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Frailty and acute coronary syndrome: does gender matter?

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Journal of Geriatric Cardiology 2019年第2期16卷 138-144页

作者： Lourdes Vicent manuel martinez-selles Servicio de Cardiologia Hospital General Universitario Gregorio MaraiionCIBERCVMadridSpain Universidad Europea Universidad ComplutenseMadridSpain

There are important sex-related differences in elderly patients with acute coronary syndrome(ACS).Women are older,more frequently frail,and present more comorbidities than *** symptoms at presentation are also more common in female patients,they are leaded to a delayed diagnosis and *** angiography and subsequent revascularization are frequently underused in elderly women and they tend to receive less guidelines-recommended *** prognosis in elderly frail women with ACS is poor,and it is with high mortality and readmissions *** is recurrent ischemic events in which it is more frequent in women than in *** time might be long,and a multidisciplinary approach is desirable to improve prognosis and quality of *** studies are needed in order to clarify the benefit of the different therapies in the group of frail women,and this is particularly true for revascularization,as scientific evidence in this group is very scarce.

关键词： Acute coronary syndrome Frailty The elderly Women

Atrial fibrillation in the elderly

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Journal of Geriatric Cardiology 2017年第3期14卷 155-157页

作者： manuel martinez-selles Antonio Bayes de Lun Hospital General Universitario Gregorio Maranon CIBER C V Universidad Europea Universidad Complutense Madrid Spain Fundacio Investigacio Cardiovascular ICCC Hospital de Sant Pau Barcelona Spain

Atrial fibrillation （AF） is the most frequent arrhythmia. Due to population aging, AF is a growing epidemic and its importance will continue to increase in the next decades. Although the prevalence of AF is high in advanced age, the number of subjects with predisposing factors for AF is even higher. Most of these factors increase the risk of atrial fibro- sis, an important component of atrial arrhythmia mecha- nisms. In fact, the new techniques to detect atrial fibrosis are showing the strong association between atrial fibrosis and AF risk. Regarding predisposing factors for AF, interatrial block （LAB） seems to be a key factor.

关键词： Age Atrial fibrillation Interatrial block Predisposing factors

Anticoagulation in elderly patients at high risk of atrial fibrillation without documented arrhythmias

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Journal of Geriatric Cardiology 2017年第3期14卷 166-168页

作者： manuel martinez-selles Eusebio Garcia-Izquierdo Jaen Ignacio Fernandez Lozano Servicio de Cardiologia Hospital General Universitario Gregorio Maranon Universidad Complutense CIBERCV Madrid Spain Servieio de Cardiologia Hospital Universitario Puerta de Hierro Majadahonda Madrid Spain

Recent studies have suggested that patients with high CHA2DS2VASc-score [Congestive Heart failure, hyperten- sion, Age ≥ 75 years （doubled）, Diabetes, Stroke （doubled）, Vascular disease, Age 65-74 years, Sex category （female sex）] thromboembolic complications occurred irrespective of the presence of atrial fibrillation （AF） and anticoagulant therapy may be initiated irrespective of documented AF.

关键词： Anticoagulation Atrial fibrillation Interatrial block Prognosis

Prediction of sudden death in elderly patients with heart failure

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Journal of Geriatric Cardiology 2018年第2期15卷 185-192页

作者： Ana Ayesta Helena martinez-sellest Antonio Bayes de Luna manuel martinez-selles Cardiology Department Hospital Universitario del Sureste Arganda del Rey Madrid Spain Universidad Complutense Madrid Spain Fundacio lnvestigacio Cardiovascular ICCC Hospital de Sant Pau Barcelona Spain Cardiology Department Hospital General Universitario Gregorio Maranon CIVERCK Universidad Europea Madrid Spain

