American Journal of Geriatric Cardiology最新文献

Antiplatelet drugs, β-blockers, statins, and angiotensinogen-converting enzyme inhibitors reduce mortality following myocardial infarction (MI). The data on the impact of combination evidence-based medications on mortality following acute MI in elderly patients are limited. In this study, 5529 patients with MI admitted between January 2000 and December 2003 were assessed. Based on discharge use of evidence-based medications, the patients were divided into those using 0, 1, 2, 3, or 4 medications. The impact of medications on 1-year mortality was assessed for patients younger than 75 years and 75 years and older. Mean age of the patients was 63±13 years (71% male). The unadjusted 1-year mortality post-MI was 18.3% and 52.7% for young and elderly patients, respectively. Compared with patients with 0 medications, the adjusted odds ratio for 1-year mortality was lower in patients with 1, 2, 3, and 4 medications in both groups. Use of combination evidence-based medications was independently associated with lower 1-year post-MI mortality irrespective of age.

Smoking cessation has immediate health benefits; however, the efficacy of smoking cessation interventions among older adults and women has received limited research attention. The original Women's Initiative for Nonsmoking (WINS) study was a randomized controlled trial that tested the efficacy of a smoking cessation intervention for Bay Area women hospitalized with cardiovascular disease. The current study, which used the WINS dataset, compares participants 62 and older with those younger than 62 years. The sample (n=277) contained 136 older smokers and 141 younger smokers. At the 6-month follow-up, 52.1% of older smokers had quit smoking compared with 40.6% of younger smokers. At the 12-month follow-up, 52.0% of older smokers had quit smoking compared with 38.1% of younger smokers. The difference at 12 months was statistically significant, and a Kaplan-Meier survival analysis further supported these findings. Clinicians should be sure to also include older smokers in smoking assessments and smoking cessation interventions.

(Am J Geriatr Cardiol. 2008;17:37–47)

Patients with heart failure (HF) are at increased risk for frailty, and identification is challenging. The authors assessed the distance on the 6-minute walk test (6MWT) as a measure of frailty in 60 older HF patients (ejection fraction ≤40%) compared with frailty phenotype (FP). Scores were dichotomized to frail (F) or nonfrail (NF), and the results of 6MWT were dichotomized to low endurance (LE) or normal endurance (NE). FP and 6MWT results were in moderate agreement (κ=0.57, confidence interval [CI], 0.36–0.79; age-adjusted κ=0.54, 95% CI, 0.33–0.76);25% of participants were classified as F/LE, and 55% were classified as NF/NE. Discordance was asymmetric (McNemar P=.006); 18% of participants were NF/LE. There were no differences between the NF/LE and other groups in age, sex, body mass index, or physical activity level. Results in the NF/LE group differed from those in the NF/NE group by a slower 8-foot walking speed (P=.02), weaker grip strength (P=.056), and worse renal function (P=.01) and from those in the F/LE group by faster 8-foot walking speed (P<.001). The 6MWT may be useful to identify frailty and those in transition to frailty.