Low Systolic Blood Pressure and Mortality in Elderly Patients After Acute Myocardial Infarction

Background Optimal blood pressure in elderly patients after acute myocardial infarction is still a matter of debate. In a prospective observational study, we aimed to identify optimal systolic blood pressure during the 48 first hours after admission for acute myocardial infarction and its prognostic value for cardiovascular mortality. Methods and Results From the Observatoire des Infarctus de Côte d'Or survey, all consecutive patients aged >75 years admitted for an acute myocardial infarction in a coronary care unit from 2012 to 2015 and discharged alive were included (n=814). Exclusion criteria were in‐hospital death, cardiogenic shock, and end‐stage renal disease. Average systolic blo…

Effet bénéfique de la transfusion à la phase aiguë de l’infarctus du myocarde du sujet âgé : étude prospective de 3316 cas

IF 0.905; International audience; IntroductionL’anémie est fréquente dans la population âgée à la phase aiguë d’un infarctus du myocarde (IDM) et est associée à une augmentation de la mortalité à long terme. Cependant, le bénéfice de la transfusion de concentrés de globules rouges (TCGR) dans ce contexte reste incertain.Patients et méthodesTous les patients de 65 ans et plus, hospitalisés pour un IDM dans notre centre hospitalier universitaire ont été inclus prospectivement. Ils ont été séparés en deux groupes d’âges : les plus jeunes (65–79 ans) et les plus âgés (80 ans et plus) et trois sous-groupes de nadir de taux d’hémoglobine (NH) (≤ 8,8–10 et > 10 g/dL). Nous avons étudié l’associati…

Changes in Treatment of Very Elderly Patients Six Weeks after Discharge from Geriatrics Department

We assessed the prescriptions of patients hospitalized in a geriatric unit and subsequently discharged. This prospective and observational study was conducted over a two-month period in the geriatrics department (acute and rehabilitation units) of a university hospital. Patients discharged from this department were included over a two-month period. Prescriptions were analyzed at admission and discharge from the geriatrics department (DGD), and six weeks after DGD. We included 209 patients, 63% female, aged 86.8 years. The mean number of medications prescribed was significantly higher at DGD than at admission (7.8 vs. 7.1, p = 0.003). During hospitalization, 1217 prescriptions were changed (…

Infections et infarctus du myocarde : étude prospective multicentrique

Introduction Un lien epidemiologique a ete demontre entre les infections aigues et l’infarctus du myocarde (IDM). Toutefois, la pathogenese et le pronostic des IDM associees aux infections n’a pas fait l’objet d’etude de grande ampleur. Materiels et methodes Tous les patients consecutifs admis pour IDM avec un diagnostic d’infection aigue ont ete prospectivement identifies a partir des donnees d’un observatoire regional des IDM. Le diagnostic d’infection aigue etait a l’appreciation du clinicien. Le diagnostic d’IDM de type 1 (rupture ou erosion de plaque) ou de type 2 (fonctionnel sur desequilibre entre apports et besoins myocardiques en oxygene) etait systematiquement adjudique selon les …

Analysis of the impact of a cognitive task on the posture of elderly subjects with depression compared with healthy elderly subjects

International audience; Objective: While previous studies have demonstrated that depressive elderly subjects (DES) experience difficulties in the processing of simultaneous cognitive tasks, few have examined the coupling of cognitive tasks with seemingly 'automatic' tasks, such as standing upright. Current patient management focuses on pharmacological treatments and cognitive-behavioral therapies.Methods: Healthy elderly (HES) and non-treated DES were included. Postural sway in DES was compared with that in HES while in single-task and dual-task conditions. The single-task consisted of standing upright. For the dual-task, the subjects recalled various items from memory or counted while stan…

P6389Infection and type 2 myocardial infarction: a large observational study from emergency department

Abstract Background Troponin elevation is frequent in patients with acute infection (AI) admitted to emergency unit (EU). Acute infection (AI) has been suggested as a common trigger in type 2 myocardial infarction (T2MI), corresponding to a myocardial oxygen supply-demand mismatch without atherothrombosis. We aim to characterize risk factors of T2MI occurrence and in-hospital mortality among patients admitted to an EU with AI and elevated troponin. Methods Among the medical records of all the patients admitted from January 2014 to December 2016 in a university hospital EU (n=82 543), patients with a diagnosis of AI and elevated troponin Ic (≥0.10μg/L) (n=714) were systematically adjudicated…

A New Prognosis Score to Predict Mortality After Acute Pneumonia in Very Elderly Patients

