THE STORM (acute coronary Syndrome in paTients end Of life and Risk assesMent) study
| Autor: | Serena Bergerone, Massimo Porta, L. Scaglione, Javaid Iqbal, Federico Giusto, Pierluigi Omedè, Mauro Torchio, Claudio Moretti, Franco Veglio, Fiorenzo Gaita, Corrado Moiraghi, Fabrizio D'Ascenzo, Maurizio Bertaina, Mario Bo, Carlo Marinone, Giorgio Quadri, Paolo Cavallo Perin, Franco Riccardini, Giuseppe Montrucchio, Sebastiano Marra |
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| Rok vydání: | 2015 |
| Předmět: |
Male
Acute coronary syndrome medicine.medical_specialty Heart disease Frail Elderly Comorbidity 030204 cardiovascular system & hematology Critical Care and Intensive Care Medicine Risk Assessment 03 medical and health sciences 0302 clinical medicine Quality of life Risk Factors Internal medicine Humans Medicine Prospective Studies 030212 general & internal medicine Acute Coronary Syndrome Prospective cohort study Intensive care medicine Aged Quality of Health Care Aged 80 and over Terminal Care Ejection fraction business.industry General Medicine Emergency department Prognosis medicine.disease Quality of Life Emergency Medicine Female Emergency Service Hospital Risk assessment business |
| Zdroj: | Emergency Medicine Journal. 33:10-16 |
| ISSN: | 1472-0213 1472-0205 |
| DOI: | 10.1136/emermed-2014-204114 |
| Popis: | Introduction Elderly patients with coexisting frailty and multiple comorbidities frequently present to the emergency department (ED). Because non-cardiovascular comorbidities and declining health status may affect their life expectancy, management of these patients should start in the ED. This study evaluated the role of Gold Standards Framework (GSF) criteria for identifying patients with acute coronary syndromes (ACS) approaching end of life. Methods All consecutive patients admitted to the ED and hospitalised with a diagnosis of ACS between May 2012 and July 2012 were included. According to GSF criteria, patients were labelled as positive GSF status when they met at least one general criterion and two heart disease criteria; furthermore, traditional cardiovascular risk scores (the Global Registry for Acute Coronary Events (GRACE) score and the Age, Creatinine and Ejection Fraction (ACEF) score) were calculated and WHOQOL-BREF was assessed. Mortality and repeat hospitalisation due to cardiovascular and noncardiovascular causes were evaluated at 3-month and 12-month follow-up. Results From a total of 156 patients with ACS enrolled, 22 (14%) had a positive GSF. A positive GSF was associated with higher rate of non-cardiovascular events (22.7% vs 6.7%; p=0.03) at 3 months and higher rates of both cardiovascular and noncardiovascular events (36% vs 16.4%; p=0.04 and 27.3% vs 6.7%; p=0.009, respectively) at 12 months. In multivariate analysis, an in-hospital GRACE score was a predictor of cardiovascular events, while a positive GSF independently predicted non-cardiovascular events. Conclusions The GSF score independently predicts non-cardiovascular events in patients presenting with ACS and may be used along with traditional cardiovascular risk scores in choosing wisely the most appropriate treatment. The present results need to be externally validated on larger samples. |
| Databáze: | OpenAIRE |
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