Most heart failure （HF） related mortality is due to sudden cardiac death （SCD） and worsening HF, particularly in the case of reduced ejection fraction. Predicting and preventing SCD is an important goal but most works include no or few patients with advanced age, and the prevention of SCD in elderly patients with HF is still controversial. A recent reduction in the annual rate of SCD has been recently described but it is not clear if this is also true in advanced age patients. Age is associated with SCD, although physicians frequently have the perception that elderly patients with HF die mainly of pump failure, underestimating the importance of SCD. Other clinical variables that have been associated to SCD are symptoms, New York Heart Association functional class, ischemic cause, and comorbidities （chronic obstructive pulmonary disease, renal dysfunction and diabetes）. Some test results that should also be considered are left ventricular ejection fraction and diameters, natriuretic peptides, non-sustained ventricular tachycardias and autonomic abnormalities. The combination of all these markers is probably the best option to predict SCD. Different risk scores have been described and, although there are no specific ones for elderly populations, most include age as a risk predictor and some were developed in populations with mean age 〉 65 years. Finally, it is important to stress that these scores should be able to predict any type of SCD as, although most are due to tachyarrhythmias, bradyarrhythmias also play a role, particularly in the case of the elderly.

关键词： Heart failure Prediction Risk Sudden death The elderly

Hospital without dyspnea： rationale and design of a multidisciplinary intervention

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Journal of Geriatric Cardiology 2016年第7期13卷 625-631页

作者： Lourdes Vicent Juan manuel Nunez Olarte Luis Puente-Maestu Esther Artajona Francisco Fernandez-Aviles manuel martinez-selles Department of Cardiology Gregorio Maranon General Hospital Madrid Spain Department of Palliative Care Gregorio Maranon General Hospital Madrid Spain Department of Respirology Gregorio Maranon General Hospital Madrid Spain European University of Madrid Madrid Spain Complutense University of Madrid Madrid Spain

Dyspnea is a common and disabling symptom of respiratory and heart diseases, which is growing in incidence. During hospital admis- sion, breathlessness is under-diagnosed and under-treated, although there are treatments available for controlling the symptom. We have developed a tailored implementation strategy directed to medical staff to promote the application of these pharmacological and non-pharmacological tools in dealing with dyspnea. The primary aim is to decrease the rate of patients that do not receive an adequate relief of dyspnea. This is a four-stage quasi-experimental study. The intervention consists in two teaching talks that will be taught in Cardiology and Respiratory Medicine Departments. The contents will be prepared by Palliative Care specialists, based on available tools for management of dyspnea and patients＇ needs. A cross-sectional study of dyspnea in hospitalized patients will be performed before and after the intervention to ascertain an improvement in dyspnea intensity due to changes in medical practices. The last phase consists in the creation of consensus protocols for dyspnea management based in our experience. The results of this study are expected to be of great value and may change clinical practice in the near future and promote a changing for the better of dyspnea care.

关键词： Chronic pulmonary disease Dyspnea Heart failure Palliative care

Applicability of the PRECISE-DAPT score in elderly patients with myocardial infarction

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Journal of Geriatric Cardiology 2018年第12期15卷 713-717页

作者： Albert Ariza-Sole Francesc Formiga manuel martinez-selles Maria T Vidan Jaime Aboal department of Cardiology Hospital Universitari de BellvitgeL'Hospitalet de LlobregatBarcelona Geriatrics Medicine Unit Internal Medicine Department.Hospital Universitari de BellvitgeL'Hospitalet de LlobregatBarcelona Department of Cardiology Hospital General Universitario Gregorio MaranonMadrid Geriatrics Medicine Department Hospital General Universitario Gregorio MarahonMadrid Department of Cardiology Hospital Universitari Josep TruetaGirona