International audience; Objectives: Acute pneumonia (AP) induces an excess of mortality among the elderly. We evaluated the value of a new predictive biomarker index compared to usual prognosis scores for predicting in-hospital and 1-year mortalities in elderly inpatients with AP.Design: Retrospective study in 6 clinical departments of a university hospital.Setting: Burgundy university hospital (France).Participants: All patients aged 75 and over with AP and hospitalized between January 1 and June 30, 2013, in the departments of medicine (5) and intensive care (1) of our university hospital.Measurements: A new index, which we named UBMo, was created by multiplying the uremia (U in the formu…

Impact of Age, Multimorbidity and Frailty on the Prescription of Preventive Antiplatelet Therapy in Older Population

Platelet aggregation inhibitors (PAI) have widely proven their efficiency for the prevention of ischemic cardiovascular events. We aimed to describe PAI prescription in an elderly multimorbid population and to determine the factors that influence their prescription, including the impact of age, comorbidities and frailty, evaluated through a comprehensive geriatric assessment. This cross-sectional study included all patients admitted to the acute geriatric department of a university hospital from November 2016 to January 2017. We included 304 consecutive hospitalized patients aged 88.7 &plusmn

Letter by Putot et al Regarding Article, “Biomarkers Enhance Discrimination and Prognosis of Type 2 Myocardial Infarction”

Infections et infarctus du myocarde : étude prospective multicentrique

Introduction Un lien epidemiologique a ete demontre entre les infections aigues et l’infarctus du myocarde (IDM). Toutefois, la pathogenese et le pronostic des IDM associees aux infections n’a pas fait l’objet d’etude de grande ampleur. Materiels et methodes Tous les patients consecutifs admis pour IDM avec un diagnostic d’infection aigue ont ete prospectivement identifies a partir des donnees d’un observatoire regional des IDM. Le diagnostic d’infection aigue etait a l’appreciation du clinicien. Le diagnostic d’IDM de type 1 (rupture ou erosion de plaque) ou de type 2 (fonctionnel sur desequilibre entre apports et besoins myocardiques en oxygene) etait systematiquement adjudique selon les …

Successful management of heparin-induced thrombocytopenia using argatroban in a very old woman: a case report.

Thrombosis due to heparin-induced thrombocytopenia (HIT) is rare but has a severe prognosis. Its management is not always easy, particularly in old patients with renal insufficiency. A 95-year-old woman was hospitalized for dyspnea. Curative treatment with unfractionated heparin was started because pulmonary embolism was suspected. Disseminated intravascular coagulation was then suspected because of thrombocytopenia, hypoprothrombinemia, hypofibrinogenemia, and a positive ethanol gelation test. The first immunoassay for HIT was negative. On the 12th day of hospitalization, bilateral cyanosis of the toes occurred associated with recent deep bilateral venous and arterial thrombosis at duplex …

Infarctus du myocarde au cours de l’artérite à cellules géantes : étude de cohorte

Introduction Le risque d’evenement cardiovasculaire est accru au cours de l’arterite a cellules geantes (ACG), en particulier dans les premiers mois suivant le diagnostic de la vascularite [1] . L’objectif de ce travail etait de decrire les caracteristiques des infarctus du myocarde (IDM) survenant chez des patients atteints d’ACG et de les comparer avec des IDM survenant chez des patients ne presentant pas d’ACG au moment de leur IDM. Patients et methodes Les patients atteints d’ACG ont ete identifies parmi la liste des biopsies d’artere temporale (BAT) qui montraient des lesions d’ACG et qui avaient ete analysees entre le 1er janvier 2001 et le 31 decembre 2016 dans les deux laboratoires …

Blood Transfusion in Elderly Patients with Acute Myocardial Infarction: Data from the RICO Survey.

Red blood cell transfusion benefit during acute myocardial infarction remains unclear in the elderly. We aimed to assess the transfusion impact on 1-year mortality in acute myocardial infarction patients aged ≥65 years, according to their age and hemoglobin nadir.We included 3316 consecutive patients with acute myocardial infarction aged ≥65 years from the "obseRvatoire des Infarctus de Côte d'Or" (RICO) survey. They were categorized according to their hemoglobin nadir (≤8,8 to ≤10, and10 g/dL) and age (80 or ≥80 years).A total of 1906 patients (57%) were 65-79 years old, and 1410 (43%) were aged ≥80 years, of whom 103 (5%) and 145 (10%) patients received red blood cell transfusion, respect…

Epidemiological approach of type 2 myocardial infarction : Etiologies, characteristics, treatment and prognosis.

