The efficacy and safety of evaluating elderly patients using a comprehensive diagnostic protocol via a chest pain unit
- PDF / 646,668 Bytes
- 6 Pages / 595.276 x 790.866 pts Page_size
- 6 Downloads / 154 Views
EM - ORIGINAL
The efficacy and safety of evaluating elderly patients using a comprehensive diagnostic protocol via a chest pain unit Alexander Fardman1,2 · Moran Livne1,2 · Ronen Goldkorn1,2 · Orly Goitein1,2 · Nir Shlomo1,2 · Elad Asher1,2 · Avishay Grupper1,2 · Michael Naroditsky1,2 · Shlomi Matetzky1,2 · Roy Beigel1,2 Received: 24 July 2019 / Accepted: 29 January 2020 © Società Italiana di Medicina Interna (SIMI) 2020
Abstract Elderly patients are often excluded from a chest pain unit (CPU)-based evaluation of chest pain due to concern about adverse events and poorer outcomes. The aim of this study was to assess the feasibility and safety of thoroughly evaluating elderly patients ≥ 65 years of age presented with acute chest pain via a CPU. We evaluated 1220 consecutive patients admitted to our CPU, and stratified them according to age: those over and those under 65 years. Patients were evaluated for outcomes during hospitalization and for a composite endpoint at 60 days post discharge which included: recurrent hospitalization due to chest pain, need for coronary revascularization, acute coronary syndrome, and death. Overall, 241 (20%) patients were in the ≥ 65-year-old group and 979 (80%) patients in the group 70 years; (2) the presence of known prior coronary artery disease; (3) weight > 120 kg; (4) absence of sinus rhythm; (5) known contraindication to iodine contrast; (6) abnormal renal function (serum creatinine > 1.4 mg/dl). The study outcome was defined as safety of evaluation of patients ≥ 65 years during the observation period in the CPU, as well as the occurrence of major adverse cardiovascular events 60 days post discharge from the CPU. A composite outcome at 60 days was defined as: hospitalization due to chest pain, acute coronary syndrome, coronary revascularization (either by percutaneous Table 1 Baseline characteristics of the study cohort Male gender (n, %) Age (years, mean ± SD) Hypertension (n, %) Smokers (n, %) Diabetes mellitus (n, %) Dyslipidemia (n, %) Family history (n, %) Prior CVA/TIA (n, %) Prior PVD (n, %) Prior CAD (n, %)
intervention or bypass graft), and/or death. Follow-up was obtained either by a visit to the outpatient clinic or by a pre-specified telephone interview performed at least 60 days post discharge. We reviewed records from the Ministry of the Interior to ascertain vital status regarding patients lost to follow-up. The Sheba Medical Center institutional review board approved the study and the informed consent process. All data were analyzed using SPSS software 20 (SPSS, Inc., Chicago, Illinois, USA). Categorical variables were compared using chi-square tests. Two-tailed student’s independent t tests were used for comparison of continuous variables. A statistically significant difference was considered to be a p value
Data Loading...
