class and age. The index exhibited good discrimination (AUC, 0.79) and calibration (Brier score, 0.062) in the total cohort, outperforming both EuroSCORE II and ACCI (P < 0.001 for comparison). Internal validation through 100 bootstrap iterations yielded a C statistic of 0.694 (95% CI: 0.665-0.723) for 2-year mortality prediction. VHD-ACI scores, as a continuous variable (VHD-ACI score: adjusted HR (95% CI): 1.263 (1.245-1.282), P < 0.001) or categorized using thresholds determined by the Yoden index (VHD-ACI ≥ 9 vs. < 9, adjusted HR (95% CI): 6.216 (5.378-7.184), P < 0.001), were independently associated with mortality. The prognostic performance remained consistent across all VHD subtypes (aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation, tricuspid valve disease, mixed aortic/mitral valve disease and multiple VHD), and clinical subgroups stratified by therapeutic strategy, LVEF status (preserved vs. reduced), disease severity and etiology.

Conclusion: The VHD-ACI is a simple 13-comorbidity algorithm for the prediction of mortality in VHD patients and providing a simple and rapid tool for risk stratification.

Objective: To evaluate the safety and effectiveness of robot-assisted percutaneous coronary intervention (R-PCI) compared to traditional manual percutaneous coronary intervention (M-PCI).

Methods: This prospective, multicenter, randomized controlled, non-inferior clinical trial enrolled patients with coronary heart disease who met the inclusion criteria and had indications for elective percutaneous coronary intervention. Participants were randomly assigned to either the R-PCI group or the M-PCI group. Primary endpoints were clinical and technical success rates. Clinical success was defined as visually estimated residual post-percutaneous coronary intervention stenosis < 30% with no 30-day major adverse cardiac events. Technical success in the R-PCI group was defined as successful completion of percutaneous coronary intervention using the ETcath200 robot-assisted system, without conversion to M-PCI in the event of a guidewire or balloon/stent catheter that was unable to cross the vessel or was poorly supported by the catheter. Secondary endpoints included total procedure time, percutaneous coronary intervention procedure time, fluoroscopy time, contrast volume, operator radiation exposure, air kerma, and dose-area product.

Results: The trial enrolled 152 patients (R-PCI: 73 patients, M-PCI: 79 patients). Lesions were predominantly B2/C type (73.6%). Both groups achieved 100% clinical success rate. No major adverse cardiac events occurred during the 30-day follow-up. The R-PCI group had a technical success rate of 100%. The R-PCI group had longer total procedure and fluoroscopy times, but lower operator radiation exposure. The percutaneous coronary intervention procedure time, contrast volume, air kerma, and dose-area product were similar between the two groups.

Conclusions: For certain complex lesions, performing percutaneous coronary intervention using the ETcath200 robot-assisted system is safe and effective and does not result in conversion to M-PCI.

Caffeine is a widely consumed stimulant known for its cardiovascular and metabolic effects. However, its impact on cardiovascular risk, including arrhythmias, in older adults remains underexplored. Emerging evidence highlights sex-specific differences in caffeine metabolism, which may influence its role in cardiovascular health. This perspective examines the interaction between caffeine, hormonal changes, metabolic processes, and lifestyle factors, focusing on older women compared to men. Understanding these differences is essential for tailoring dietary and clinical recommendations to mitigate cardiovascular risks and promote healthy aging.

Background: Physical inactivity is a significant yet underappreciated risk factor for cardiovascular disease (CVD), particularly among older adults. The aim of this study was to analyze the global burden of CVD attributable to physical inactivity in individuals aged 70 years and older from 1990 to 2021 using the Global Burden of Disease data.

Methods: We assessed trends in disability-adjusted life years (DALYs) and deaths, decomposed changes into population growth, aging, and epidemiological factors, and examined health inequalities across sociodemographic index (SDI) regions.

Results: From 1990 to 2021, a substantial rise in DALYs was observed, especially in low and middle SDI regions, with a 120.06% increase in the low SDI region, but a 23.10% decline in the high SDI region. Decomposition analysis identified population aging and growth as primary drivers for the burden, contributing 66.39% and 83.56% to the increase in middle and low SDI regions, respectively. By contrast, epidemiological improvements alleviated burden in the high SDI region (54.91%). Gender disparities persisted, with women experiencing a higher burden. Inequality analysis indicated a shift in CVD burden towards the low SDI region, with declining concentration indices for DALYs (-0.03 to -0.13) and deaths (-0.07 to -0.15). The Bayesian age-period-cohort projections suggest continued increases in DALYs and deaths through 2050, with women disproportionately affected.

Conclusions: These findings highlight the urgent need for targeted interventions promoting physical activity, improving healthcare access, and implementing region-specific prevention strategies.

Background: Antithrombotic strategies after percutaneous coronary interventions (PCI) in elderly patients on oral anticoagulant therapy (OAT) are debated due to the balance between ischemic and bleeding risks. Recent guidelines recommend early transitioning from triple antithrombotic therapy to dual antithrombotic therapy, but there are limited data on elderly patients.

Methods: We performed a post-hoc age-specific analysis of the PERSEO Registry population aimed to compare clinical features, therapeutic strategies, and outcomes of individuals aged ≥ 80 years and < 80 years who were on OAT and underwent PCI with stent. The primary endpoint was net adverse clinical events at 1-year follow-up. Secondary endpoints included major adverse cardiac and cerebral events (MACCE), major bleeding [Bleeding Academic Research Consortium (BARC) type 3-5], and clinically relevant bleeding (BARC type 2-5).

Results: Among the 1234 patients enrolled, 31% of patients were aged ≥ 80 years (84 ± 3 years, 76% males). Compared to younger patients, elderly patients had higher rates of comorbidities such as hypertension, anaemia or chronic kidney disease, and atrial fibrillation was the leading indication for OAT. Elderly patients were more often discharged on dual antithrombotic therapy (23%) compared to younger patients (13%) (P < 0.0001). They experienced higher net adverse clinical events (38% vs. 21%, P < 0.001), MACCE (24% vs. 12%, P < 0.001), as well as higher bleeding rates. Specifically, rates of major bleeding (9% vs. 6%, P = 0.026), and clinically relevant bleeding (21% vs. 12%, P < 0.001) were significantly higher in elderly patients.

Conclusions: Elderly patients on OAT undergoing PCI are a particular frail population with higher risk of MACCE and bleeding compared to younger patients despite a less aggressive antithrombotic therapy.