Introduction: Type 2 Myocardial infarction (MI)has been recently defined as an imbalance between oxygen supply and demand, in the absence of atherothromthrombosis. This work aimed to describe the main etiolgies as well as epidemiological, clinical and prognostic characteristics.Method: Data from patients with type 2 MI were collected from the RICO cohort (Observatoire des Infarctus de Cote d'Or). In a complementary work, we analyzed the retrospective data of the emergency department of Dijon University Hospital.Results: Among 4,436 consecutive patients hospitalized for MI in Dijon emergency department over 3 years, 947 (21%) had type 2 MI (median age: 81 years). In the RICO cohort, 4,572 co…

Potentially inappropriate use of furosemide in a very elderly population: An observational study

International audience; ObjectiveLittle is known about furosemide prescription modalities in elderly people. We describe furosemide prescription in ambulatory elderly patients.MethodsAll patients aged over 80 years, affiliated to Mutualité Sociale Agricole de Bourgogne, a French regional health insurance plan, with a medical prescription delivered in March 2015, were retrospectively included.ResultsAmong 15 141 patients with a median age of 86 years, comprising 61.3% of women, 3937 patients (26%) had a prescription for furosemide. Severe heart failure was the most common chronic comorbidity (27.7%). Furosemide was considered a long-term therapy for almost all patients (98.7% with prescripti…

Évaluation de la prescription des inhibiteurs de la pompe à protons chez la personne âgée de 75 ans et plus dans un service de gériatrie aiguë

Resume Introduction et objectifs Les inhibiteurs de la pompe a protons (IPP) sont tres prescrits en France et seraient responsables d’effets indesirables non negligeables surtout chez la personne âgee (PA). Afin de limiter leur mesusage et un surcout pour la securite sociale, la Haute Autorite de sante (HAS) a edite des recommandations de prescription strictes. Nous avons conduit une etude chez la PA dont l’objectif principal etait d’evaluer le taux de prescription d’IPP hors recommandations de la HAS. Methode Il s’agissait d’une etude prospective, monocentrique et observationnelle portant sur des PA de 75 ans et plus admises dans un service de geriatrie aigue, sur une periode de 6 mois. La…

Type 2 Myocardial Infarction: A Geriatric Population-based Model of Pathogenesis

International audience; Distinction between type 2 myocardial infarction (T2MI), defined as an imbalance between oxygen supply and demand without atherothrombosis, and type 1 myocardial infarction (T1MI), due to plaque disruption, is often a clinical challenge in frail elderly patients. We aimed to identify the characteristics and underlying causes of T2MI using a comprehensive geriatric approach. From a multicentre population-based prospective study in coronary care units, we adjudicated 4572 consecutive patients hospitalized for an acute T1MI or T2MI, according to the 3rd universal definition and a prespecified geriatric model of T2MI pathogenesis. In total, 3710 (81%) had T1MI and 862 (1…

Évaluation de la prescription des antalgiques de palier II chez la personne âgée de 75 ans en médecine générale

Although step-2 analgesics (S2A) are recommended when step-1 analgesics (S1A) are ineffective or in cases of moderate to severe pain, their efficacy varies. This study evaluated the place attributed by general practitioners (GPs) to S2A in the treatment of nociceptive pain in elderly persons (EP). Descriptive, transversal and declarative study conducted among GPs in Burgundy. In total, 115 GPs took part in the survey. Among these, 60.8% had at least one consultation/day for pain. After paracetamol, which was systematically preferred, 56.4% prescribed S2A for EP. The reasons for prescribing S2A included pain not relieved by S1A in 93% of cases, another medical treatment or not (42.6%), or th…

The Multifaceted Interplay between Atrial Fibrillation and Myocardial Infarction: A Review

International audience; This review was conducted to emphasize the complex interplay between atrial fibrillation (AF) and myocardial infraction (MI). In type 1 (T1) MI, AF is frequent and associated with excess mortality. Moreover, AF after hospital discharge for T1MI is not rare, suggesting the need to improve AF screening and to develop therapeutic strategies for AF recurrence. Additionally, AF is a common trigger for type 2 MI (T2MI), and recent data have shown that tachyarrhythmia or bradyarrhythmia could be a causal factor in, respectively, 13–47% or 2–7% of T2MI. In addition, AF is involved in T2MI pathogenesis as a result of severe anemia related to anticoagulants. AF is also an unde…

COVID-19-Related French Lockdown: Impact on the Physical and Psychological Health of Older Adults

Analysis of Inappropriate Admissions of Residents of Medicalized Nursing Homes to Emergency Departments: A Prospective Multicenter Study in Burgundy