Background Elderly patients with acute coronary syndromes(ACS)are at higher risk both for ischemic and bleeding *** guidelines recommend the PRECISE-DAPT score for bleeding risk stratification in this setting,but no study assessed its applicability in elderly *** study aimed to assess the performance of the PRECISE-DAPT score in a series of non-selected elderly patients with ACS from routine clinical *** The IFFANIAM registry included prospectively patients aged>75 years with ST segment elevation myocardial infarction(STEMI).Main outcome measured was the incidence of relevant bleeding after discharge(bleeding leading to hospital readmission,need for transfusion,intervention,stop of antithrombotic drugs or death).Bleeding risk was classified:(A)according to PRECISE-DAPT values above or not the recommended cut-off point(>25);and(B)according to the quartiles of PRECISE-DAPT values observed in the IFFANIAM series(QI:45).Results A total of 208 patients were *** age was 81.9±4.5 *** patients(92.6%)had a PRECISE-DAPT value>25.A total of 25 patients(12.0%)had bleeding events and 49 patients(23.6%)*** significant differences regarding the incidence of bleeding were observed according to the recommended cutt of point>***,a progressive increase in the incidence of bleeding was observed across PRECISE-DAPT quartiles observed in this series(P=0.038).Conclusions The vast majority of elderly patients have PRECISE-DAPT values above the recommended cut-off point for bleeding *** different cut-off points could be a more rational approach for predicting bleeding risk in these complex patients.

关键词： Acute coronary syndromes Bleeding Prognosis The elderly

Diagnosis of interatrial block

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Journal of Geriatric Cardiology 2017年第3期14卷 161-165页

作者： Antoni Bay, s de Luna Adrian Baranchuk Luis Alberto Escobar Robledo Albert Masso van Roessel manuel martinez-selles Catalan Institute of Cardiovascular Sciences St. Pau Hospital Barcelona Spain Heart Rhythm Service Kingston General Hospital Queen's University Kingston ON Canada Cardiology Department Hospital Universitario Gregorio Maranon Universidad Europea Universidad Complutense Madrid Spain

In the 70＇s, we classified for the first time the blocks at the atrial level into interatrial blocks （IAB）, partial and advanced, and other types of atrial blocks including the concept of atrial aberrancy, and atri... 详细信息

关键词： Atrial fibrosis Diagnosis Interatrial block

End-of-life care in a cardiology department： have we improved？

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Journal of Geriatric Cardiology 2016年第7期13卷 587-592页

作者： Juan Rulz-Garcia Pablo Dlez-Villanueva Ana Ayesta Vanessa Brufia Lourdes M Figueiras-Graillet Laura Gallego-Parra Francisco Fernandez-Aviles manuel martinez-selles Department of Cardiology Hospital General Universitario Gregorio Maranon Calle Doctor Esquerdo Madrid Spain Department of Cardiology Hospital Universitario de Torrejon Calle Mateo Inurria Torrejon de Ardoz Madrid Spain Universidad Francisco de Vitoria Carretera Pozuelo a Majadahonda Pozuelo de Alareon Madrid Spain Department of Cardiology Hospital Universitario de la Princesa Calle de Diego de Leon Madrid Spain Departmet of Cardiology Hospital Universitario del Sureste Ronda del Sur Arganda del Rey Madrid Spain Universidad Complutense de Madrid Av. Seneca Madrid Spain Universidad Europea de Madrid Urbanizacion E1Bosque Calle Tajo Villaviciosa de Odon Madrid Spain