Abstract Objectives To determine the rate of inappropriate admissions to emergency departments (EDs) and to identify determinants of these admissions. Design Prospective multicenter study. Setting Burgundy (France), EDs and medical nursing homes (MNHs). Participants 1000 Burgundy MNH residents admitted to EDs, from April 17 to June 20, 2013. Measurements For each subject, a questionnaire was completed. Data included age, gender, type of health professional who referred the resident to the ED (THP), whether or not a medical dispatcher organized the transfer to the ED, transport mode, reason for admission to the ED, level of independence according to the Groupes Iso-Ressource score (GIRS), an…

Direct Oral Anticoagulants versus Vitamin K Antagonists in Patients Aged 80 Years and Older.

The effectiveness of direct oral anticoagulants (DOAC) is non-inferior to vitamin K antagonists (VKA) to treat atrial fibrillation and venous thromboembolism (VTE). In this cross-sectional study, we compared older persons taking DOACs to those taking VKAs. We included ambulatory individuals ≥80 years, affiliated to Mutualité Sociale Agricole of Burgundy, who were refunded for a medical prescription in September 2017. The demographic conditions, registered chronic diseases (RCD), and number and types of prescribed drugs were compared in the DOAC group and VKA group. Of the 3190 included individuals, 1279 (40%) were prescribed DOACs and 1911 (60%) VKAs. Individuals taking VKAs were older than…

Prognostic impact of systolic blood pressure in acute heart failure with preserved ejection fraction in older patients

Abstract Aims Recent guidelines recommend a systolic blood pressure (SBP) target below 130 mmHg in heart failure patients with preserved ejection fraction (HFpEF), whatever their age. We investigated whether this intensive SBP control was associated with better survival in very old adults hospitalized for acute HFpEF. Methods and results We conducted an observational study in an acute geriatric unit: all consecutive patients discharged from hospital for acute heart failure from 1 March 2019 to 29 February 2020 with a diagnosis of HFpEF were included. Re‐hospitalization and all‐cause mortality at 1 year were compared according to the mean SBP at discharge (patients with a mean SBP < 130 mmHg…

The Prescription of Vitamin K Antagonists in a Very Old Population: A Cross-Sectional Study of 8696 Ambulatory Subjects Aged Over 85 Years

We compared very elderly people taking vitamin K antagonists (VKA) and those not taking VKA (noVKA). Individuals were included in the noVKA group if there was no VKA on their reimbursed prescriptions during the study period. We also compared three subgroups, constituted by VKA type (fluindione, warfarin, or acenocoumarol). We included individuals aged over 85 years, affiliated to Mutualit&eacute

Management of elderly patients suffering from cancer: Assessment of perceived burden and of quality of life of primary caregivers

International audience; Objective: To evaluate the perceived burden and the quality of life (QoL) at 3 and 6 months of the primary caregiver (PC) of patients aged 70 and over suffering from cancer and the predictors of QoL in this population.Methods: In this prospective observational study, 98 patients aged 70 and older with cancer and 96 PCs were included between 01/06/2014 and 18/03/2015. The Medical Outcomes Study 12-item Short Form Health Survey (SF-12) was used to assess the QoL of PCs and the Zarit Burden Interview (ZBI) was used to measure the perceived burden at 3 and 6 months. The major determinants of QoL were identified using mixed linear models for the dimensions of the SF-12 th…

Comment on "Factors Associated with Potentially Inappropriate Transfer to the Emergency Department Among Nursing Home Residents".

P852Frequency and prognosis of type 2 myocardial infarction vs non ischemic myocardial injury: large observational study from an emergency department

Abstract Background Type 2 Myocardial Infarction (T2MI), due to myocardial oxygen supply-demand mismatch in the absence of atherothrombosis and non-ischemic myocardial injury (NIMI), corresponding to troponin elevation without overt ischemia, are emerging concepts which are suspected to be common in patients hospitalized. However, their respective frequencies, risk profiles and short term prognosis in current routine clinical practice of emergency unit remains to be investigated. Methods Among the medical records of all the patients admitted from January 2014 to December 2016 in a university hospital emergency unit (n=82 543), patients with elevated troponin Ic (≥0.10μg/L) (n=4568) were sys…

Iléite à cytomégalovirus chez une personne âgée non immunodéprimée : à propos d’une observation