Background End-of-life care is not usually a priority in cardiology departments. We sought to evaluate the changes in end-of-life care after the introduction of a do-not-resuscitate （DNR） order protocol. Methods ＆ Results Retrospective analysis of all deaths in a cardiology department in two periods, before and after the introduction of the protocol. Comparison of demographic characteristics, use of DNR orders, and end-of-life care issues between both periods, according to the presence in the second period of the new DNR sheet （Group A）, a conven- tional DNR order （Group B） or the absence of any DNR order （Group C）. The number of deaths was similar in both periods （n = 198 vs. n = 197）. The rate of patients dying with a DNR order increased significantly （57.1% vs. 68.5%; P = 0.02）. Only 4% of patients in both periods were aware of the decision taken about cardiopulmonary resuscitation. Patients in Group A received the DNR order one day earlier, and 24.5% received it within the first 24 h of admission （vs. 2.6% in the first period; P 〈 0.001）. All patients in Group A with an implantable cardioverter defibrillator （ICD） had shock therapies deactivated （vs. 25.0% in the first period; P = 0.02）. Conclusions The introduction of a DNR order protocol may improve end-of-life care in cardiac patients by increasing the use and shortening the time of registration of DNR orders. It may also contribute to increase ICD deactivation in patients with these orders in place. However, the introduction of the sheet in late stages of the disease failed to improve patient participation.

关键词： Cardiology Cardiopulmonary resuscitation End-of-life Palliative care

Clinical and prognostic implications of delirium in elderly patients with non–ST-segment elevation acute coronary syndromes

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Journal of Geriatric Cardiology 2019年第2期16卷 121-128页

作者： Miquel Vives-Borras manuel martinez-selles Albert Ariza-Sole Maria T.Vidan Francesc Formiga Hector Bueno Juan Sanchis Oriol Alegre Albert Duran-Cambra Ramon Lopez-Palop Emad Abu-Assi Alessandro Sionis LONGEVO-SCA Investigators Department of Cardiology Hospital de la Santa Creu i Sant PauInstitute of Biomedical Research I1B Sant PauCIBERCVUniversitat Autonoma de BarcelonaBarcelonaSpain department of Cardiology Hospital General Universitario Gregorio MarahonC1BERCVUniversidad ComplutenseUniversidad EuropeaMadridSpain Hospital Universitari de Bellvitge L'Hospitalet de LlobregatBarcelonaSpain Hospital General Universitario Gregorio Maranon IiSGMCIBERFESUniversidad ComplutenseMadrid.Spain Hospital Doce de Octubre Centro Nacional de Investigaciones CardiovascularesMadridSpain Hospital Clinico de Valencia INCLIVAUniversidad de ValenciaCIBERCVSpain Hospital Universitario San Juan AlicanteSpain Hospital Alvaro Cunqueiro VigoSpain 不详

Background Elderly patients with non-ST-segment elevation acute coronary syndromes(NSTE-ACS)may present delirium but its clinical relevance is *** study aimed at detennining the clinical associated factors,and prognostic implications of delirium in old-aged patients admitted for *** LONGEVO-SCA is a prospective multicenter registry including unselected patients with NSTE-ACS aged>80 *** variables and a complete geriatric evaluation were assessed during *** association between delirium and 6-month mortality was assessed by a Cox regression model weighted for a propensity score including the potential confounding *** also analysed its association with 6-month bleeding and cognitive or functional *** Among 527 patients included,thirty-seven(7%)patients presented delirium during the *** was more frequent in patients with dementia or depression and in those from nursing homes(27.0%vs.3.1%,24.3%vs.11.6%,and 11.1%V5.2.2%,respectively;all P<0.05).Delirium was significantly associated with in-hospital infections(27.0%vs.5.3%,P<0.001)and usage of diuretics(70.3%vs.49.8%,P=0.02).Patients with delirium had longer hospitalizations[median 8.5(5.5-14)vs.6.0(4.0-10)days,P=0.02]and higher incidence of 6-month bleeding and mortality(32.3%vs.10.0%and 24.3%vs.10.8%,respectively;both P<0.05)but similar cognitive or functional *** was independently associated with 6-month mortality(HR=1.47,95%CI:1.02-2.13,P=0.04)and 6-month bleeding events(OR=2.87;95%CI:1.98-4」6,P<0.01).Conclusions In-hospital delirium in elderly patients with NSTE-ACS is associated with some preventable risk factors and it is an independent predictor of 6-month mortality.

关键词： Acute coronary syndromes Delirium Prognosis The elderly