Resume Introduction Les ileites a cytomegalovirus surviennent rarement chez l’immunocompetent. Observation Une femme, âge de 88 ans, presentait une douleur intense de la fosse iliaque droite. La C-reactive proteine etait elevee et associee a une hyperleucocytose a polynucleaires neutrophiles. La coloscopie revelait un aspect tres ulcere et inflammatoire de la muqueuse ileale terminale. L’analyse anatomopathologique des biopsies retrouvait un effet cytopathogene typique avec cellules ballonisees et inclusions intranucleaires, confirme par un immunomarquage positif a l’anticorps anti-cytomegalovirus. La recherche de cytomegalovirus par PCR dans le plasma etait positive. L’evolution clinico-bi…

Post-Infectious Myocardial Infarction: New Insights for Improved Screening

Acute infection is suspected of involvement in the onset of acute myocardial infarction (MI). We aimed to assess the incidence, pathogenesis and prognosis of post-infectious MI. All consecutive patients hospitalized for an acute MI in coronary care units were prospectively included. Post-infectious MI was defined by a concurrent diagnosis of acute infection at admission. Type 1 MI (acute plaque disruption) or Type 2 MI (imbalance in oxygen supply/demand) were adjudicated according to the universal definition of MI. From the 4573 patients admitted for acute MI, 466 (10%) had a concurrent acute infection (median age 78 (66–85) y, 60% male), of whom 313 (67%) had a respiratory tract infection.…

Post-infectious myocardial Infarction: Does percutaneous coronary intervention improve outcomes? A propensity-score matched analysis

Acute infection is a frequent trigger of myocardial infarction (MI). However, whether percutaneous coronary intervention (PCI) improves post-infectious MI prognosis is a major but unsolved issue. In this prospective multicenter study from coronary care units, we performed propensity score-matched analysis to compare outcomes in patients with and without PCI for post-infectious MI with angiography-proven significant coronary stenosis (&gt

The prescription of direct oral anticoagulants in the elderly: An observational study of 19 798 Ambulatory subjects.

International audience; Objective Direct oral anticoagulants (DOACs) are increasingly prescribed to elderly people, but the epidemiologic data for this population remains scarce. We compared the elderly population taking DOACs and those not taking DOACs (noDOAC). Method We included individuals over 75 years old, affiliated to Mutualite Sociale Agricole of Burgundy (a French regional health insurance agency), who had been refunded for a prescribed DOAC between 1st and 30th September 2017. The DAOC group (DAOCG) and noDOAC group (noDOACG) were compared in terms of demographic conditions, registered chronic diseases (RCD), and number and types of prescribed drugs. In the DOACG, we compared the…

Type 1 or Type 2 Myocardial Infarction in Patients with a History of Coronary Artery Disease: Data from the Emergency Department

A type 2 myocardial infarction (T2MI) is the result of an imbalance between oxygen supply and demand, without acute atherothrombosis. T2MI is frequent in emergency departments (ED), but has not been extensively evaluated in patients with previously known coronary artery disease (CAD). Our study assessed the incidence and characteristics of T2MI compared to type 1 (T1MI) in CAD patients admitted to an ED. Among 33,669 consecutive patients admitted to the ED, 2830 patients with T1MI or T2MI were systematically included after prospective adjudication by the attending clinician according to the universal definition. Among them, 619 (22%) patients had a history of CAD. Using multivariable analys…

Bedside chest ultrasound to distinguish heart failure from pneumonia‐related dyspnoea in older COVID‐19 patients

Abstract Aims In the older population, acute heart failure is a frequent, life‐threatening complication of COVID‐19 that requires urgent specific care. We aimed to explore the impact of point‐of‐care chest ultrasound (CUS) use in older bedridden inpatients during the COVID‐19 pandemic as a tool to distinguish between cardiogenic pulmonary oedema and isolated viral pneumonia‐related dyspnoea. Methods and results This prospective series included 16 patients aged 75 or older, hospitalized for acute dyspnoea in an acute geriatric unit of a university hospital and testing positive for a SARS‐Cov2 infection. We collected demographic characteristics, medical history, biological screening, clinical…

Evolving epidemiology and antimicrobial resistance in spontaneous bacterial peritonitis: a two-year observational study.

Background Current recommendations for empirical antimicrobial therapy in spontaneous bacterial peritonitis (SBP) are based on quite old trials. Since microbial epidemiology and the management of patients have changed, whether these recommendations are still appropriate must be confirmed. Methods An observational study that exhaustively collected the clinical and biological data associated with positive ascitic fluid cultures was conducted in four French university hospitals in 2010–2011. Results Two hundred and sixty-eight documented positive cultures were observed in 190 cirrhotic patients (median age 61.5 years, 58.5% Child score C). Of these, 57 were classified as confirmed SBP and 140 …